Dumping syndrome

　　How is dumping syndrome caused? Briefly described as follows:

　　The onset of early dumping syndrome is due to the rapid entry of food into the small intestine, with the migration of fluid in the blood vessels to the gastrointestinal tract to maintain normal osmotic pressure within the gastrointestinal tract, leading to systemic symptoms due to low blood volume. However, there are also doubts about the mechanism of the 'high osmotic pressure theory' in the occurrence of dumping syndrome, because the amount of migrating fluid is only 300 to 700ml, and such a loss of fluid is usually easy to tolerate acutely. Hinshaw first reported the vasodilation of peripheral blood vessels during dumping induced by oral glucose, rather than the contraction under low blood volume as traditionally believed. The expansion of peripheral veins and splenic veins may be an important factor in the occurrence of systemic symptoms and signs in early dumping. Some studies have shown the role of serotonin and bradykinin-kinin system in the attack of dumping, but the evidence is not striking. After taking glucose, the plasma glucagon in dumping patients significantly increases, and there are similar responses in vasoactive intestinal peptide, YY peptide, pancreatic polypeptide, and norepinephrine. Late dumping syndrome is caused by reactive hypoglycemia. The rapid entry of food into the small intestine and the rapid absorption of glucose lead to hyperinsulinemia and hyperglycemia, with hyperinsulinemia causing secondary hypoglycemia.

　　What diseases does dumping syndrome trigger? Briefly described as follows:

　　1. Dizziness, palpitations, tachycardia, extreme weakness, excessive sweating, trembling, pale or flushed complexion may occur, with severe cases showing a drop in blood pressure and fainting.

　　2. Late dumping syndrome occurs more than half a year after surgery, with symptoms of hypoglycemia appearing 1 to 3 hours after meals, such as weakness, hunger, palpitations, sweating, dizziness, anxiety, and even mental confusion and fainting.

　　What are the symptoms of dumping syndrome? Briefly described as follows:

　　Symptoms appear during or within 30 minutes after eating, lasting 15 to 60 minutes, and lying flat after meals can alleviate symptoms. The early postprandial symptom group mainly includes two groups of symptoms:

　　1, The first group is gastrointestinal symptoms, the most common being a feeling of fullness after eating a little, followed by upper abdominal distension and discomfort, nausea and vomiting, vomiting of alkaline bile-containing material, abdominal colic, increased bowel sounds, diarrhea, loose stools, etc.

　　2, The other group is neurological and circulatory symptoms: palpitations, tachycardia, sweating, dizziness, pallor, fever, weakness, and blood pressure drop.

　　The method of prevention for this disease is that the resection of the stomach during surgery should not be too much, the residual stomach should not be too small, and the anastomosis should be moderate in size, generally with a width of 4cm being appropriate. If there are symptoms after eating, lie flat as much as possible, eat high-nutrient and easily digestible solid food, eat less and more meals, and avoid sweet, salty, strong food and dairy products. Water and liquid food can be taken between meals instead of during meals. Most patients with early postoperative symptoms have mild symptoms, and after a period of gastrointestinal adaptation and dietary adjustment, the symptoms can disappear or be easily controlled.

　　The clinical symptoms of dump syndrome patients are not typical, and during the examination process, it is necessary to understand the patient's medical history in detail, and combine it with physical examination, blood pressure, blood sugar, blood routine, X-ray, CT, and other examination results to make a diagnosis.

　　Patients with dump syndrome should eat less and more meals, chew slowly, avoid large amounts of sweet, hot liquid food, and lie flat for 10-20 minutes after meals. Among them, the control of dietary components and the number of meals is the most important link in all treatments, and it is recommended that the total daily food intake be divided into 6 times, and dietary intake should be low sugar and high protein food.

　　The drug treatment for倾倒综合征 can be antihistamines or anticholinergic agents as well as antispasmodics and sedatives. In recent years, there have also been trials with antiserotonin drugs, with certain effects. Literature reports indicate that somatostatin therapy is also effective.

　　In a few patients, symptoms are significant, and if the above medication and preventive measures are ineffective, surgical treatment can be considered. There are many types of surgical methods used in clinical practice. The principle is not to narrow the anastomosis, change the gastrojejunal anastomosis to gastroduodenal anastomosis, transplant a segment of jejunum between the stomach and duodenum (jejunal replacement of the stomach), etc., all of which aim to slow down the speed of food entering the jejunum directly.