Objective-Polyneuropathy has been reported after gastrectomy performed to t
reat various lesions. Although thiamine deficiency is a possible cause of t
his neuropathy, the pathogenesis still remains to be clarified. Seventeen p
atients with peripheral neuropathy with thiamine deficiency after gastrecto
my are described.
Methods-Seventeen patients with polyneuropathy after gastrectomy accompanie
d by thiamine deficiency were selected. Patients were restricted to those w
ith total or subtotal gastric resection to treat ulcer or neoplasm. Patient
s who had undergone operations to treat morbid obesity were excluded.
Results-Intervals between the operation and onset of neuropathy varied from
2 months to 39 years. Most patients did not seem malnourished. Serum conce
ntrations of B vitamins other than thiamine were nearly normal. Symmetric m
otorsensory polyneuropathy, predominantly involving the lower limbs, had pr
ogressed over intervals varying from 3 days to 8 years. Relative degrees of
motor and sensory impairment also varied extensively. Some cases that prog
ressed rapidly mimicked Guillain-Barre syndrome. Electrophysiological and p
athological findings were those of axonal neuropathy. Substantial functiona
l recovery from polyneuropathy was seen in most patients by 3 to 6 months a
fter initiating thiamine supplementation. Motor recovery was better than se
Conclusions-Various symptoms were seen in patients with postgastrectomy neu
ropathy. Thiamine deficiency should be considered in the differential diagn
osis of motor-sensory polyneuropathy after gastrectomy.