Abstract
There seem to be few studies which deal with the metabolism of substances in reference to complaints, particularly changes in the dietary preference in patients who have resumed their social activities in contrast with many reports on the metabolism of various substances after total gastrectomy. In the current study, the dietary preference after total gastrectomy was examined by conducting a written questionnaire on dietary habits and also by performing an oral glucose tolerance test (OGTT) to determine blood sugar levels, blood insulin levels and blood glucagon levels in totally gastrectomized patients whose past and family histories are not remarkable before surgery and who have progressed favourably without dumping syndrome and other complications for more than one year after surgery. The subjects were 106 gastrectomized patients who co-operated with the study. Of these, 21 cases were subjected to total gastrectomy; for reconstruction, 8 cases were treated by Roux-Y method, 8 cases by double tract method, 3 cases by interposition method and 2 cases by other methods. Eighty five cases of distal partial gastrectomy were used as control. In reconstruction of these cases, Billroth I method in 68 cases and Billroth II method in 17 cases were used. The findings obtained were as follows: According to the questionnaire, the food intake after surgery was absolutely decreased, compared with that before operation in the majority of the cases of total gastrectomy and changes in the dietary preference were observed in 94 percent of the cases that showed a decrease in the food intake and there was a particular preference for sugar. When the preference for sugar was studied by OGTT, a state of excessive reaction of insulin to the sugar levels from 90 min after sugar loading was presumed in cases where the preference for sugar increased compared with that before surgery (hereinafter referred to sugar preference (+) group) . Furthermore, the blood glucagon levels from 90 min after sugar loading remained higher in the sugar preference (+) group than in the cases where the sugar preference remained unchanged compared with that before operation (hereinafter referred to the sugar preference (-) group) . When this was examined by the ratio of difference in the blood glucagon levels (ΔGI) to the difference in the blood insulin levels (ΔIRI) before and after sugar loading (ΔGI/ΔIRI ratio), the sugar preference (+) group was presumed to be in a state of high glucagon reaction compared to the sugar preference (-) group. An overall study of the relationship between the sugar preference and reconstruction method after total gastrectomy showed that the sugar preference was somewhat stronger in the cases with interposition method and double tract method than in the cases with Roux-Y method. From the findings above, it was surmised that factors such as insulin and pancreatic glucagon would be con-cerned with changes in the sugar preference after total gastrectomy.
