The Impact and Clinical Implications of Gastric Surgery on the Gastric Conduction System

Abstract

Chronic symptoms of gastric dysfunction are common following gastric surgery, but the mechanisms underlying these have remained poorly understood. Disturbances of foregut motility are suspected to play a central role, however knowledge of how these abnormalities manifest and relate to symptoms requires elucidation. Emerging data suggests that abnormalities of the gastric conduction system are a common consequence of gastric surgery and may contribute to dysmotility and post-operative symptoms. This review provides a primer on the gastric conduction system. The normal physiology of the gastric conduction system and factors that influence resilience to surgery are outlined, together with focused discussion on three surgical procedures that impact post-operative gastric dysfunction: resection of the gastric pacemaker, resection or bypass of the pylorus, and vagotomy. The mechanistic pathways that underpin the clinical effects of these procedures are discussed. Future horizons are also evaluated, including newly established body surface gastric mapping techniques that provide a non-invasive method to detect changes in the gastric conduction system and relate these to symptoms in postoperative patients, with the goal of developing targeted interventions for prevention and therapy.