medigraphic.com

2007, Number 6

<< Back Next >>

Cir Cir 2007; 75 (6)

Dumping syndrome in patients submitted to gastric resection

Rivera I, Ochoa-Martínez CI, Hermosillo-Sandoval JM, Morales-Amezcua JM, Fuentes-Orozco C, González-Ojeda A

Language: Spanish
References: 44
Page: 429-433
PDF size: 61.62 Kb.


ABSTRACT

Background: We undertook this study to establish the incidence of dumping syndrome after partial or total gastric resection and its association with patient’s preoperative nutritional status as well as the clinical behavior with dietary management during a short-term follow-up period.
Methods: This was a prospective study of consecutive patients › 30 years of age and who were submitted to gastrectomy for gastric cancer or complicated ulceropeptic disease during a 24-month period in a highly specialized hospital.
Results: A total of 42 patients were evaluated with a slight female predominance (n = 22, 52.4 %). Twenty nine cases (69 %) had subtotal gastrectomy and 13 (31 %) had a total gastrectomy. Patients had a medium age of 54.4 ± 7.6 vs. 66 ± 14 years, respectively (p = 0.034). Reconstruction techniques were Roux-en-Y gastrojejunostomy in 69 % and Roux-en-Y esophago-jejunostomy in 28.5 %. We found dumping syndrome in 45 % of the cases associated with acute or chronic undernutrition (p = 0.003). Fifty three percent of the patients with dumping syndrome improved with adequate dietetic manipulation during a follow-up period of 211 days.
Conclusions: Although the majority of reconstructions were performed with dysfunctionalized small bowel segments, the incidence of dumping syndrome was 45 %. Patient’s preoperative nutritional status influenced the presence of clinical manifestations. Adequate dietary management reduced, in 53 % of the patients, the presence of dumping symptoms during a short-term follow-up period.


REFERENCES

  1. Mallory GN, Macgregor AM, Rand CS. The influence of dumping on weight loss after gastric restrictive surgery for morbid obesity. Obes Surg 1996;6:474-478.

  2. 2. Bufler P, Ehringhaus C, Koletzko S. Dumping syndrome: a common problem following Nissen fundoplication in young children. Pediatr Surg Int 2001;17:351-355.

  3. 3. Gilger MA, Yeh C, Chiang J, Dietrich C, Brandt ML, El-Serag HB. Outcomes of surgical fundoplication in children. Clin Gastroenterol Hepatol 2004;2:978-984.

  4. 4. Eagon JC, Miedema BW, Kelly KA. Postgastrectomy syndromes. Surg Clin North Am 1992;72:445-465.

  5. 5. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract 2005;20:517-525.

  6. 6. Rehnberg O. Antrectomy and gastroduodenostomy with or without vagotomy in peptic ulcer disease: a prospective study with a 5-year follow-up. Acta Chir Scand Suppl 1983;515:1-63.

  7. 7. Pemberton JH, van Heerden JA. Vagotomy and pyloroplasty in the treatment of duodenal ulceration: long-term results. Mayo Clin Proc 1980;55:14-18.

  8. 8. Mulholland M, Morrow C, Dunn DH, Schwartz ML, Humphrey EW. Surgical treatment of duodenal ulcer: a prospective randomized study. Arch Surg 1982;117:393-397.

  9. 9. Hertz AF. The cause and treatment of certain unfavorable after effects of gastro-enterostomy. Ann Surg 1913;58:466-472.

  10. 10. Wyllys E, Andrew E, Mix CL. “Dumping stomach” and other results of gastrojejunostomy: operative cure by disconnecting old stoma. Surg Clin Chicago 1920;4:879-892.

  11. 11. Sigstad H. A clinical diagnostic index in the diagnosis of the dumping syndrome: changes in plasma volume and blood sugar after a test meal. Acta Med Scand 1970;188:479-486.

  12. 12. Azpiroz F, Malagelada JR. Gastric tone measured by an electronic barostat in health and postsurgical gastroparesis. Gastroenterology 1987;92:934-943.

  13. 13. Jordan GL Jr, Overton RC, De Bakey ME. The postgastrectomy syndrome: studies on pathogenesis. Ann Surg 1957;145:471-478.

  14. 14. Snook JA, Wells AD, Prytherch DR, Evans DH, Bloom SR, Colin-Jones DG. Studies on the pathogenesis of the early dumping dumping syndrome induced by intraduodenal instillation of hypertonic glucose. Gut 1989;30:1716-1720.

  15. 15. Kalser MH, Cohen R. Correlation of jejunal transfer of water and electrolytes with blood volume in postgastrectomy patients: response to hypertonic glucose meal. Ann Surg 1966;164:821-829.

  16. 16. Creaghe SB, Saik RP, Pearl J, Peskin GW. Noninvasive vascular assessment of dumping syndrome: usefulness in therapeutic decisions. J Surg Res 1977;22:328-332.

  17. 17. Aldoori MI, Qamar MI, Read AE, Williamson RC. Increased flow in the superior mesenteric artery in dumping syndrome. Br J Surg 1985;72:389-390.

  18. 18. Vecht J, Winter M, Chang PC, Lamers CBHW. Acute vasodilatation in early dumping syndrome. Gastroenterology 1996;110:A329.

  19. 19. Norryd C, Dencker H, Lunderquist A, Olin T, Tylen U. Superior mesenteric blood flow during experimentally induced dumping in man. Acta Chir Scand 1975;141:187-196.

  20. 20. Johnson LP, Jesseph JE. Evidence for a humoral etiology of the dumping syndrome. Surg Forum 1961;12:316-317.

  21. 21. Wong PY, Talamo RC, Babior BM, Raymond GG, Colman RW. Kallikrein-kinin system in postgastrectomy dumping syndrome. Ann Intern Med 1974;80:577-581.

  22. 22. Yamashita Y, Toge T, Adrian TE. Gastrointestinal hormone in dumping syndrome and reflux esophagitis after gastric surgery. J Smooth Muscle Res 1997;33:37-48.

  23. 23. Tomita R, Fujisaki S, Tanjoh K, Fukuzawa M. Studies on gastrointestinal hormone and jejunal interdigestive migrating motor complex in patients with or without early dumping syndrome after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer. Am J Surg 2003;185:354-359.

  24. 24. Mehagnoul-Schipper DJ, Lenders JW, Willemsen JJ, Hopman WP. Sympathoadrenal activation and the dumping syndrome after gastric surgery. Clin Auton Res 2000;10:301-308.

  25. 25. Weir GC. Glucagon-like peptide-1 (GLP-1): a piece of the incretin puzzle. J Clin Invest 1995;95:1.

  26. 26. Layer P, Holst JJ, Grandt D, Goebell H. Ileal release of glucagon-like peptide-1 (GLP-1): Association with inhibition of gastric acid secretion in humans. Dig Dis Sci 1995;40:1074-1082.

  27. 27. Vecht J, Gielkens HA, Frolich M, Lamers CB, Masclee AA. Vasoactive substances in early dumping syndrome: effects of dumping provocation with and without octreotide. Eur J Clin Invest 1997;27:680-684.

  28. 28. Holst JJ. Glucagon like peptide 1: a newly discovered gastrointestinal hormone. Gastroenterology 1994;107:1848-1855.

  29. 29. Andreasen JJ, Orskov C, Holst JJ. Secretion of glucagon-like peptide-1 and reactive hypoglycemia after partial gastrectomy. Digestion 1994;55:221-228.

  30. 30. Lacy BE, Weiser K. Gastric motility, gastroparesis, and gastric stimulation. Surg Clin North Am 2005;85:967-987.

  31. 31. Carvajal SH, Mulvihill SJ. Postgastrectomy syndromes: dumping and diarrhea. Gastroenterol Clin North Am 1994;23:261-279.

  32. 32. Miranda R, Steffes B, O’Leary JP, Woodward ER. Surgical treatment of the postgastrectomy dumping syndrome. Am J Surg 1980;139:40-43.

  33. 33. Lygidakis NJ. A new method for the surgical treatment of the dumping syndrome. Ann R Coll Surg Engl 1981;63:411-414.

  34. 34. Vogel SB, Hocking MP, Woodward ER. Clinical and radionuclide evaluation of Roux-Y diversion for postgastrectomy dumping. Am J Surg 1988;155:57-62.

  35. 35. Behrns KE, Sarr MG. Diagnosis and management of gastric emptying disorders. Adv Surg 1994;27:233-255.

  36. 36. Sigstad H. Effect of tolbutamide on the dumping syndrome. Scand J Gastroenterol 1969;4:227-231.

  37. Leichter SB, Permutt MA. Effect of adrenergic agents on postgastrectomy hypoglycemia. Diabetes 1975;24:1005-1010.

  38. 38. Bernard PF, Baschet C, Le Henand F, Bouderlique JR, Lortat-Jacob JL. Treatment of 65 cases of dumping syndrome with methysergide in recently gastrectomized patients. Presse Med 1970;78:549-550.

  39. 39. Shibata C, Funayama Y, Fukushima K, et al. Effect of steroid therapy for late dumping syndrome after total gastrectomy: report of a case. Dig Dis Sci 2004;49:802-804.

  40. 40. Chandos B. Dumping syndrome and the regulation of peptide YY with verapamil. Am J Gastroenterol 1992;87:1530-1531.

  41. 41. Salvatore T, Giugliano D. Pharmacokinetic-pharmacodynamic relationships of acarbose. Clin Pharmacokinet 1996;30:94-106.

  42. 42. Ng DD, Ferry RJ Jr, Kelly A, Weinzimer SA, Stanley CA, Katz LE. Acarbose treatment of postprandial hypoglycemia in children after Nissen fundoplication. J Pediatr 2001;139:877-879.

  43. Lamers CB, Bijlstra AM, Harris AG. Octreotide, a long-acting somatostatin analog, in the management of postoperative dumping syndrome. An update. Dig Dis Sci 1993;38:359-364.

  44. Vecht J, Lamers CB, Masclee AA. Long-term results of octreotide-therapy in severe dumping syndrome. Clin Endocrinol (Oxf) 1999;51:619-624.




2020     |     www.medigraphic.com