It is very important to understand that each patient is an individual. Some have had extensive surgery and others have had less extensive surgery. There are different types of gastric surgery with different “plumbing configurations”. By it’s very nature, the information presented here is very general and is only intended for informational purposes. It is important to discuss your individual symptoms and needs with your doctor. What works for one patient may not work for another. It may take some time to find out what works for you.

The stomach acts as a reservoir for food. With the help of stomach acids and other digestive enzymes, food is broken down in the stomach into a liquid called chyme.The primary function of the stomach is to reduce food to an easily digested form. The primary function of the small intestine is to absorb the digested food.The pyloric sphincter (or valve) regulates the passage of chyme from the stomach into the upper part of the small intestines (the duodenum). It usually takes somewhere between 40 minutes to a few hours for the stomach to digest food. Chyme then slowly passes into the duodenum through the pyloric valve.

stomach

Small Intestine

The primary function of the small intestine is to pass nutrients through the intestinal wall to the blood. This blood is carried from the small intestine to the liver for filtering, removal of toxins and nutrient processing. Most absorption takes place in the small intestine.

As chyme enters the duodenum it is mixed with bile (which helps digest fat), pancreatic juices and enzymes, and intestinal enzymes.

Gastrectomy

Surgical removal of the stomach is sometimes performed, especially in patients with cancers originating in the stomach. This type of surgery is called a gastrectomy. Sometimes the entire stomach is removed and sometimes only a portion of the stomach will be removed. Nearby organs, such as the pancreas, gall bladder or spleen may need to be removed as well.

pancreas

The above image is from Wikipedia. Click on the image to view a Wikipedia definition of each organ.

Gastrectomies that result in removal of the pylorus/plyroic valve can allow food to move into the upper part of the small intestine (the duodenum) very rapidly. The absence of the pyloric valve combined with removal of the stomach (resulting in no “storage area ” for digestion) can cause “dumping syndrome”.

Dumping Syndrome

Causes

Some patients that have had gastrectomies suffer from a condition known as Dumping Syndrome. Dumping Syndrome is caused when food moves too rapidly into the small intestines. The incidence and severity of symptoms are directly related to the extent of gastric surgery.

The symptoms can be divided into two stages, early stage and late stage. Early stage symptoms occur 15 to 60 minutes after eating. They are caused when sugar and simple carbohydrates pass too rapidly into the small intestine. This pulls fluids into the intestines resulting in bloating/abdominal pain. To slow the rate of emptying, drink liquids slowly during meals and don’t drink much during the meal.

Note: The typical instructions for limiting fluid intake during meals to minimize Dumping Syndrome conflict with the instructions for taking Gleevec with a meal and a full glass of water. Patients taking Gleevec need to find the balance that works for them. Gleevec can cause nausea, even in patients that have never had any kind of stomach surgery. Drinking water during a meal may help reduce the nausea caused by Gleevec. On the other hand, drinking too much with a meal may increase the severity of dumping syndrome.

Early-Stage Symptoms Late-Stage Symptoms Other Symptoms
  • Bloating/feeling full
  • Weakness
  • Low Blood Sugar (hypoglycemia)
  • Nausea
  • Sweating
 
  • Diarrhea
  • Dizziness
 
  • Rapid pulse
  • Anxiety/nervousness
 
  • Dizziness or light-headedness
  • Rapid heart beat
 
  • Weakness and fatigue
  • Fainting
 
  • Sweating
  • Confusion
 
  • Abdominal cramping
   

Treatment of Dumping Syndrome

Treatment consists of a post-gastrectomy diet, high in protein, and low in carbohydrates and concentrated sugars. Small frequent meals (6 or more per day), with limited liquids during meals are generally recommended. People with severe rapid gastric emptying may need to take prescribed medicine to slow their digestion.

Tips to avoid Dumping Syndrome:

  • Limit liquids during meals to about 4 ounces or, better yet, wait 1/2 hour to one hour after meals before drinking.
  • Limit or avoid sweets and sugars.
  • Limit or avoid simple carbohydrates.
  • Eat slowly and chew your food well.
  • Stay away from acidic foods. Tomatoes and citrus fruits are hard for some people to digest.
  • Lying down after a meal may allow food to enter the intestines more slowly and reduce dumping syndrome.
  • Often, milk products can cause bloating, abdominal pain and diarrhea. When these symptoms are present low lactose milk products (such as Lactaid) may be tried.

Your doctor may prescribe medicines. Medicines to slow the passage of food may be prescribed by your doctor. Medicines that may be prescribed include:

  • Acarbose
  • Octreotide (Sandostatin)
  • Other complications

Vitamin B12 is absorbed in the small intestine with the aid of a stomach secretion called intrinsic factor. Loss of intrinsic factor results in a vitamin B12 deficiency in patients with a gastrectomy. Patients that have had a gastrectomy will generally require regular vitamin B12 shots. Oral vitamin B12 may be given as an alternative. Oral vitamin B12 with intrinsic factor will probably be absorbed better than oral vitamin B12 alone, however it is not clear if the additional vitamin B12 that a patient would absorb by taking the combination is actually required. Your doctor can order blood tests to make sure that you are getting adequate levels of vitamin B12.

Supplements with iron, folate and calcium may also be required. See Post-Gastrectomy: Managing the Nutrition Fall-Out by Amy E. Radigan

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