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PubMed1987

[Dumping syndrome after selective proximal vagotomy].

An analysis of causes of the development of dumping-syndrome after selective proximal vagotomy (SPV) has been made. Dumping-syndrome most frequently developed after SPV with draining operation (12.9%). The dumping-syndrome was rare and of light degree after SPV without drainage. The authors consider that disturbed motor-evacuatory function of the stomach and small intestine is responsible for the development of dumping-syndrome after SPV as well as the width of gastroduodenal anastomosis in draining operation which must be not more than 2-2.5 cm.

Drainage↗

PubMed1987

Hypoglycemia pathogenesis in children with dumping syndrome.

Three children with severe hypoglycemic reactions secondary to dumping syndrome were studied to discern the mechanism by which hypoglycemia occurred. Symptoms in patient 1 developed after fundoplication, generalized autonomic dysfunction occurred in patient 2, and dumping syndrome developed in patient 3 after malplacement of a feeding gastrostomy tube. Average blood glucose levels studied during and after two to seven meals in each child were 375 +/- 97 mg/dL (mean +/- SD) 30 minutes postprandially and 35 +/- 10 mg/dL greater than 120 minutes later. Swings in glucose values were proportional to the volume of meals. Insulin and glucagon levels were followed during a single meal challenge test in each patient; the average glucose concentration increased to 356 +/- 59 mg/dL 30 minutes postprandially and decreased to 32 +/- 11 mg/dL at 150 +/- 30 minutes. Hormonal analyses indicated (1) inappropriate early release of glucagon (300 pg/mL at 15 minutes) in patient 1, (2) exuberant early release of insulin (maximum 190 +/- 15 microU/mL) resulting in rapid decrease in glucose concentration in all patients, (3) development and/or persistence of hypoglycemia after the decline in circulating insulin to undetectable levels, and (4) inadequate glucagon response to hypoglycemia resulting in sustained hypoglycemia. These data indicate that gross disturbances of the insulin-glucagon axis attend childhood dumping syndrome.

Blood Glucose↗

PubMed1988

The dumping syndrome after pancreatoduodenectomy.

Some patients have postoperative nutritional problems after a pancreatoduodenectomy. These problems have been attributed without objective evidence to the partial gastrectomy that is performed at the time of the pancreatoduodenectomy. The dumping syndrome has been implicated, and the results of this study determine, for the first time, the role of the dumping syndrome in pancreatic surgical procedures. Sixty-four dumping provocation tests have been performed upon patients with pancreatic disease or after pancreatic surgical treatment. Three patients had the dumping syndrome, and in eight, the result of the test was equivocal. Results of the present study demonstrate an incidence of dumping syndrome after pancreatoduodenectomy of 10 per cent; however, in none of these patients, was the dumping syndrome a significant problem. There was no instance of the dumping syndrome after pylorus-preserving or duodenum-preserving pancreatectomy. It is concluded that, contrary to previous assumptions, the dumping syndrome does not contribute to long term postoperative problems after pancreatic surgical procedures.

Diagnosis, Differential↗

PubMed1988

[A study of portal blood flow changes in patients with early dumping syndrome and patients with oxyhyperglycemia].

Changes of portal blood flow in patients with early dumping syndrome and those with oxyhyperglycemia were determined after oral ingestion of 300ml of 25% glucose solution by a linear-type B mode electroscanner and pulsed Doppler flowmeter. In normal volunteers, the portal blood flow increased slowly to the peak level of 201% of fasting value at 40 minutes. The portal blood flow in postgastrectomy patients reached the peak value more quickly, with the peak level of 245% at 10 minutes in patients with the early dumping syndrome, and of 172% at 15 minutes in patients without the syndrome. The portal blood flow in patients with early dumping syndrome was significantly greater than that without the syndrome. Patients with early dumping syndrome had characteristic symptoms such as general malaise, cold sweat, nausea, abdominal pain, diarrhea in accordance with increased portal blood flow. Patients with high grade oxyhyperglycemia (peak blood sugar after 75g OGTT greater than 250mg/dl) had significantly higher portal blood flow and peripheral blood sugar than those with low grade oxyhyperglycemia (peak blood sugar less than 250mg/dl) without difference in IRI between the two groups.

Adult↗

PubMed1981

Neurotensin and substance P and dumping syndrome.

To investigate the pathophysiological relation between releases of gut hormones and dumping syndrome, plasma radioimmunoassayable neurotensin, substance P, glucagon-like immunoreactivity (GLI), insulin and blood sugar were measured in both gastrectomized patients and control subjects after 50 g oral glucose tolerance tests. Remarkable rises of radioimmunoassayable neurotensin and GLI were found in all gastrectomized patients, but not in control subjects. In contrast, plasma radioimmunoassayable substance P responses were not detected in either gastrectomized patients or control subjects. There were three patients with symptoms of dumping syndrome in the early stage of the test. Plasma radioimmunoassayable neurotensin responses in two out of these three were higher than those in other patients, though the other patient with symptoms had the same degree of neurotensin elevation as patients with no symptoms. In view of the pharmacological effects of neurotensin, it could not be ruled out that a part of the early symptoms of dumping syndrome may result from the remarkably enhanced plasma neurotensin release in some patients, although the enhanced neurotensin responses did not always accompany symptoms of dumping syndrome.

Adult↗

PubMed1980

Surgical treatment of the postgastrectomy dumping syndrome.

Fifteen patients were treated surgically for dumping syndrome at the University of Florida between 1972 and 1977. Five of them had a reversed jejunal segment interposed between the stomach and the Roux limb and 10 had simple 45 cm Roux-en-Y gastrojejunostomy. The reversed segment has been, in our experience, a uniform disappointment. Straight Roux-en-Y duodenal diversion, with the exception of temporary delay in gastric emptying in a few cases, has proved successful in treating the postgastrectomy dumping syndrome.

Adult↗

PubMed1985

Somatostatin and the dumping syndrome.

Infusion of somatostatin reduced the symptoms of the early dumping syndrome after oral glucose was given and also reduced the associated tachycardia and rise in packed cell volume. It inhibited the secretion of enteroglucagon, neurotensin, and vasoactive intestinal polypeptide, which are raised in patients with the dumping syndrome and may have an aetiological role. It also prevented the reactive hypoglycaemia of late dumping by inhibiting the release of gastric inhibitory polypeptide and insulin. Somatostatin, possibly through its inhibitory effects on hormonal secretion, may have a role in the management of patients with the early and late dumping syndrome.

Blood Glucose↗

PubMed1998

Dumping syndrome in a young Jamaican child.

The dumping syndrome in childhood is an uncommon complication of gastro-oesophageal surgery, principally Nissen fundoplication. A Jamaican child developed the syndrome after fundoplication and pyloroplasty to relieve gastro-oesophageal reflux complicating the repair of a congenital tracheo-oesophageal fistula. He developed marasmus and failed to gain weight on the standard remedial milk-based high-energy diet. An oral glucose tolerance test confirmed the diagnosis of dumping syndrome. A low sugar low milk diet based on adult type meals with continuous nibbling of fried dumplings relieved his diarrhoea and hypoglycaemia and he gained weight. This is a cheaper and more practical dietary therapy than the regimens described previously.

Dumping Syndrome↗

PubMed1994

A case of late dumping syndrome.

We report a case of late dumping syndrome in a 49-year-old lady who had partial gastrectomy for bleeding peptic ulcer 11 years ago. She presented with unexplained syncopal attacks which did not have any apparent relationship to meal or posture. An unusual reaction to oral glucose tolerance test ordered by her gynaecologist who was seeing her for uterine fibroid led to the diagnosis. Late dumping syndrome was confirmed by a repeat oral glucose tolerance test. At the second hour of the test, she developed hypoglycaemic coma with a blood glucose level of 50 mg/dL and a hypocount of 47 mg/dL. She regained full recovery after dextrose infusion which raised the hypocount to 123 mg/dL. The dizzy spells and syncopal attacks disappeared with dietary adjustment.

Diagnosis, Differential↗

PubMedDate not supplied

[The relations between the morphology of the postresection gastric stump after a gastroduodenal ulcer and the dumping syndrome].

Of a group of 272 patients subjected to gastric resection for gastric-duodenal ulcer, the "dumping" syndrome was found in 46 (17%). The most frequent (39.7%) was in the Reichel-Polya anastomosis type and the less frequent (9%) in pyloroplasties. The test of induced hyperglycemia by ingesting 15 g/kg body glucose did not show differences in the values of the maximum glycemia in the patients with the "dumping" syndrome versus the other group. The surface of the anastomosis opening and the length of the gastric stump were appreciated with a central imaging endoscope. The surface of the anastomosis opening was found larger in those with a "dumping" syndrome and Reichel-Polya's resection, although the differences are not statistically significant; likewise, there seems to be a less length of the gastric stump and a higher weight difference in those with the "dumping" syndrome. The lack of pyloric sphincter seems to be very important in producing the "dumping" syndrome due to the fact that the alimentary bolus is not fractionated and its sequential evacuation in duodenum and jejunum does not take place.

Anastomosis, Surgical↗

PubMedDate not supplied

[Effects of wheat bran on the rate of gastric stump and small intestine evacuation in patients with dumping syndrome after stomach resection].

A total of 65 patients with dumping syndrome after gastric resection were under study. It has been found that addition of 10 and 20 g of wheat bran to semolina porridge significantly (p less than 0.05) inhibits the rate of gastric stump and small intestine evacuation, and in 1/3 of the patients it promotes lowered manifestation and duration of dumping syndrome. It has been suggested that the inhibitory action of wheat bran is caused by bran viscosity and, probably, mediated by intestinal hormones released from endocrine cells of the small intestine mucosa. The results of the investigations conducted can be used in the validation of the diet therapy of patients with dumping syndrome.

Diet↗

PubMed1975

Proximal jejunal reversal procedure without interposition for management of dumping syndrome.

For control of disabling dumping syndrome, a short jejunal reversal interposition between the gastric remnant and the duodenum or between the gastric remnant and the jejunum with or without a second jejunal reversal is in current use. A new procedure, proximal jejunal reversal based on a modified antiperistaltic Roux-en-Y without interposition of the jejunal loop is presented and three cases are reported.

Adult↗

PubMed1996

Mechanisms by which octreotide ameliorates symptoms in the dumping syndrome.

Octreotide reduces abdominal and vasomotor symptoms in dumping syndrome by unknown mechanisms. Effects of octreotide (50 microgram) on symptoms, hemodynamic parameters and plasma glucose and insulin levels after glucose meals were tested in double-blind, placebo-controlled, crossover fashion in eight patients with dumping syndrome. Gastric scintigraphy tested whether octreotide reduces symptoms by slowing gastric emptying. Octreotide reduced diarrhea, lightheadedness and palpitations after 75 g of glucose, compared with placebo (P < .001). Orthostatic pulse increases after glucose decreased from 36 +/- 6 beats/min after placebo to 9 +/- 5 beats/min after octreotide (P < .05), and standing blood pressure decreases after glucose were abolished (P < .05), but octreotide had no effect on increase in hematocrit or plasma osmolarity after glucose. Late hypoglycemia was prevented by octreotide, and peak fed insulin levels were reduced from 87 +/- 15 to 26 +/- 9 microU/ml after octreotide (P < .05). Times to maximal plasma glucose levels after meals were prolonged from 28 +/- 4 to 78 +/- 6 min after octreotide (P < .05). Octreotide had no effect on gastric emptying of liquids or solids. In conclusion, amelioration of dumping symptoms by octreotide is associated with reduced orthostasis, which is not a consequence of prevention of hemoconcentration. Prevention of late hypoglycemia may be due to blunted insulin release. Octreotide does not reverse rapid gastric emptying, indicating a limited role for this purported mechanism of action.

Adult↗

PubMed1977

Dumping syndrome and diarrhoea after vagotomy.

The frequency and severity of the post-vagotomic dumping syndrome and diarrhoea were studied in 470 cases. After vagotomy the incidence of the dumping syndrome is lower and that of diarrhoea higher than after conventional gastric resection. The dumping syndrome occurred in 8.30 percent [39 cases], but only three patients belonged into the severe group [0.80 percent]. The frequency of post-vagotomy diarrhoea was 11.49 percent [54 cases] of which six belonged into the severe group [1.34 and 1.04 percent, respectively]. The possibility respectively of preventing or reducing the frequency of these side-effects is discussed.

Diarrhea↗

PubMed2005

A possible role of GLP-1 in the pathophysiology of early dumping syndrome.

Exaggerated plasma concentrations of GLP-1 precede reactive hypoglycemia after oral glucose in gastrectomy patients, resulting in late dumping syndrome. Recently, we showed that GLP-1 elicits the activation of sympathetic outflow. Because sympathetic activation is thought to be a cause of early dumping, we hypothesized that exaggerated GLP-1 may contribute to the pathophysiology of early dumping syndrome. In 11 patients after gastrectomy and 14 controls, blood pressure, heart rate, and plasma concentrations of norepinephrine, epinephrine, GLP-1, glucagon, insulin, and glucose were measured after oral glucose. In gastrectomy patients, GLP-1, norepinephrine, and heart rate peaked 15 to 30 min after oral glucose. Significant positive correlations were found among GLP-1, norepinephrine, and heart rate at 30 min, and these parameters at 30 min were significantly higher in patients with early dumping syndrome. These results suggest that GLP-1 is involved in the pathophysiology of early dumping syndrome.

Adult↗

PubMedDate not supplied

Hypoglycemia unawareness in a patient with dumping syndrome: report of a case.

We report the case of a 49-yr-old man affected by coma and hypoglycemia unawareness following repetitive hypoglycemic episodes due to dumping syndrome. The dumping syndrome, which was due to partial gastrectomy and vagotomy performed for recurrent peptic ulcer, was responsible for reactive hyperinsulinemia as demonstrated by an oral glucose tolerance test. While the glucose counterregulatory hormones were all normally sensitive to specific stimulation tests, insulin-induced hypoglycemia failed to induce an adequate counterregulatory response, causing no response in plasma norepinephrine, a slight and short increase in plasma cortisol, ACTH and glucagon and an insufficient increase in plasma epinephrine and GH. This case demonstrates that hypoglycemia unawareness has to be taken into account not only in patients affected by IDDM or insulinoma but also in any case of reactive hypoglycemia.

Adrenocorticotropic Hormone↗

PubMed1997

The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment.

The dumping syndrome is encountered in approximately 10% of patients after gastric surgery. A postprandial peripheral and splanchnic vasodilatation and ensuing relative hypovolaemia are pivotal in the pathophysiology of early systemic symptoms. Late dumping symptoms are a consequence of a reactive hypoglycaemia, which results from an exaggerated insulin and glucagon-like peptide-1 release. The diagnosis of dumping syndrome can reliably be made with the aid of a provocation test using 50 g glucose orally. Most patients with dumping can be treated with advice on diet and lifestyle. Octreotide effectively controls the signs and symptoms of dumping in patients refractory to standard therapy. It acts through its inhibitory effects on insulin and gut hormone release, a delay of intestinal transit time and inhibition of food-induced circulatory changes. Its long-term use is somewhat limited by side effects, particularly diarrhoea and steatorrhoea.

Dumping Syndrome↗

PubMed1989

Long acting somatostatin analogue in dumping syndrome.

The effect of long acting somatostatin analogue, SMS 201-995, on postprandial dumping syndrome was studied in eight patients with Billroth II gastric resection. Each patient was subjected to two oral glucose challenges with 75 g glucose. One challenge was premedicated with 50 micrograms SMS 201-995 subcutaneously 15 min before the oral intake of glucose, the other with placebo. With placebo all patients experienced the subjective symptoms of the early dumping syndrome with significant (P less than 0.001) increases (mean (s.d.)) in pulse rate (from 66 (8) to 102 (10) beats/min), in packed cell volume (from 0.36 (0.05) to 0.43 (0.1) l/l) and in the plasma levels of vasoactive intestinal polypeptide (from 3.0 (0.5) to 10.2 (1.8) pmol/l). During the somatostatin study the subjective symptoms and the changes in the various parameters were not detected. In the control study seven patients showed postprandial hypoglycemia. In these patients significant elevations (P less than 0.001) in the insulin level (from 10 (0.9) to 40 (9.1) microE/ml) and gastric inhibitory peptide (GIP) concentration (from 100 (13) to 220 (41) ng/l) were seen, compared with the initial values. During the application of SMS 201-995 hypoglycaemia did not develop and plasma insulin and GIP concentrations remained unchanged. These results indicate that the long acting somatostatin analogue alleviates the symptoms of early and late postprandial dumping syndromes.

Double-Blind Method↗