Erythromycin accelerates delayed gastric emptying of solids in patients after truncal vagotomy and pyloroplasty

Abstract

Objective: To find out if erythromycin (a motilin agonist) accelerated gastric emptying after vagotomy and in normal subjects.

Design: Double blind controlled study.

Setting: Two referral centres.

Subjects: 15 patients who had previously undergone vagotomy and who did (n = 8) or did not (n = 7) have symptoms of gastric stasis and 10 normal controls.

Interventions: A standard meal containing 185 x 10(5) Bq -99mTc was eaten after either erythromycin 200 mg or 40 ml placebo (normal saline) had been given intravenously. Subjects were then scanned by gamma camera.

Main outcome measures: Measurement of: the length of time from completion of the meal to the onset of gastric emptying; the length of time from completion of the meal until half of the meal had left the stomach; the length of the time from the onset of gastric emptying until half of the meal had left the stomach; and the percentage of the meal that was left in the stomach at 60 and 120 min after the end of the meal.

Results: Gastric emptying was significantly delayed in those patients with symptoms compared with normal subjects and patients without symptoms. Erythromycin accelerated the first two phases of gastric emptying in all patients and normal subjects, but did not affect the length of time from the onset of gastric emptying until half the meal had left the stomach.

Conclusion: Erythromycin could be a useful gastrokinetic agent in patients with symptoms of gastric stasis after vagotomy.