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At least 73 records · Page 4Linked to original sources
PubMed1993

Octreotide, a long-acting somatostatin analog, in the management of postoperative dumping syndrome. An update.

Severe long-term complaints of dumping occur in a small number of patients after gastric surgery. Dietary modification, fiber preparations, and medical therapy are often ineffective. In these severely affected patients administration of the somatostatin analog octreotide before meals appears to be a promising new strategy. The effects of octreotide on both gastrointestinal transit time and hormonal changes appear to contribute to the benefits seen in dumping syndrome. However, as the majority of studies conducted have employed only a single dose of octreotide, careful long-term assessment of the nutritional and metabolic effects will be required. Recent results suggest that octreotide may be administered up to 2 hr before a meal and therefore has a sufficiently long duration of action to be of practical long-term use. Moreover, general improvements in life-style, as well as beneficial effects on symptoms, have been reported with long-term treatment, although the potential development of diarrhea will require careful monitoring. The development of an oral or nasal formulation should further improve the practical application of octreotide as a treatment for dumping syndrome.

Clinical Trials as Topic↗
PubMedDate not supplied

[The dumping syndrome: its risk factors and evolution].

The paper reports on a comparative study of 24 cases of operated gastroduodenal ulcer, in which the dumping syndrome appeared at a short interval after the operation, and of a control lot of patients operated for ulcerous disease without complications. This study shows that the incidence of the dumping syndrome in the ulcerous patients operated is of 12.83%, predominant in gastric ulcer (15%). Among the factors favouring the development of the dumping syndrome, mention is made of subtotal gastric resection with Billroth II anastomoses, early surgical indication, and pre-existing neuroendocrine disturbances. Although the dumping syndrome causes weight loss, its evolution in time is benign and improving after 3 years, surveillance.

Age Factors↗
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↗
PubMed1990

[Atrial natriuretic peptide in dumping syndrome].

The significance of atrial natriuretic factor (ANF) was investigated in the maintenance of the fluid volume in hypovolemia associated with dumping syndrome following gastric resection. The study was performed on 10 patients with Billroth II procedure. Ten age and sex matched patients--without previous gastric surgery served as controls. Each patient underwent oral glucose challenge. The patients following gastric resection underwent an other glucose challenge with intravenous infusion for the maintenance of the fluid volume. All patients with gastric resection showed subjective symptoms of the early dumping syndrome with significant (p less than 0.001) increases in heart rate and in hematocrit, while plasma ANF level decreased significantly (p less than 0.01). Significant negative correlation was found between the changes in hematocrit and the changes in plasma ANF level (r = -0.89; p less than 0.001). Neither the subjective symptoms characteristic for early dumping syndrome, nor changes in the laboratory parameters were noted in the patients during the challenge with infusion. The results show that the hypovolemia in dumping syndrome is associated with significant decreased ANF activity, and in the regulation of ANF release besides the well known stimulating effect of hypervolemia, there exists an inhibition of secretion in volume depleted states.

Atrial Natriuretic Factor↗
PubMed1980

Elevation of plasma neurotensin in the dumping syndrome.

1. The pathophysiology of the dumping syndrome is poorly understood. Plasma levels of four small intestinal hormones have been measured after an oral glucose provocation test in 19 patients with dumping symptoms and in matched controls. 2. Plasma levels of neurotensin, a newly discovered highly potent, hypotensive ileal peptide, were significantly increased in symptomatic patients compared with those of controls [20 min rise of 43 +/- 6.0 (mean +/- SEM) pmol/l in 19 symptomatic patients, 8.0 +/- 5.5 pmol/l in 20 postoperative symptom-free patients, and 4.1 +/- 3.5 pmol/l in 20 pre-operative patients with duodenal ulcer, P < 0.01]. 3. The rise in enteroglucagon was greater than normal but of similar magnitude to that seen in several other gastrointestinal conditions not associated with dumping symptoms. 4. The release of both gastric inhibitory peptide and motilin did not differ significantly from that of controls.

Blood Glucose↗
PubMed1993

Atrial natriuretic peptide in dumping syndrome.

The significance of atrial natriuretic peptide (ANP) was investigated in the maintenance of the fluid volume in hypovolemia associated with dumping syndrome following gastric resection. The study was performed on 10 patients who had undergone a Billroth II procedure. Ten age- and sex-matched patients without previous gastric surgery served as control. Each patient underwent an oral glucose challenge. The patients with gastric resection underwent another glucose challenge with intravenous infusion to maintain the fluid volume. All patients with gastric resection showed subjective symptoms of the early dumping syndrome with significant (p < 0.001) increases (initial and maximum rates; mean +/- SD) in heart rate (from 70 +/- 3 to 122 +/- 4 beats/min) and in hematocrit (from 0.40 +/- 0.005 to 0.45 +/- 0.003). The plasma ANP level decreased significantly from 27.24 +/- 5.01 to 15.94 +/- 3.61 fmol/ml (p < 0.01). A significant negative correlation was found between the changes in hematocrit and the changes in plasma ANP level (r = 0.68; p < 0.001). Neither the subjective symptoms characteristic of the early dumping syndrome nor changes in laboratory parameters were noted in the patients during the challenge with infusion. The results show that the hypovolemia in dumping syndrome is associated with a significant decrease in ANP activity. The regulation of ANP release is also affected: apart from the well-known stimulating effect of hypervolemia, there exists an inhibition of secretion in volume-depleted states.

Atrial Natriuretic Factor↗
PubMed1991

Dumping syndrome after combined pyloroplasty and fundoplication.

Dumping syndrome in infancy is a rare complication following gastric surgery. We describe an 11-month-old infant affected by recurrent peptic oesophagitis who underwent a combined Nissen fundoplication and pyloroplasty. Early dumping symptoms such as irritability, pallor, sweating, abdominal distension and watery diarrhoea were observed postoperatively after bolus feeding. Gastric emptying, measured after the administration of 150 ml of regular cow milk mixed with 200 microCi (8 MBq) of technetium-99m sulfur colloid (99mTc-SC), demonstrated an early rapid and massive emptying of the isotopes into the small intestine, followed by duodenogastric reflux and a second wave of emptying and reflux at 9 min. The initial pattern of gastric emptying and duodenogastric reflux was followed by a slow emptying phase with half-emptying time of 81 min. Isotope studies should be used to investigate motility disorders caused by this type of anti-reflux operation.

Dumping Syndrome↗
PubMed1989

Somatostatin analogue SMS 201-995 (octreotide) as a possible solution to the dumping syndrome after gastrectomy or vagotomy.

The dumping syndrome, which may follow partial gastrectomy or truncal vagotomy and drainage, may be refractory to treatment. The aim of this study was to determine the effect of the somatostatin analogue, SMS 201-995 (octreotide), on dumping provoked by hypertonic glucose. Ten patients with symptoms and signs of dumping were studied. After a dumping provocation test with placebo, all patients developed severe symptoms: seven patients had early dumping, two had both early and late dumping and one had late dumping alone. With either 50 or 100 micrograms SMS 201-995, the symptoms of early dumping were much reduced in all patients, and those of late dumping were completely abolished. The packed cell volume, pulse and systolic blood pressure changes of early dumping were significantly reduced by SMS 201-995 and the fall in blood glucose in patients with late dumping was abolished. SMS 201-995 may be a useful treatment for early and late dumping.

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↗
PubMed1988

[Diagnosis and therapy of dumping syndrome following Nissen fundoplication with reference to pathogenetic aspects].

Between 1982 and 1987 27 Nissen's fundoplications were carried out in our institution. Postoperatively 7 infants showed a typical dumping syndrome. The symptoms were irritability, pallor, sweating, tachycardia, lethargy, diarrhoea and vomiting. In all cases an absolute refusal of feeding was observed. The diagnosis was confirmed by a typical early postprandial hyperglycaemia with hyperinsulinaemia leading to a reactive hypoglycaemia. Additionally, we were able to demonstrate an increased HbA1c as an expression of recurrent hyperglycaemias in 3 infants. In 6 infants the dumping syndrome was of short duration and the symptoms disappeared after application of a so-called dumping diet. In this diet the easily resorbable carbohydrates are replaced by uncooked starch. But in one case we were forced to use continuous enteral nutrition because of persistence of the symptoms 1 year after the Nissen fundoplication. Complete refusal of feeding is an early symptom of the dumping syndrome. If this symptom is observed after a Nissen's fundoplication, a dumping syndrome must be excluded.

Blood Glucose↗
PubMed1986

Effect of neurotensin in the dumping syndrome.

The possibility that the gut peptide, neurotensin, may contribute to the dumping syndrome was investigated in 17 patients with a long history of dumping after a Billroth II gastrectomy for duodenal ulcer. After a test meal plasma levels of neurotensin were higher than in normal subjects, but no correlation to the severity of symptoms was found. In eight of the patients with meal-provoked dumping symptoms, intravenous infusion of neurotensin in relevant doses produced neither symptoms nor changes in blood glucose, blood pressure, or pulse rate. The apparent plasma half-life of neurotensin (t1/2 = 2.3 min) did not differ from that previously found in normal subjects. The results indicate that it is unlikely that neurotensin alone has a pathogenetic role in the dumping syndrome in gastrectomized patients.

Aged↗
PubMed1986

Infant dumping syndrome: reversal of symptoms by feeding uncooked starch.

Two infants with dumping syndrome after Nissen's fundoplication were bolus-fed with regular cows' milk formula and with test meals containing either cooked or uncooked starch. Cows' milk formula and test meals made with cooked starch provoked dumping symptoms, hyperglycaemia and hyperinsulinaemia. Dumping symptoms vanished and normoglycaemia was established when meals contained uncooked starch as the sole carbohydrate. The findings suggest that uncooked starch has a place in the dietary control of dumping syndrome in infants and possibly in adults.

Dietary Carbohydrates↗
PubMed1994

Nutritional management of dumping syndrome associated with antireflux surgery.

Eight children were identified as having dumping syndrome by a glucose tolerance test and evidence of rapid gastric emptying. All had undergone a fundoplication with concomitant feeding gastrostomy placement at 18.4 +/- 17.4 months of age (range, 3 to 54 months). Symptoms suggestive of dumping syndrome occurred 1 to 4 months after surgery. There was considerable delay in diagnosis (3 to 8 months). These children were successfully managed with nutritional manipulation alone, using a combination of a complex carbohydrate and a fat emulsion. Complete resolution of symptoms and normoglycemia was achieved in all the children, without any complications.

Child, Preschool↗
PubMed1985

Increased flow in the superior mesenteric artery in dumping syndrome.

Transcutaneous Doppler ultrasound was used to measure resting and postprandial blood flow in the superior mesenteric artery (SMABF) in nine patients with dumping syndrome and in ten normal volunteers of matching age and sex. All nine patients experienced signs and symptoms of dumping during the investigation, but none of the controls did so. At rest, SMABF in the dumping patients (567 +/- 47 ml/min) (mean +/- s.e.m.) did not significantly differ from that of the normal volunteers (493 +/- 72 ml/min). Five minutes from the end of a balanced liquid meal, flow had approximately doubled in each group (1232 +/- 140 and 941 +/- 128 ml/min). Compared with controls, increased SMABF was observed in patients with dumping syndrome at 10 min (76 per cent), 15 min (66 per cent), 30 min (55 per cent) and 45 min (42 per cent) (P = 0.05-0.01). Splanchnic pooling and abnormal redistribution of blood probably contribute to the pathogenesis of the early dumping syndrome.

Adult↗
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↗