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PubMed1995

Dumping syndrome in a young child.

UNLABELLED: We describe a 17-month-old child with dumping syndrome after plication of the right diaphragm. He presented with periods of abdominal distension and pallor, recurrent convulsions, glucosuria and refusal of feeding. After changing the diet the symptoms disappeared. CONCLUSION: Although dumping syndrome in children is rare, early recognition is important. Serial determination of blood glucose after bolus feeding can lead to the diagnosis. Treatment should consist of dietary changes.

Blood Glucose↗
PubMed1983

Treatment of congenital microgastria and dumping syndrome.

Two children with congenital microgastria and associated anomalies requiring surgery as infants, developed severe dumping syndrome which necessitated a remedial operation. A Roux-en-Y jejunal pouch (Hunt-Lawrence) was formed at 22 months and 10 months respectively. Weight gain was immediate in both patients and has been sustained for 6 months and 8 years respectively. Symptoms of the dumping syndrome were relieved and the pouch delays filling of the jejunum.

Body Weight↗
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↗
PubMed1990

Octreotide acetate induces fasting small bowel motility in patients with dumping syndrome.

The long acting somatostatin analogue octreotide acetate has been effective in the treatment of early dumping syndrome. We hypothesized that this may be related to its effects on inhibiting gastric emptying and delaying intestinal transit. To study the effect of octreotide acetate on intestinal motility in patients we carried out a randomized, double-blinded study using a subcutaneous injection of either octreotide acetate (100 micrograms) or placebo given 20 min prior to ingestion of a high carbohydrate "dumping" meal in six patients with known severe dumping syndrome. Prior to each study a multilumen polyethylene tube was inserted into the efferent limb to study small intestinal contractions using low compliance pneumo-hydraulic water-perfused manometry. Octreotide acetate prevented dumping symptoms in all six patients and induced the appearance of migrating myoelectric complexes (MMC) characteristic of interdigestive motility. After ingestion of the dumping meal the postprandial "fed" motility pattern lasted for 141 +/- 9 min while after octreotide acetate the fed motility lasted for 29 +/- 5 min (P less than 0.03). The vigor of the fed motility pattern as measured by the motility index (MI = loge (sum of amplitudes X No. of contractions + 1] was lower after octreotide acetate than after placebo (15.1 +/- 0.1 vs 13.4 +/- 0.2, P less than 0.03). The induction of fasting MMC motility pattern and reduction in the duration and vigor of fed motility may explain the symptomatic relief these patients obtained with octreotide acetate. It is not known whether the induction of the MMC is a direct effect of octreotide acetate or secondary to the concomitant inhibition of peptide release (neurotensin, insulin, glucagon, pancreatic polypeptide) that has been demonstrated in earlier studies.

Dumping Syndrome↗
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↗
PubMedDate not supplied

Surgical treatment of the dumping syndrome after gastroduodenal resection.

The correction of the dumping syndrome is based on three surgical techniques: narrowing of the gastrojejunal for gastroduodenal) anastomosis, interposition of an intestinal loop between the gastric stump and the duodenum, or conversion of Billroth II to Billroth I. The authors report the results obtained in a series of 22 cases.

Dumping Syndrome↗
PubMed1997

Gastrointestinal hormone in dumping syndrome and reflux esophagitis after gastric surgery.

Several problems are associated with gastric resection, including the dumping syndrome, reflux esophagitis, and malabsorption. A better understanding of the pathophysiological changes will shed light on new and improved therapy. Serum levels of seven circulating gastrointestinal hormones following a standardized solid meal and a brief score of symptoms were evaluated in 10 patients after partial distal gastrectomy and 12 patients after total gastrectomy, both groups reconstructed by Billroth II anastomosis, and 9 age-matched healthy controls. Patients underwent resection for gastric cancer and were studied 45 +/- 10 months after surgery. At the time of study, the patients had adapted well to surgery and no longer exhibited the severe symptoms of dumping seen immediately post-operatively. In contrast, the total gastrectomy patients exhibited the symptoms of reflux esophagitis. The gastrointestinal hormone changes could be divided into three patterns; obtunded responses (gastrin, PP), normal release (motilin, GIP) and increased secretion (CCK, neurotensin, PYY). In these, the early reaction of neurotensin correlated with the scores of late dumping syndrome and reflux esophagitis. In the literature, many gastrointestinal hormones have been shown to respond as an enhancement rather than adaptation. In other gastrointestinal hormones, secretin belonged to the obtunded type and enteroglucagon were classified in the increased type. However, pathophysiological significance of these hormonal changes remained uncertain. The late adaptive changes in gastrointestinal hormone secretion may help to compensate for loss of gastric motor function which accompanies gastric resection. On the other hand, these hormonal changes may exacerbate the esophageal reflux following gastrectomy.

Adaptation, Physiological↗
PubMed2000

Sympathoadrenal activation and the dumping syndrome after gastric surgery.

Dumping symptoms suggest concomitant sympathoadrenal activation. To evaluate the relation between dumping symptoms and postprandial plasma catecholamine changes, standardized dumping-provocation tests with use of oral glucose were performed for 16 gastric surgery patients with dumping, for 14 gastric surgery patients without dumping, and for 14 healthy control patients. Early dumping symptoms were present for all patients with dumping, and late symptoms developed in three patients with dumping after glucose ingestion. Patients without dumping and healthy control patients had slight complaints or no complaints. Systolic and diastolic blood pressure remained unaffected for the three groups. Positive breath-hydrogen tests, heart rate increments, and reactive plasma glucose decrements were present for patients with dumping and for patients without dumping, but not for control patients. Plasma noradrenaline and adrenaline increased for patients with dumping and for patients without dumping, but not for control patients. The noradrenaline increment was higher for patients with dumping (98%) than for patients without dumping (78%; p <0.05). The noradrenaline increment was related to the dumping score and to the heart rate increment for the first hour after glucose ingestion, whereas the adrenaline increment was related to the plasma glucose decrement for the third hour. Therefore, dumping symptoms clearly are accompanied by postprandial sympathoadrenal activation, but sympathoadrenal activation cannot account completely for development of dumping symptoms.

Adrenal Glands↗
PubMed1994

The successful application of jejunal interposition for severe dumping syndrome: report of a case.

We report herein the case of a 76-year-old man with intractable dumping syndrome which had manifested itself 3 years after he underwent a gastric resection and Billroth I reconstruction for a gastric ulcer. Despite aggressive medical therapy by the time of admission, he had suffered from disabling dumping symptoms for 9 years. In an attempt to relieve these symptoms, a 15-cm segment of the jejunum was placed isoperistaltically between the lesser curvature of the remnant stomach and the duodenum, and a selective vagotomy was performed. The dumping symptoms that he had experienced preoperatively completely disappeared after the revisory surgery. Postoperatively, an upper gastrointestinal series demonstrated a larger gastric pouch and slower gastric passage into the small intestine than what was seen preoperatively, while gastric emptying studies using the acetaminophen method also showed normal patterns in both the early and late postoperative phases. Thus, we consider that this surgical procedure is a simple and effective way to inhibit rapid gastric emptying and to slow intestinal transit in the treatment of dumping syndrome.

Aged↗
PubMed1989

Trial of pectin-enriched muffins in patients with severe dumping syndrome after gastric resection. Observations on symptoms and gastric emptying pattern.

Pectin is known to delay gastric emptying and alleviate dumping symptoms when ingested with hyperosmolar, glucose-containing meals. As the treatment of dumping syndrome includes frequent, small dry meals, the effect of pectin ingested in muffins was tested in five patients with severe, intractable dumping syndrome after gastric resection. Ingestion of 99mTc-DTPA-labelled muffins containing 5 g pectin did not alleviate dumping symptoms or delay gastric emptying compared with muffins without pectin. Pectin does not seem to be beneficial as a supplement in the conventional dietary management of post-gastrectomy dumping.

Aged↗
PubMed1990

Efficacy of octreotide acetate in treatment of severe postgastrectomy dumping syndrome.

The present study evaluates the acute and chronic use of a long-acting somatostatin analog, octreotide acetate, in the treatment of patients with severe postgastrectomy dumping syndrome. In the acute phase, 10 patients with severe dumping were studied over 2 consecutive days before and for 3 hours after the ingestion of a 'dumping breakfast' in a randomized double-blind fashion. On one day octreotide (100 micrograms) was given subcutaneously 30 minutes before the test meal and on the other day an equal volume of vehicle was injected. An additional group of six postgastrectomy patients without dumping were studied in a similar fashion and these acted as controls. During placebo treatment the test meal resulted in an immediate increase (p less than 0.01) in the pulse rate and in plasma levels of glucose, glucagon, pancreatic polypeptide, neurotensin, and insulin. Similar changes were seen in the control group with respect to placebo; however glucagon and neurotensin (p less than 0.05) did not show the same magnitude of increase as seen with placebo. Treatment with octreotide acetate prevented the development of both vasomotor and gastrointestinal symptoms and completely ablated all of the above responses in plasma peptides. These changes were associated with complete ablation of diarrhea (p less than 0.001). Pretreatment with octreotide acetate completely suppressed the rise in plasma insulin response to the meal and this ablated the late hypoglycemia of dumping. Treatment with octreotide acetate resulted in delayed gastric emptying and transit time (578 +/- 244 minutes) versus 76 +/- 23 minutes with placebo and 125 +/- 36 minutes in controls (p less than 0.05). Chronic daily treatment with octreotide acetate resulted in minimal side effects. These patients demonstrated a stable fasting plasma glucose, normal liver function tests, and an average weight gain of 11% during a 12-month period. In addition most patients were able to resume employment. The long-acting somatostatin analog, octreotide acetate, is highly effective in preventing the development of symptoms of severe dumping syndrome, both vasomotor and gastrointestinal.

Adult↗
PubMedDate not supplied

[The correction of the hormonal response during the treatment of the dumping syndrome with potable mineral waters].

Glucose tolerance test (40 g/lm2 b.s.) in patients with stomach resected for gastroduodenal ulcer provoked dumping-syndrome seen 15-30 min after glucose introduction. There was also a rise in blood sugar (by 77%), ACTH (by > 400%), STH (by > 400%), hydrocortisone (by 56%). Aldosterone levels fell by 68%. There was also a marked fall in activity of early insulin pool changed for elevation of its secretion by the test minute 60. 65 patients with dumping-syndrome following a course of drinking mineral water demonstrated improvement in clinical symptoms of the disease and changed hormonal response to glucose which manifested with activation of insulin secretion early phase and reduced rise of hydrocortisone levels.

Dumping Syndrome↗
PubMed1991

[Anatomo-functional status of the upper segments of the gastrointestinal tract in patients with dumping syndrome after gastrectomy by the Billroth II method].

From study of the condition of the upper gastrointestinal tract in 51 patients suffering from the dumping syndrome after Hofmeister-Finsterer modification of Billroth II gastrectomy, the authors concluded that the intracavitary pressure gradient between the gastric stump and the efferent intestinal loop, as well as the diameter of the gastroenteroanastomosis, influence the dumping syndrome. A method is suggested for measuring the diameter and surface of the gastroenteroanastomosis and measuring the intracavitary pressure in the Gastric and duodenal stump and the efferent and afferent loops of the small intestine.

Adult↗
PubMed1990

[Clinico-roentgenological diagnosis of dumping syndrome in expert medical evaluation of work capacity].

The authors conducted complex clinical and X-ray examination of 80 patients suffering from the dumping syndrome of various degree. They were sent to the Central Scientific Research Institute of Expert Medical Assessment of Working Capacity for establishing the degree of severity of morphological and functional disorders affecting their capacity for work. The method of examination of such patients, including X-ray and other clinical methods, is described. The main clinical and roentgenosemeiotic signs characteristic of the mild, moderately severe, and severe forms of the dumping syndrome are pointed out. Clinical cases are described in illustration of the diagnostic possibilities and the expert approach to the results of the examination of such patients.

Adult↗
PubMed1988

[Studies on the relation between late dumping syndrome and glucagon responses to glucose].

This study was planned in pursuit of the relation between glucagon responses to glucose and the late dumping syndrome. Clinically, 75 g oral glucose tolerance test to seven late dumpers, ten gastrectomized patients and ten normal subjects were performed. And experimentary, 20 ml 25% glucose was put into small intestinal blind loops prepared in dogs, which were made the jejunum region and then the ileum region. 1. The mean oral glucose tolerance curve in gastrectomized patients was oxyhyperglycemic, and this tendency was seen in late dumpers. But, for only late dumpers, the low blood glucose concentration which was under 50 mg/dl appeared within one and half to three hours after oral glucose load. 2. The change of serum IRI in gastrectomized patients displayed the initial hyperinsulinemia, that was similar in late dumpers. 3. Pancreatic glucagon (GI) levels were within normal limits in normal subjects and late dumpers, but were significantly increased in gastrectomized patients. 4. Enteroglucagon (gutGLI) levels were not so increased in normal subjects, but were significantly increased in gastrectomized patients and late dumpers as well. 5. GutGLI levels were increased only by putting into the ileum loop. But hypersecretion of gutGLI did not affect the blood glucose curve and the change of serum IRI significantly. These results described above suggest that the pathogenesis of the hypoglycemia in the late dumping syndrome may be responsible for no hypersecretion of GI, for some reason, to prevent hypoglycemia against hyperinsulinemia with oxyhyperglycemia, and that gutGLI may not play so important part in the regulation of the blood glucose level.

Aged↗
PubMedDate not supplied

[Effect of different types of food loads on the rate of emptying of the gastric stump in patients with the dumping syndrome after gastric resection].

The influence of carbohydrate, carbohydrate-fatty and protein test breakfasts on the rate of gastric stump evacuation was studied in 62 patients with dumping syndrome of mild and moderate severity, using the x-ray method developed by the authors. It has been established that in patients with dumping syndrome carbohydrate and carbohydrate-fatty food is most quickly evacuated from the gastric stump. Doubled amount of fat in the carbohydrate-fatty breakfast (up to 40 g) induced no significant deceleration in the gastric stump evacuation, moreover, in some cases its evacuatory function was accelerated. Intake of mineral water before breakfast did not noticeably influence the rate of gastric stump evacuation after carbohydrate and carbohydrate-fatty breakfasts, and significantly decelerates the gastric stump evacuation after protein breakfast.

Adult↗
PubMed1981

A new method for the surgical treatment of the dumping syndrome.

A new method for the operative treatment of the dumping syndrome is reported and an analysis of the results obtained in 28 patients followed up for periods of 10 months to 10 years presented. There were no deaths, the complication rate was low, and the results in terms of relief of dumping symptoms and weight gain satisfactory. The method offers a surgical approach for the treatment of patients with severe and disabling dumping symptoms.

Adult↗
PubMed2005

[Use of less invasive techniques in surgical treatment of dumping syndrome].

Aiming to minimize the surgical trauma and interventional risks of treatment, as well as to reach the most precise visualization and safe separation of the n. vagus, in order to increase the efficacy of truncal vagotomy during correction of severe post-gastric-resection dumping syndrome we have developed the new method of thoracoscopic supradiafragmal vagotomy. The suggested method of bilateral thoracoscopic supradiafragmal truncal vagotomy allows to decrease the surgical intervention trauma, and the risk of post operative complications, as well as to better the immediate and remote results of treatment of the dumping syndrome.

Dumping Syndrome↗