[Pathophysiology of bone disorder after total gastrectomy].

Sixty two total gastrectomized patients were studied in serum biochemistry, bone microdensitometry, Calcium infusion test and clinical symptoms related to bone disorder. Thirty total gastrectomized Wistar rats were studied in food-intake amount, serum biochemistry, bone histological changes and intestinal absorption of 45Ca. I. Clinical: 63% of the patients showed bone abnormality by microdensitometry, and 52% showed hypocalcemia and 47% showed high A1-P. Urinary excretion of calcium in bone disordered patients was below 28% by calcium infusion test, which suggested that the change of bone seemed to be osteomalacia. II.

METHODS

The longer of time after gastrectomy, the thinner of cortex and lesser of trabeculation was observed in femoral bone of rats. Food-intake, serum calcium and vitamin D levels decreased, but on the other hand, the lipid content in feces increased, and disturbance of intestinal 45Ca absorption was marked in total gastrectomized rats.

CONCLUSIONS

1. After total gastrectomy, bone disorder was observed in 63% of patients and in all of rats. 2. The longer after operation, the worse of the bone change. 3. It resembled osteomalacia rather than osteoporosis. 4. Vitamin D and calcium malabsorption due to low food intake and fatty diarrhea may be the major etiologies.