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Upper gastrointestinal tract has various physiological roles, such as, the capacity to store or empty the ingested food by the stomach, and the tolerance to volume load to receive a certain amount of food by the upper gastrointestinal tract as a whole. The gastric surgery may alter these physiological properties, and then, could impair the patient's living states. However, the information about this concern is limited.
[Aim] To study the effect of physiological properties of the upper gastrointestinal tract on patients' living states after gastrectomy.
[Methods] 13C-acetate breath test (13-BT), drink test (DT) and the questionnaire had performed in the patients [n=53] who received conventional gastrectomy (total with Roux-en-Y [TG; n=17], distal with Billroth-I [n=17], distal with Roux-en-Y [n=19]). For 13-BT, liquid meal (200kcal/200ml) mixed with 100 mg of 13C-acetate sodium salt was given. Breath samples were collected before and 5, 10, 15, 20, 30, 40, 50, 60, 75, 90, 105, 120, 135, 150, 165, 180 minutes after meal. 13CO2 content was measured by infrared spectrophotometry. Wagner-Nelson analysis was performed on measured data. The reservoir and emptying capacity of the remnant stomach were calculated as retention rate at 5 minutes after meal (RR5) and half emptying time (T1/2), respectively. For drink test, mineral water (10ml/kg) was ingested for 5 min at equal rate. The severity and the duration of abdominal symptoms caused by DT was scored 0 (none) to 3 (severe) and 0 (none) to 4 (more than 30 minutes), respectively. The tolerance to volume load was assessed by DT total score (the sum of both severity and duration scores). The questionnaire was performed to examine the ingested amount of food per meal, the frequency of daily meals, the change in body weight and the restriction to daily life.
The multivariable analysis was performed to explore the effect of physiological properties on patients' living states after gastrectomy.
[Results] (Table 1) The reservoir and emptying capacity of the remnant stomach had no effect on patients' living states. The impairment in the tolerance to volume load (higher scores) resulted in reduced meal amount and restricted daily life. The frequency of daily meal was higher in the patients with total gastrectomy.
[Conclusion] The tolerance to volume load by DT, but not the reservoir or emptying capacity by 13C-BT, reflected the patients' living states after gastrectomy.
The effect of physiological properties on patients' living states after gastrectomy.

	Ingested amount of food		Frequency of daily meals		Change in body weight		Restriction to daily life
	β	p-value	β	p-value	β	p-value	OR (95% CI)	p-value
RR5 (%)	-	NS	-	NS	-	NS	-	NS
T1/2 (min)	-	NS	-	NS	-	NS	-	NS
DT tolal score	-0.436	0.0012*	-	NS	-0.269	0.0561	1.48 (1.09-2.01)	0.0128*
Type of gastrectomy [TG]	-	NS	0.395	0.0062*	-0.274	0.0671	-	NS
R2	0.294		0.260		0.168		0.144

* p<0.05