Dumping syndrome

Dumping syndrome occurs in patients who underwent extensive gastrectomy, especially in the modification of Billroth II. Allocate an early and late dumping syndrome.

Early dumping syndrome is observed in the majority of operated patients in the immediate postoperative period, in the long term - in 30% of patients with mild degree and in 10% of patients. The frequency of the dumping syndrome depends on the nature of the operation performed: it is maximal after the Bilrot-I resection, less pronounced after the Bilrot-1 resection, and least after vagotomy with the stomach draining operations. The reason for the development of the dumping reaction is the rapid entry of untreated food into the upper section of the small intestine, which has a high osmolarity, which leads to the movement of the extracellular fluid into the lumen of the intestine, the expansion of the intestinal wall and the release of biologically active substances: histamine, sredtonin, kinin. As a result of these processes, there is a decrease in BCC, vasodilation, and intestinal peristalsis is increased.

Symptoms, course. After 10-15 minutes after eating, especially sweet and dairy dishes, weakness, dizziness, headache, pain in the heart, palpitation, profuse sweat, a feeling of heat. Along with this, raspiranie and pain in epigastrium, rumbling, colicky pain and diarrhea. When expressed dumping syndrome patients are forced after eating to take a horizontal position. Diagnosis is based on clinical symptoms, data radiographic examination of the passage of the radiopaque food mixture on the gastrointestinal tract.

Late dumping syndrome (hypoglycemic) develops 2-3 hours after ingestion. It is associated with excessive release of insulin during an early dumping reaction, accompanied by an increase in the level of sugar in the blood. Increased release of insulin reduces the sugar level to subnormal figures.

Symptoms. Weakness, a sharp feeling of hunger, acute sucking pain in epigastrium, trembling, dizziness, palpitations, lowering of blood pressure, bradycardia, pallor, sweat. These symptoms quickly pass after taking a small amount of food, especially carbohydrate. Patients often carry sugar, biscuits and, with the first symptoms of hypoglycemia, take them. The diagnosis is based on typical manifestations of the disease, lowering the blood sugar level at the time of the attack.

Classification of dumping syndrome by severity: an easy-dumping reaction occurs only after dairy and sweet dishes. It is characterized by a slight weakness, a pulse rate of 10-15 per 1 min. The duration of the attack is up to half an hour, the body weight deficit is not more than 5 kg, the work capacity is preserved; The average-dumping reaction occurs when any food is taken, the patient has to lie down at the height of the reaction, the pulse rate increases by 20-30 per min, AD with a tendency to increase the systolic pressure. The duration of the attack up to 1 hour, a body weight deficit of up to 10 kg, the ability to work is reduced; Heavy - the dumping reaction develops with the intake of any food; Patients take food lying down and are in a horizontal position up to 2-3 hours after eating, heart rate increases by more than 30 in 1 min, AD labile, sometimes bradycardia, hypotension, collapse. Deficiency of body weight more than 10 kg, work capacity is lost.

Treatment can be conservative and surgical. Conservative treatment: a diet high in protein, restriction of carbohydrates, especially simple. Separate reception of dense and liquid food in small portions, 5-6 times a day. To reduce the response to a fast food intake in the small intestine before meals appoint novocaine, anesthesin, antihistamines (pifolen, suprastin), reserpine, insulin p / k. Substitution therapy: gastric juice, hydrochloric acid, panzinorm, festal, vitamins. When psychopathological syndromes appear, treatment is coordinated with a psychiatrist.

Surgical treatment is rarely used. It is indicated for severe dumping syndrome in the case of ineffective therapeutic nutrition and long-term complex medication. Surgical intervention consists in reduodenization with gastroduodenoplasty. The small intestine slows down the emptying of the stomach stump, and the inclusion of the duodenum improves digestion and in a number of patients can reduce the intensity of the dumping reaction.

Prevention: widespread use of organ-preserving surgeries in combination with vagotomy in the treatment of duodenal ulcer. If it is necessary to perform gastrectomy, it is advisable to apply gastroduodenoanastomosis.