Effects of gastric resection and vagotomy on blood and bone mineral content

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Abstract
This investigation evaluates the effects of the Billroth II and I gastric resections and of vagotomy on blood and bone minerals in comparable groups of male patients with peptic ulcer who had no other potentially demineralizing conditions. The series includes 153 patients divided into 3 subgroups according to the type of gastric operation that had been carried out on an average of 5 years earlier (range 1–10 years).A definite trend towards hypocalcemia (p < 0.001) and a modest loss of bone mineral as judged by photon absorptiometry (p < 0.05) occurred in the groups subjected to gastric resection, while changes of statistical significance were not observed following vagotomy. Significant hypomagnesemia, hypophosphatemia, or hyperphosphatasia did not occur in any group. The observations in the vagotomy group suggest that the amount of gastric acid secreted may be unimportant for the maintenance of blood and bone mineral normality. We were unable to establish the true nature of the bone disease that follows gastric resection. On the other hand, there was no substantial evidence indicating that osteomalacia was the only disorder involved.We conclude that in patients without conditions predisposing to disturbed mineral metabolism, none of the surgical procedures evaluated in this study seem to carry an appreciable risk of bone demineralization of clinical importance. With regard to mineral metabolism, vagotomy is preferable to gastric resection.