Effects of mosapride citrate on patients after vagal nerve preserving distal gastrectomy reconstructed by interposition of a jejunal J pouch with a jejunal conduit for early gastric cancer.

BACKGROUND

Vagal nerve-preserving distal gastrectomy reconstructed by interposition of a jejunal J pouch with a jejunal conduit (hereinafter called DGP) is a function-preserving operation for early gastric cancer. However, some patients after DGP have suffered from postprandial stasis in the substitute stomach, and postprandial stasis leads to abdominal symptoms. To clarify the significance of mosapride citrate (MS) for prevention of food stasis in the substitute stomach for patients after DGP, we studied the effects of MS before and after administration of MS.

METHODS

In a total of 18 patients (10 men, 8 women; aged 34 to 70 years, average 63.1 years) during 5 years after DGP for early gastric cancer (Billroth I, D1+alpha lymph node dissection, curability A), the relationship between their postoperative quality of life (QOL) and emptying function of the substitute stomach (EFS) was compared using a radioisotope method before MS therapy and after MS therapy at an oral dose of 15 mg/day for 3 months.

RESULTS

(1) Interview. After MS therapy patients evidently had more appetite and ate more, with a slightly increase in body weight (0.5 approximately 2 kg) compared with patients before MS therapy. Before and after MS therapy no patients had early dumping symptoms, and after MS therapy all patients clearly had fewer symptoms such as reflux esophagitis, nausea, and abdominal pain compared with before MS therapy. After MS therapy they also had significantly decreased abdominal fullness compared with before MS therapy (P=0.0026). Endoscopically, we found reflux esophagitis in 2 patients from the before MS therapy group but in no patients from the after MS therapy group. All patients in the before MS therapy group showed residual contents in the substitute stomach, and seven patients in the after MS therapy group showed residual contents in the substitute stomach (P<0.0001). There was a significant difference between before and after MS therapy (P<0.0001). (2) EFS; The time to 50% residual rate of the before MS therapy group (80.5+/-16.2 min) was significantly slower than that of the after MS therapy patients (65.6+/-9.4 min) (P=0.0091). After MS therapy (28.4%+/-5.2%), the residual rates at 120 minutes were significantly decreased compared with patients before MS therapy (38.2%+/-5.7%) (P=0.0372).

CONCLUSIONS

Patients from the after MS therapy group clearly had improved gastric stasis compared with the before MS therapy group. These results showed more satisfactory QOL in patients after MS therapy. It is possible that MS therapy improves abdominal fullness due to the postprandial stasis in the substitute stomach, contributing to the improvement of QOL of patients after DGP.