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At least 19 recordsLinked to original sources
PubMed1977

[Pathogenesis, diagnosis and therapy of the dumping syndrome].

The dumping-syndrome is a severe complication of gastric surgery after operations which destroy or weaken the sphincter mechanism of the pylorus. The pathogenesis involves the release of kinins, the triggering of neurogen reflex mechanisms by distending the jejunum, the massive flow of fluid in jejunal lumen, the loss of the reservoir function of the stomach, and, possibly, the pathologic release of gastrointestinal hormones. Preoperatively, intensive diagnostic efforts are necessary, which must include a psychiatric check-up. For surgical treatment several modifications of reversal operations from Billroth II to Billroth I with reconstruction of duodenal passage have been developed. Our own modification includes, beside testitution of the duodenal passage, the construction of a gastric pouch.

Dumping Syndrome↗
PubMed1976

The early postprandial dumping syndrome: prevention and treatment.

The early postprandial dumping syndrome can be prevented or minimized by the appropriate selection of the operative procedure to fit the patient and the peptic ulcer problem he presents, and by proper attention to diet in the early postoperative period. When it does occur, the syndrome usually responds favorably to dietary management and tends to spontaneously regress in severity with time. For these reasons further surgery is seldom required for the early postprandial dumping syndrome. In the patient who fails to improve with diet therapy and time and has disabling symptoms often accompanied by progressive malnutrition, revisional surgery should be undertaken. It is the objective of the surgeon to alter the reconstruction in such a way that emptying from the stomach or gastric remnant is delayed. Therefore, the upper small intestine dose not receive a large, rapidly introduced hyperosmolar bolus to initiate the release of humoral substances causing the syndrome. All revisions utilized are potentially ulcerogenic and if vagotomy has not been a part of the original procedure, it should routinely be performed at the time of revision. Patients who have primarily has a Billroth II gastrectomy will frequently improve markedly with simple conversion to a Billroth I reconstruction. This is particularly true when the residual stomach is moderately large (i.e., after antrectomy) and when the gastrojejunal stoma is larger in diameter than the normal jejunum. Under such circumstances approximately 80 per cent of patients will improve sufficiently so that a more complex procedure need not be utilized at once. Under all other conditions we prefer a 10 cm. segment of reversed jejunum anastomosed proximally to the gastric stump and distally to a 40 cm. isoperistaltic Roux-en-Y jejunal limb. This procedure is so successful that one can justify its use as first recourse even in the anatomically favorable Billroth II patient. It should be pointed out emphatically that an isoperistaltic jejunal interposition (Henley loop) has little or no effect on the early postprandial dumping syndrome and should not be considered. Plicated loops of intestine to recreate a gastric reservoir frequently fail to empty satisfactorily and the incidence of satisfactory results is too low to consider their utilization in surgical treatment of the dumping syndrome.

Adult↗
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↗
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↗
PubMed1975

[Work capacity of patients with dumping syndrome after stomach surgery].

Of 528 patients subjected to radical operations on the stomach for cancer, polyposis and ulcerous disease the dumping-syndrome was revealed in 74 patients. Following resection of the distal gastric portion the latter was observed in 49 cases, after resection of the cardia--in 18, and after gastrectomy--in 7. In most patients with the dumping-syndrome an impairment of basic hepatic functions and motor-evacuative function of the gastric stump was observed. The study of the work capacity in patients with the dumping-syndrome has deomonstrated its reduction in most patients (in 74% of cases). 55 of 74 investigated patients proved to be invalids of the second and third group. The capacity for work was mostly impaired in patients showing the dumping-syndrome of average and severe gravity.

Adult↗
PubMedDate not supplied

[The morphofunctional state of the gastric stump in patients with the dumping syndrome and its significance for the formulation of diet therapy].

In 42 patients with the dumping syndrome. the mucosa of the resected gastric stump was examined histologically. Bioptic materials were obtained by applying fibrobiopsy and aspiration biopsy under roentgenological control. The great majority of the examined demonstrated some or other degree of the glandular atrophy attended by a fall of the secretary function. In spite of a considerable time lapsed since gastric resection the gastric glands remained intact and the secretary function of the stump continued to be normal. According to the authors the severity of the dumping syndrome does not depend on the nature of morphological changes in the gastric stump mucosa. A sizable proportion of the examined patients demonstrated various changes in the motor function of the stump, more often an accelerated evacuation. The listed changes in the morphological-functional condition of the gastric stump were given due consideration in compiling a dietary pattern for patients with the dumping syndrome.

Dumping Syndrome↗
PubMed1976

Gastric antrum and dumping syndrome. Possible pathogenetic correlations.

On the basis of the observation that the dumping syndrome is seen very rarely now compared to the past, experimental and clinical research was carried out with a view to explaining this phenomenon. These studies showed that it is possible that the gastric antrum plays a basic role in the pathogenesis of the dumping syndrome.

Dumping Syndrome↗
PubMed1977

[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.

Dumping Syndrome↗
PubMed1975

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↗
PubMed1976

The early postprandial dumping syndrome: clinical manifestations and pathogenesis.

Our present concept of the pathogenesis of the early postprandial dumping syndrome is well summarized by Jesseph. Resection, division or bypass of the sphincter mechanism at the gastric outlet permits rapid passage of hyperosmolar material into the upper small intestine. This provides direct stimulation of the enterochromaffin (argentaffin) cells in the mucosa, which are highly concentrated here. The hyperosmolarity pulls fluid into the intestine resulting in a fall in plasma volume and distention of the intestine, further stimulating secretion by the argentaffin tissue. The plasma volume per se probably has little, if anything, to do with the symptoms produced although the outpouring of intravascular fluid into the intestinal lumen probably contributes to intestinal hyperperistalsis and the resultant symptoms of intestinal hurry. Although other sources are possible, studies to date would indicate that the argentaffin cells are the major source of humoral agents. In addition to serotonin, at least one vasoactive polypeptide, bradykinin, has been identified. It is likely that others are present and pharmacologic therapy will probably not be successful until these are more completely identified and characterized. The known biologic effects of serotonin and the kinins can certainly account for all the vasomotor and gastrointestinal symptoms characterizing the early postprandial dumping syndrome.

Adult↗
PubMed1976

Use of hypertonic-barium mixtures in the diagnosis of the dumping syndrome.

A hypertonic glucose-barium test meal is a useful study in making the diagnosis of dumping syndrome. A distorted small bowel pattern is seen in the positive response as a result of the rapid entrance of hypertonic glucose into the small bowel with edema of the bowel wall and excessive fluid outpouring into the bowel lumen. The findings in the glucose-barium meal test should be correlated with clinical and laboratory findings to confirm the diagnosis. A negative response to the hypertonic glucose-barium test meal practically precludes the diagnosis of the dumping syndrome. A positive test is highly suggestive of the syndrome but not diagnostic in itself.

Barium Sulfate↗
PubMed1977

[Surgical treatment of the Dumping-syndrome (author's transl)].

We observed 106 patients suffering from severe dumping syndrome after gastric resection. For remedying the authors performed Billroth-I reconstruction, the Sacharov-Henley operation, antiperistaltic interposition of a short jejunal segment and practiced a new method of their own: interposition of a long iliac segment. The results obtained are reported.

Adult↗
PubMed1975

[Results of reconstructive jejunogastroplasty in dumping syndrome].

135 reduodenizations were performed for grave forms of the dumping-syndrome. Clinico-roentgenological investigations of patients in later terms after reduodenization have evidenced the development of great morphological and functional compensatory changes of the gastric stump, jejunal graft, duodenum and other portions of the small intestine. The results of reconstructive surgery in different terms of observations are presented.

Dumping Syndrome↗
PubMed1992

[The release of vasoactive intestinal peptide in patients with dumping syndrome and its clinical significance].

Plasma vasoactive intestinal peptide (VIP), blood glucose concentration and hematocrit (HCT) were measured in 15 patients after Billroth-II subtotal gastrectomy (B-II SG) and 8 healthy controls before and after oral glucose ingestion. In B-II SG group the rate of rise of VIP concentration was in positive correlation to the rate of rise of HCT (r = 0.501 P < 0.05) and to that of blood glucose (r = 0.715 P < 0.01). Also, the elevation rate of HCT blood glucose and VIP concentration was significant higher in B-II SG group than in controls (P < 0.05). It was found that the elevation rate of VIP concentration was much higher in patients with dumping syndrome after B-II SG than those without (P < 0.05). The results suggest that VIP may play a role in the pathogenesis of dumping syndrome.

Blood Glucose↗
PubMed1975

[Transformation surgery in dumping syndrome after Billroth II stomach resection].

After ineffective conservative therapy of the dumping-syndrome the transformation of Billroth's second operation into Billroth's first operation or the interposition of a jejunum segment between reamins of the stomach and duodenum are indicated. The increased risk of operation demands a careful selection of the patients. By means of these interventions an essential improvement of the complaints may be achieved.

Adult↗
PubMed1975

A protein dietary supplement for the severe dumping syndrome.

A protein dietary supplement has been developed for use in patients with severe dumping symptoms unresponsive to the usual medical regimens. The supplement, consisting entirely of casein and soy, is given three times a day and supplies 1,155 calories. This has not been associated with dumping symptoms or diarrhea. Three patients with severe malnutrition from the dumping syndrome were given the supplement over a six month period. They all evidenced rapid weight gain and maintained the weight gain even after the supplement was discontinued.

Adult↗