Effect of small bowel bypass on gastric secretory function: Postintestinal exclusion hypersecretion, a phenomenon in search of a syndrome

Patients undergoing partial ileal bypass for hyperlipidemia and jejunoileal bypass for massive obesity were studied pre- and postoperatively: Group A consisted of fourteen jejunoileal bypass patients, restudied at one year; Group B consisted of seven partial ileal bypass patients, restudied at three months; and Group C was composed of seven partial ileal bypass patients, restudied at one year. There were significant differences in only the Group B posthistalog volume (-46.14 ± S.E. 15.28 ml. per 30 minutes, p < 0.05) and in Group A postHistalog peak acid output (+4.07 ± S.E. 1.32 mEq. per 30 minute peak, p < 0.01). Two of three Group A preoperative hypersecretors showed a better than 2 S.E. increase (other patient unchanged), and four normal secretors became hypersecretors (with an increase greater than +2 S.E.). Only one of 14 partial ileal bypass patients became a hypersecretor. None of the patients with hypersecretion manifested clinical evidence of acid-peptic disease. We conclude: (1) There is a significant decrease in Histalogstimulated gastric juice volume three months following partial ileal bypass, this effect is not present at one year. (2) There is a significant increase in free acid in Histalog-stimulated gastric juice one year after jejunoileal bypass. (3) There is a difference in postoperative stimulation of gastric secretion between partial ileal bypass and jejunoileal bypass patients. (4) Gastric hypersecretion rarely occurs following partial ileal bypass. (5) Gastric hypersecretion frequently occurs following jejunoileal bypass, with an incidence rate as high as 43 percent.