Five women and one man had muscle weakness and wasting following subtotal gastrectomy and gastroenterostomy. Five patients (age, 45 to 75 years) had a gastrojejunostomy and one had a gastroduodenostomy six months to 18 years before the onset of the neuromuscular disorder. Muscle weakness involved distal muscle groups in four patients and proximal muscle groups in two. Five had visible muscle fasciculations. Deep tendon reflexes were hyperactive in three, hypoactive in two, and normal in one patient. Electromyography revealed neurogenic atrophy. Mild steatorrhea, low carotene levels, hypoalbuminemia, and poor vitamin B12 absorption were most commonly encountered. Diabetes mellitus was found in five patients by intravenous glucose tolerance testing. It is postulated that the combination of malabsorption and diabetes mellitus results in a deficiency of factor or factors necessary for the preservation of the neuromuscular complex.
Kniffen JC, Quick DT. Neuromuscular Disorder Following Gastric Resection. Arch Intern Med. 1969;124(3):336–340. doi:10.1001/archinte.1969.00300190076012
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