Dumping Syndrome

Dumping Syndrome

    * Introduction
    * Signs and symptoms
    * Pathogenesis
    * Medical therapy
    * Surgical Therapy
    * Diet dumping syndrome
The stomach serves as a place to store ingested food. Primary functions of the stomach is the tank, initiating the digestive process and release the contents of the duodenum in a controlled manner. Stomach capacity is an adult. 5-2 liters and its location in the abdomen allows a considerable distensibilitate.
Gastric motility is regulated by enteric nervous system is influenced by circulating hormones and extrinsic innervated. Change gastric anatomy after surgery, vagotomy interferes with innervate extrinsic and has profound effects on gastric emptying. These effects have been known postgastrectomie syndrome. Postgastrectomie syndromes include limited gastric capacity, dumping, bile gastritis, afferent loop syndrome, efferent loop syndrome, anemia and metabolic bone disease.
Dumping syndrome (garbage disposal) is clinically manifest in 10% of patients after gastric surgery. It is symptomatic of systemic features and power. The most common and debilitating syndrome observed after a variety of postprandial gastric surgical procedures such as vagotomy, pyloroplasty, and fundoplicaturarea gastrojejunostomia laparoscopic Nissan. Dumping syndrome can be divided into early and late form depending on the symptoms over time from a table. Both forms are due to rapid release of large quantities of food and fluids osmotically active in the duodenum. Dumping syndrome is a direct result of the alteration of storage and emptying pyloric stomach.
The incidence and severity of symptoms in dumping syndrome is related directly to the extension of gastric surgery. 25-50% of patients who underwent gastric surgery have some symptoms of dumping. Titus only 1-5% reported debilitating symptoms. The incidence of dumping syndrome is reported in 6-14% after vagotomy and drainage truncata and 14-20% after partial gastrectomy. . incidence of dumping syndrome after proximal gastric vagotomy without drainage is less than 2%. Syndrome in the pediatric population is described only after fundoplicaturarea Nissen.
Dumping syndrome, clinical presentation can be divided into gastrointestinal and vasomotor symptoms. Gastrointestinal symptoms include early satiety, abdominal cramps, nausea, vomiting and explosive diarrhea. Vasomotor symptoms include diaphoresis, rash, dizziness, palpitations and intense desire to lie.
Therapy consists of administration of acarbose, which interfere with the absorption of carbohydrates, the administration of synthetic somatostatin analogue octreotide. Prevention of dumping syndrome is preferred to treat it. Corrective surgery is indicated in patients refractory to medical therapy or in patients who do not wish to continue medical therapy. Several surgical techniques have been developed to correct the symptoms of dumping. These include collapse gastrojejunale stoma surgery, Billroth II to I conversion, interpozitia jejuni and pyloric reconstruction.
Changes in the need for elective gastric surgery led to a decline in frequency postgastrectomie syndromes. A 10-fold reduction occurred in the elective surgery for peptic ulcer disease in the last 20-30 years. Although this trend before the introduction of histamine 2 antagonistelor these drugs and proton pump inhibitors have accelerated this decline. Treatment for Helicobacter pylori eradication of patients with peptic ulcer disease have decreased even more the need for surgery.