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Neurotensin, vasoactive intestinal peptide, and Roux-en-Y gastrojejunostomy. Their role in the dumping syndrome.

This study evaluated the effect of gastric bypass on the glucose, insulin, vasoactive intestinal peptide (VIP), neurotensin, and motilin response to orally administered glucose in eight morbidly obese patients before and after operation. Preoperatively, all eight patients remained asymptomatic during an oral glucose tolerance test, which showed glucose intolerance and hyperinsulinism. Plasma VIP, neurotensin, and motilin remained below detectable levels for the entire test. At three months following gastric bypass (21% weight loss), all eight patients became acutely ill during a repeated oral glucose tolerance test and had the following symptoms: facial flushing (eight patients), palpitations (eight patients), nausea (seven patients), abdominal fullness (seven patients), pallor (four patients), diaphoresis (two patients), vomiting (two patients), and diarrhea (two patients). Significant release of neurotensin occurred in seven patients while three patients had release of VIP, further implicating these two peptides as part of the pathophysiologic spectrum of the "dumping syndrome."

Adult↗

Postgastrectomy syndromes: dumping and diarrhea.

This article reviews the current literature on the postgastrectomy syndromes of dumping and postvagotomy diarrhea. Pathophysiology, diagnosis, incidence, and treatment options are discussed. These syndromes present some of the most difficult treatment dilemmas seen after surgery. Specific recommendations for both medical and surgical treatments are included.

Diarrhea↗

[Post-resection dumping syndrome (case report)].

During the last twenty years a significant reduction of the number of gastric resections on account of peptic ulceration occurred due to better therapeutic possibilities in gastrodudodenal ulcers and due to changes in the epidemiology of gastric tumours. However, resections are made, frequently on account of complicated cases of unsuccessful treatment of ulcers in "treatment at any cost". This problem was frequently the subject of professional discussions. Therefore we consider it important to remind young colleagues of the omitted chapter of possible pathological conditions which develop after gastric resections. The latter include a group of vasomotor, gastrointestinal and humoral symptoms which develop as a result of the loss of reservoir function and the function of the closing mechanism of the pyloroantral part of the stomach after gastric resections in derivation surgery. In addition to data in the literature reporting that dumping syndrome is encountered only in 2-3% of any gastric operation the authors describe two of their own observations and the results of their surgical treatment.

Adult↗

[Dynamics of food transit in gastrectomized patients with and without dumping syndrome studied with the gamma camera and a marked meal].

Scintigraphy was performed on a group of patients following the administration of a solid radiolabelled meal. As a tracer, human albumin microspheres were used with 99mTc, mixed with fresh scrambled eggs, eaten as a sandwich in two slices of white bread. The analysis of transit and emptying-rate of the radiolabelled meal in the gastric or derivative loop areas was performed by means of a medium field (300 mm) gamma camera interfaced with a digital computer; the data were collected at 15" frames for 90'-120'. Twenty-nine patients were examined who had undergone sub-total gastrectomy: 11 of them were "dumpers" and 18 "non-dumpers"; moreover, 9 volunteers without any history of gastrointestinal diseases and 11 patients with different gastric disorders were checked. In the first group of gastrectomized patients the half-emptying time (T50) was significantly shorter than in the 11 people being checked (Md = 27.5 +/- 10.8 versus 69.6 +/- 19 minutes); in "non-dumpers" T50 was even shorter (Md = 24.2 +/- 13 min). There was no significant statistical difference between the two classes of gastroresected patients in both T50 and emptying-rate of the radioactive solid food, which excludes the accelerated transit as a factor in the functional post-prandial symptoms of the dumping syndrome. On the contrary, the dynamic selective analysis of the radiolabelled food transit through derivative afferent and efferent loops showed different patterns in the two groups of gastroresected patients: the progression of the propulsive wave was very irregular and constantly hyperperistaltic only in the dumpers.

Adult↗