PDA

View Full Version : Dumping



tvnguyen
20-12-08, 06:29 AM
DUMPING
Maingot 2007, P. 346
Dumping is defined as a postoperative clinical syndrome with gastrointestinal and vasomotor symptoms. The cause of dumping is uncertain but is likely related to unregulated entry of ingested food into the proximal small bowel following vagotomy and resection or division of the pyloric sphincter. Early dumping symptoms occur within 1 hour of ingestion of a meal and include nausea, epigastric discomfort, tremulousness, and sometimes dizziness or syncope. Late dumping symptoms follow a meal by 1–3 hours. Late symptoms also include reactive hypoglycemia.
Most patients that undergo vagotomy or gastrectomy do not experience dumping symptoms postoperatively. For patients that experience mild dumping symptoms in the early postoperative period, dietary alterations and time bring improvement in all but approximately 1%. For those that remain persistently symptomatic, the long-acting somatostatin analogue, octreotide, improves dumping symptoms when administered subcutaneously before a meal.46 The effects of somatostatin on the vasomotor symptoms of dumping are postulated to be due to effects of the compound on splanchnic vessels that prevent vasodilatation. Octreotide also inhibits the release of vasoactive peptides from the gut and slows intestinal transit, effects that may alleviate dumping symptoms. Octreotide administration before meal ingestion has been shown to prevent changes in pulse, systolic blood pressure, and red blood cell volume.