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Gut. 1985 March; 26(3): 252–257.
PMCID: PMC1432626

Regulation of vitamin D and calcium metabolism after gastrectomy.


Fifteen men, who had undergone Billroth I gastrectomy and 19 men who had undergone Billroth II gastrectomy were studied with respect to vitamin D and other indices of calcium metabolism. The Billroth I group had hypocalcaemia, raised concentration of serum alkaline phosphatase, and reduced bone mineral content. The same biochemical disturbances were found in the Billroth II group, but bone mineral content was normal. In neither of the groups was found signs of increased bone resorption. The calcium absorption was situated in the lower part of the normal range and the fractional absorption and elimination rates were normal. The 25OHD concentrations in both groups were reduced (p less than 0.05-0.01) and the 1.25(OH)2D concentrations raised (p less than 0.01-0.001). The 1,25(OH)2D concentrations were inversely related to bone mineral content, but directly related to signs of bone turnover and calcium absorption. We suggest that the high 1,25(OH)2D concentration is the result of a compensatory process with the aim of preventing hypocalcaemia.

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Selected References

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  • Blichert-Toft M, Beck A, Christiansen C, Transbøl I. Effects of gastric resection and vagotomy on blood and bone mineral content. World J Surg. 1979 Jun 11;3(1):99–135. [PubMed]
  • Tougaard L, Rickers H, Rödbro P, Thaysen EH, Christensen MS, Lund B, Sörensen OH. Bone composition and vitamin D after Pólya gastrectomy. Acta Med Scand. 1977;202(1-2):47–50. [PubMed]
  • Alhava EM, Aukee S, Karjalainen P. Bone mineral after partial gastrectomy. I. Scand J Gastroenterol. 1974;9(5):463–466. [PubMed]
  • Pittet PG, Davie M, Lawson DE. Role of nutrition in the development of osteomalacia in the elderly. Nutr Metab. 1979;23(2):109–116. [PubMed]
  • Eddy RL. Metabolic bone disease after gastrectomy. Am J Med. 1971 Apr;50(4):442–449. [PubMed]
  • Agnew JE, Holdsworth CD. The effect of fat on calcium absorption from a mixed meal in normal subjects, patients with malabsorptive disease, and patients with a partial gastrectomy. Gut. 1971 Dec;12(12):973–977. [PMC free article] [PubMed]
  • Fujita T, Okuyama Y, Handa N, Orimo H, Ohata M, Yoshikawa M, Akiyama H, Kogure T. Age-dependent bone loss after gastrectomy. J Am Geriatr Soc. 1971 Oct;19(10):840–846. [PubMed]
  • Kocián J, Brodan V. New observations on the absorption of 47Ca in patients with partial gastrectomy. Digestion. 1975;12(4-6):193–200. [PubMed]
  • Gregory DH, Van Uelft R. Calcium absorption following gastric resection. Am J Gastroenterol. 1972 Jan;57(1):34–40. [PubMed]
  • Gertner JM, Lilburn M, Domenech M. 25-Hydroxycholecalciferol absorption in steatorrhoea and postgastrectomy osteomalacia. Br Med J. 1977 May 21;1(6072):1310–1312. [PMC free article] [PubMed]
  • Imawari M, Kozawa K, Akanuma Y, Koizumi S, Itakura H, Kosaka K. Serum 25-hydroxyvitamin D and vitamin D-binding protein levels and mineral metabolism after partial and total gastrectomy. Gastroenterology. 1980 Aug;79(2):255–258. [PubMed]
  • von Lilienfeld-Toal H, Mackes KG, Kodrat G, Ochs H, Sonnenberg A. Plasma 25-hydroxyvitamin D and urinary cyclic AMP in German patients with subtotal gastrectomy (Billroth II). Am J Dig Dis. 1977 Jul;22(7):633–636. [PubMed]
  • Schoen MS, Lindenbaum J, Roginsky MS, Holt PR. Significance of serum level of 25-hydroxycholecalciferol in gastrointestinal disease. Am J Dig Dis. 1978 Feb;23(2):137–142. [PubMed]
  • Shepard RM, Horst RL, Hamstra AJ, DeLuca HF. Determination of vitamin D and its metabolites in plasma from normal and anephric man. Biochem J. 1979 Jul 15;182(1):55–69. [PubMed]
  • Christiansen C, Naestoft J, Hvidberg EF, Larsen NE, Petersen B. An easy procedure for in vivo estimation of protein binding and correction of elevated serum values induced by venous stasis. Clin Chim Acta. 1975 Jul 9;62(1):65–71. [PubMed]
  • Pødenphant J, Larsen NE, Christiansen C. An easy and reliable method for determination of urinary hydroxyproline. Clin Chim Acta. 1984 Sep 15;142(1):145–148. [PubMed]
  • Christiansen C, Rödbro P. Long-term reproducibility of bone mineral content measurements. Scand J Clin Lab Invest. 1977 Jun;37(4):321–323. [PubMed]
  • Nilas L, Gotfredsen A, Christiansen C. Relationship between local and total bone mineral content after gastric surgery. Scand J Gastroenterol. 1984 Jul;19(5):591–595. [PubMed]
  • Marshall DH, Nordin BE. A comparison of radioactive calcium absorption tests with net calcium absorption. Clin Sci (Lond) 1981 Oct;61(4):477–481. [PubMed]
  • Marshall DH, Nordin BE. Kinetic analysis of plasma radioactivity after oral ingestion of radiocalcium. Nature. 1969 May 24;222(5195):797–797. [PubMed]
  • Boddy K, King PC, Hume R, Weyers E. The relation of total body potassium to height, weight, and age in normal adults. J Clin Pathol. 1972 Jun;25(6):512–517. [PMC free article] [PubMed]
  • Tothill P, Dellipiani AW, Calvert J. Plasma concentrations of radiocalcium after oral administration, and their relationship to absorption. Clin Sci. 1970 Jan;38(1):27–39. [PubMed]
  • Arman E, Nilsson LH, Reizenstein P. Studies in the dumping syndrome. VI. Calcium deficiency after partial gastrectomy. Am J Dig Dis. 1970 May;15(5):455–462. [PubMed]
  • Lund B, Sørensen OH, Lund B, Agner E. Serum 1,25-dihydroxyvitamin D in normal subjects and in patients with postmenopausal osteopenia. Influence of age, renal function and oestrogen therapy. Horm Metab Res. 1982 May;14(5):271–274. [PubMed]
  • Thompson GR, Lewis B, Booth CC. Vitamin-D absorption after partial gastrectomy. Lancet. 1966 Feb 26;1(7435):457–458. [PubMed]
  • Stamp TC. Intestinal absorption of 25-hydroxycholecalciferol. Lancet. 1974 Jul 20;2(7873):121–123. [PubMed]
  • Arnaud SB, Goldsmith RS, Lambert PW, Go VL. 25-Hydroxyvitamin D3: evidence of an enterohepatic circulation in man. Proc Soc Exp Biol Med. 1975 Jun;149(2):570–572. [PubMed]

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