c) Technetium labelled food is not helpful in diagnosing this condition
After billroth II gastrectomy, if a cuff of gastric mucosa remains with duodenum, this entity is called as retained antrum syndrome. This cuff of gastric mucosa is cut off from the proximal stomach and inhibitory effect of hormones such as VIP (Vasoactive Intestinal Peptide) leading to a persistent hypergastrinemic state. ALso this gastric mucosa is continuously bathed by the alkaline contents of duodenum , which further increases the acid formation.
Both Basal and maximal gastric acid outputs increase but it is not as high as seen in zollinger ellison syndrome. Typically less than 1000 pg/ml
This condition can present as recurrent and persistent ulcerations. Technetium scanning is the diagnostic modality of choice. Treatment is re do surgery and antral excision.
Technetium pertechnate imaging has a sensitivity of 73% and specificity of 100%
- Retained antrum syndrome occurs due to incomplete antrectomy, commonly after Billroth II gastrectomy.
- Loss of inhibitory hormonal control leads to persistent hypergastrinemia.
- Serum gastrin levels are elevated but usually <1000 pg/ml.
- Presents with recurrent or refractory peptic ulcer disease.
- Technetium pertechnate scan is the investigation of choice.
- Definitive treatment is redo surgery with excision of retained antrum.
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