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[On the problem of the pathogenesis and therapy of dumping syndrome].
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[THE DUMPING SYNDROME].
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[Gastric motility and post-gastrectomy dumping syndrome].
A direct relationship was revealed between disorders of gastric motility before the operation and the frequency and severity of the post-gastrectomy dumping syndrome in patients with peptic ulcer. The level of increase in the frequency and amplitude of the contractions and the basal tonus of the gastric stump may serve as an objective criterion for establishing the severity of the dumping syndrome. Patients with an initial hyperkinetic type of motility are predisposed to the dumping syndrome, which must be borne in mind in choosing a variant of the operation and the method for creating the gastrointestinal anastomosis.
[The effect of changes in the rate of gastric emptying on the development of dumping syndrome after vagotomy].
Under analysis were results of the stomach emptying rate in 85 patients with duodenal ulcer not earlier than 6 months after vagotomy. The dumping-syndrome took place in 47 of them. It was shown that when studying the dumping-syndrome the investigation of the evacuatory function of the stomach must be performed when patients are in vertical posture. Of main significance in the appearance of dumping-syndrome was the accelerated emptying of the stomach during the first 10 min after the test breakfast.
Dumping syndrome as a complication of laparoscopic Nissen fundoplication in an adult.
BACKGROUND: Dumping syndrome is a recognized complication of various gastric surgical procedures, such as vagotomy, pyloroplasty, and gastrojejunostomy. However, it has not to date been reported following laparoscopic Nissen fundoplication in adults. CASE REPORT: We describe the case of a 34-year-old woman who developed late dumping syndrome following an uneventful laparoscopic Nissen fundoplication for gastroesophageal reflux disease. CONCLUSION: This condition should be considered in patients who develop hypoglycemic symptoms following laparoscopic fundoplication.
[Serotonin and the dumping syndrome (author's transl)].
The serotonin level in patients after a 2/3 resection of the stomach (Billroth II) is normal to moderately raised. Patients with a dumping syndrome show no significantly different figures for the excretion of free serotonin in the 24-hr urine. The level of serotonin in patients after gastric operation is regulated to normal or slightly raised values by increased serotonin production in the gastrointestinal tract whether a dumping syndrome develops or not. Knowledge of the serotonin levels is consequently of therapeutic significance because a dumping syndrome may exist with and without raised serotonin values.
[Serotonin and dumping syndrome (author's transl)].
5-hydroxyindole acetic acid, xanthurenic acid and kynurenin, --that is to say the major metabolites of serotonin, were measured in the urines of 31 patients with dumping syndrome. Serotonin concentrations were measured as well in peripheral venous blood before and after a glucose load in 47 patient with dumping syndrome. All values measured were in the normal range. Comparison of serotonin levels in peripheral and portal venous blood yielded normal results as well. It is therefore concluded, that serotonin does not play an essential role in the etiology of the dumping syndrome.
[The effect of calcium antagonists on the rate of gastric emptying in patients with duodenal peptic ulcer and the dumping syndrome].
Comparative evaluation of single-dose finoptin, corinfar and falicor by effect on gastric evacuation was conducted in 33 peptic ulcer and 48 postgastrectomy dumping syndrome patients. Finoptin was found to prolong the evacuation in contrast to corinfar which stimulated it. Nonsignificant delay in gastric evacuation occurred in falicor administration. When designing therapy of cardiovascular diseases associated with gastric evacuation, due consideration should be given to pharmacokinetic action of calcium antagonists and functional status of gastric evacuation. Finoptin is preferable in dumping syndrome, corinfar in slow gastric evacuation. In view of the above corinfar treatment is undesirable in postgastrectomy patients, otherwise they could develop rapid gastric stump evacuation and dumping syndrome.
[Results of clinico-roentgenological comparisons in dumping syndrome after vagotomy].
The authors have compared clinical and roentgenological data in 39 patients with the dumping syndrome. It is assumed that the conditions for the dumping syndrome to develop would arise more often after the truncal and proximal vagotomy and following the Billroth-II gastric resection.
[Pathogenetic basis of diet therapy in dumping syndrome patients after a stomach resection].
A total of 462 patients with the dumping syndrome after gastric resection for peptic ulcer were under-observation. The critical response to qualitatively different nutritional loads and the content of a number of the vegetative nervous system mediators and insulin were examined. Moreover, function of the digestive organs and metabolic rates reflecting the course of a number of metabolic processes were studied. The evidence obtained furnished a background for validating and elaborating the system of staged differentiated nutritional therapy of the dumping syndrome with due regard for the syndrome gravity, various post-operative periods and the character of concomitant affections.
[Dumping syndrome: a case after Nissen's operation].
We report on a case of dumping syndrome 1 month after Nissen fundoplication in a 5 month-old infant presenting with symptoms of late hypoglycemia. Blood glucose levels in pre- and post-prandial periods, oral glucose tolerance test and isotopic gastric emptying study confirmed the diagnosis. All symptoms resolved with diet therapy which could be stopped 8 months later. Dumping syndrome is not a so rare complication of gastric surgery and should be considered in patients with non specific symptoms.
[Pathogenesis, prevention and treatment of dumping syndrome].
The work presents results of treatment of 123 patients with a severe dumping-syndrome following resection of the stomach for ulcer disease. The author considers that there is not any predisposition for the dumping-syndrome in resection of the stomach. This pathology is a result of inconsiderable errors in operation and can be prevented by strict observation of the rules of performing the operation. The reconstructive operation aimed at the creation of favorable conditions for the functioning of the gastric stump is indicated if the conservative treatment failed during 6-10 months.
Gastroenteric anastomosis in Billroth II gastrectomy with maintenance of the physiologic diameter of the normal pylorus to prevent the dumping syndrome. Part II. Results in 1,300 cases.
Clinical results of the use of a gastroenteric anastomosis with a diameter the size of the normal pylorus (1.9 cm) in 1,300 cases between 1954 and 1971 are presented mainly in terms of prevention of the dumping syndrome. We have had no patient with clinical manifestations of any degree of the dumping syndrome in the first two years after operation. These excellent results have led us to employ the method routinely. We recommend this method for its simplicity and, above all, its effectiveness in preventing the dumping syndrome.
Dumping syndrome in children. Diagnosis and effect of glucomannan on glucose tolerance and absorption.
Dumping syndrome is rarely seen in children. We studied ten children with symptoms following various types of gastric surgery. All had abnormal blood glucose and breath hydrogen responses after oral glucose challenge, indicating reduction of both glucose tolerance and glucose absorption, as compared to controls. Glucose tolerance was best expressed as the difference between peak and subsequent lowest blood glucose level, the upper limit of normal (mean + 3 SD) being 5.9 mmol/l. In eight children with persisting symptoms we tested the effects of glucomannan, a highly hygroscopic tasteless fibre, on glucose tolerance and glucose absorption. Glucomannan significantly improved glucose tolerance, but did have no overall effect on glucose absorption. Four children tested glucomannan added to the main meals. Breath hydrogen excretion, as established with the daytime breath hydrogen profile, decreased significantly in two, but complaints increased in three children. Glucomannan does not appear to be suitable for the treatment of dumping syndrome in children as the side effects seem to overrule the beneficial effects.
Studies on the pathogenesis of the early dumping syndrome induced by intraduodenal instillation of hypertonic glucose.
A reaction indistinguishable from the early dumping syndrome was induced in four of nine normal volunteers by intraduodenal instillation of a hypertonic glucose meal. Tachycardia and marked peripheral vasodilatation were demonstrated in 'dumpers' by Doppler ultrasound measurements of the arterial blood flow signal. The dumping reaction was not detectably altered by the addition of guar to the meal. Plasma VIP concentration rose and plasma volume fell to a similar degree in 'dumpers' and 'non-dumpers', suggesting that neither event is an integral component of the dumping mechanism. In contrast, the rates of rise of blood glucose and enteroglucagon concentration were markedly greater in 'dumpers'. The results are inconsistent with the conventional explanation that the early dumping syndrome is caused by a large osmotic fluid shift, but are compatible with a mechanism involving an initial period of intestinal hypermotility.
Plasma peptide YY (PYY) in dumping syndrome.
The newly isolated hormonal peptide PYY is mainly localized to endocrine cells of the lower intestinal mucosa. The release of PYY by oral glucose was studied in six patients with the dumping syndrome to ascertain the effect of this condition on PYY release. Plasma PYY concentrations were greatly increased following oral glucose in patients with the dumping syndrome compared with healthy controls. In a separate series of experiments, the effect of somatostatin infusion on the PYY release by glucose in these patients was investigated. The release of PYY was completely blocked by infusion of somatostatin, and its release from the bowel in normal subjects may therefore be modulated by local somatostatin in the gut. PYY has been shown to inhibit gastric acid secretion and emptying, at plasma concentrations similar to those seen after glucose, in patients with the dumping syndrome. PYY may therefore be a factor involved in the pathophysiological changes associated with this condition.
Octreotide therapy in dumping syndrome: Analysis of long-term results.
BACKGROUND: Octreotide therapy is effective in controlling severe dumping symptoms during short-term follow-up but little is known about long-term results. AIM: To report on the long-term results of patients with severe dumping syndrome treated at the Leiden University Medical Center with subcutaneous or depot intramuscular (long-acting release) octreotide. METHODS: Follow-up of 34 patients with severe dumping syndrome refractory to other therapeutic measures treated between 1987 and 2005 with octreotide subcutaneous/long-acting release. At regular intervals symptoms, quality of life, weight, faecal fat excretion and gallstone formation were evaluated. RESULTS: All patients had excellent initial relief of symptoms during octreotide subcutaneous therapy. However, during follow-up 16 patients stopped therapy because of side effects (n = 9) or loss of efficacy (n = 7). Four patients died. Fourteen patients (41%) remain using octreotide (follow-up 93 +/- 15 months), seven are on octreotide subcutaneous and seven on octreotide long-acting release. Patients with severe dumping (both early and late) do better on subcutaneous than long-acting release despite the inconvenience of frequent injections. Dumping symptoms are reduced by 50% even in long-term users. Body weight continues to increase during therapy despite more pronounced steatorrhoea. CONCLUSION: The long-term the efficacy of octreotide is much less favourable compared with short-term treatment.