Dumping syndrome in gastric surgery

2021-01-30 12:00 AM

Early symptoms occur because high-sugar foods pass from the stomach into the small intestine too quickly

Outline

Dumping's syndrome is a group of symptoms that can occur if you have surgery to remove all or part of your stomach, or if your stomach has had a bypass surgery to help you lose weight. This syndrome is also known as rapid empty stomach syndrome, which occurs when the undigested parts of your stomach are transported or "poured" into the small intestine too quickly. Common symptoms include stomach upset and nausea.

Most people with Dumping's syndrome show symptoms immediately after eating. In other cases, symptoms may occur 1-3 hours after eating. In both cases, symptoms can range from mild to severe.

Dumping's syndrome usually improves without medical treatment or after adjusting your diet. In more severe cases, you may need medication or surgery.

Symptom

Early symptoms

Usually occurs during a meal or within 15-30 minutes after a meal. Early symptoms occur because high-sugar foods pass from the stomach into the small intestine too quickly. Because the food is so concentrated, it attracts a corresponding large amount of fluid into the intestines, causing it to stretch and be sore. Early symptoms of Dumping's syndrome include:

Nausea.

Vomiting.

Stomach-ache.

Diarrheal.

Dizziness, dizziness.

Flatulence, belching.

Tired.

Palpitations, tachycardia.

Late symptoms

Usually occurs 1-3 hours after eating. Late symptoms are caused by significant changes in blood sugar. When sugar is eaten, they are rapidly absorbed into the bloodstream causing a rapid rise in blood sugar. The pancreas responds by secreting an evenly large amount of insulin to absorb this excess blood sugar. However, sometimes the pancreas produces too much insulin, leading to hypoglycaemia. Late symptoms of Dumping's syndrome include:

Sweat.

Weakness, fatigue.

Dizziness, dizziness.

Tremulous.

Feelings of stress, anxiety.

Palpitations, tachycardia.

Fainting.

Psychosis.

Diarrheal.

Hypoglycaemia.

Some people experience both early and late symptoms. Conditions like dizziness and a fast heartbeat can happen either early or late - or both. No problem when symptoms increase, however, they can get worse after a meal high in sugar, especially rich in sucrose or fructose.

Some people experience symptoms of hypoglycaemia, due to increased blood insulin levels, as part of the syndrome. Hypoglycaemia is more common in late symptoms. Insulin affects the tissues to lower the patient's blood sugar.

Reason

In Dumping Syndrome, food and stomach fluids move from your stomach to your small intestine abnormally quickly and uncontrollably. This process is usually associated with surgical changes in the stomach. For example, when the door (pyloric) between the stomach and the first part of the small intestine (duodenum) has been damaged or removed during surgery, dumping syndrome can occur.

Dumping syndrome can occur mildly in at least a quarter to half of people who have had gastric bypass surgery. This syndrome occurs most commonly within weeks after surgery, or right after you go back to your normal diet. The more parts of the stomach are removed or disconnected, the more likely it is that a serious condition will occur. It sometimes becomes a chronic disorder.

The gastrointestinal hormones are also believed to play an important role in this process.

The danger elements

Several types of stomach surgery increase your risk of Dumping's syndrome, including:

Gastrectomy, in which part or all of your stomach is removed. Usually includes the elimination of the pylorus.

Gastrointestinal fusion surgery, in which your stomach is surgically connected directly to the small intestine. Doctors sometimes perform this surgery in people with stomach cancer.

Illustration of rectal fusion surgery (from left to right: PEAN-style Billroth I connection, FINSTERER-type Billroth II connection, direct connection of the jejunum - oesophagus in the complete gastric bypass surgery)

Vaginal nerve resection surgery, in which the nerves that reach your stomach are removed to reduce the amount of acid produced by your stomach.

Fundoplication Surgery, which is surgery sometimes performed on people with acid reflux disease. The surgeon wraps the upper part of the stomach around the lower part of the oesophagus to apply pressure to reduce the reflux from the stomach to the oesophagus. However, in rare cases, certain nerves to the stomach are accidentally damaged during surgery, leading to Dumping's syndrome.

Gastric bypass surgery, which is performed to treat obesity. Surgery creates a stomach pouch that is smaller than the entire stomach, meaning you can no longer eat as much as before, resulting in you losing weight.

Some of these diseases and drugs can also make you more susceptible to Dumping's syndrome. These include:

Diabetes.

Cyclic vomiting syndrome (CVS).

Zollinger-Ellison syndrome, causing severe stomach ulcers.

Metoclopramide (REGLAN), sometimes prescribed to relieve nausea, vomiting, and heartburn.

 Symptoms

In people with severe cases of Dumping's syndrome, weight loss and malnutrition can occur. Sometimes people who lose a lot of weight may also develop a gradual fear of eating, which is related to discomfort due to the rapid drop of undigested food. They may also avoid outdoor physical activities in order to easily stay near a toilet (?). Some have difficulty at work because of their chronic symptoms.

Treatment

Internally medical treatment

The purpose of taking medications is to minimize the incidence of the disease and minimize complications.

Drugs to reduce blood glucose: works in the late stage.

Acarbose (Precose, Prandase): essentially an alpha-glycoside hydrolase inhibitor, effects:

Reduces blood sugar by inhibiting gastrointestinal glucose absorption.

Reduce the rate of postprandial hyperglycaemia.

Reduce secondary diarrheal due to fermentation of unabsorbed carbohydrates.

Anti-excretion drugs: reduce the incidence.

Somatostatin (Octreotide): effects on receptors of somatostatin subtypes II and V to:

Reduces the excretion of GH, as well as limits the endocrine or non-endocrine factors of the gastrointestinal tract: glucagon, VIP (vasopressin intestinal peptide) and other peptides.

Delay the initial gastric emptying.

Slow down bowel movements.

Inhibits insulin release.

Vascular constriction and visceral vasodilation inhibition after eating.

Surgical treatment

It is necessary to accurately identify the surgical procedure that is causing the Syndrome:

Gastric restructuring:

Purpose: to slow gastric emptying.

Method: narrowing the opening of the stomach - jejunum.

Disadvantages: it is difficult to determine the exact hole size to be achieved. Obstruction of the way out of the stomach is also common.

Convert Billroth II to Billroth I:

Restores the physiological circulation of food from the stomach without the risk of narrowing the gastric outlet obstruction.

The procedure is simple and reduces the rate of complications.

Pyloric shaping: scarring and stitching along the pyloric length.

Interference in the jejunum by Schoemaker: placed in the jejunum to suit the peristalsis (??), however, can cause ulcers and narrowing of the loop.

Roux-en-Y conversion: works by interrupting peristalsis, hindering peristalsis as well as counter motility.