Residual Antrum Syndrome

　　The occurrence of this disease is mainly caused by irregular process during the gastric surgery. The cause of this disease is that the mucosa of the residual gastric antrum is stimulated by the reflux of alkaline duodenal juice, which produces a large amount of gastrin, absorbed into the blood, acts on the mucosa at the bottom of the stomach, stimulates the parietal cells of the residual stomach, promotes excessive secretion of gastric juice, high gastric acid, and postoperative anastomotic ulceration.

　　The residual antrum of the abdominal surgery is stimulated by the reflux of alkaline duodenal juice, which secretes a large amount of gastric acid, easily leading to recurrent ulcers. Even after a second gastric surgery, the prognosis is usually poor.

　　The main symptoms of residual antrum syndrome (after gastric resection) are excessive secretion of gastric juice and a series of symptoms caused by ulceration at the anastomosis, such as long-term, periodic, and hunger-related upper abdominal pain, burning sensation in the upper abdomen, acid regurgitation, belching, and so on.

　　In clinical diagnosis of residual antrum syndrome, it is necessary to completely resect the residual gastric antrum and restore the physiological duodenal passage. This can change the Billroch II method to I, such as direct end-to-end anastomosis between the stomach and duodenum and free jejunal loop replacement surgery. Some people advocate the simultaneous performance of bilateral vagotomy.

　　The examination of gastrointestinal diseases mainly relies on gastroscopy and imaging examination, but fiberoptic endoscopy and upper gastrointestinal barium meal examination are not satisfactory for the diagnosis of residual antrum. The preoperative diagnosis of residual antrum syndrome is relatively difficult, and most patients are diagnosed only after exploratory surgery of the duodenal残端.

　　Patients with general diseases should pay attention to their diet, especially patients with gastrointestinal diseases, as reasonable diet is particularly important. Improper diet can easily worsen the condition and cause serious adverse consequences. Patients with this disease should mainly pay attention to the following points:

　　1. Chewing slowly: Food stimulates the secretion of saliva (containing enzymes beneficial for the digestion of carbohydrates) in the mouth, and careful chewing can make the food particles smaller. The saliva is thoroughly mixed with the food, partially replacing the function of the stomach. Slow swallowing refers to slow swallowing and long intervals between swallows to prevent dizziness, palpitations, and other symptoms of dizziness after rapid swallowing of a large amount of food.

　　2. Small and frequent meals: After surgery, the residual stomach or the subsequent intestinal segment cannot be compared with the past, and the body needs a longer period of time to adapt to this change. Clinical experience shows that it takes at least 8-10 months to recover to normal daily meals of three meals a day. Start with 5-8 meals a day, with an intake of 50-100 grams each time, gradually increasing the intake and reducing the frequency of meals according to the patient's tolerance (no bloating or discomfort indicates good tolerance). The process of adaptation varies from person to person due to individual differences.

　　3. Diversified Diet: The variety of food can be chosen according to the patient's dietary preferences and habits, but attention should be paid to consume as many nutritionally rich and easily digestible high-protein, high-vitamin diets as possible. For example, fish, eggs, fresh vegetables, fruits (it is best to drink juice), etc. Iron supplementation should be noted, and more iron-rich foods should be consumed, such as animal liver, spinach, legume products, etc. Drinking some yogurt is also beneficial.

　　4. Postprandial Position: After surgery for the entrance of the stomach, to prevent food regurgitation after eating, it should be maintained in a sitting or slope position; after surgery for the outlet of the stomach, to prevent the rapid downward movement of food after eating, it is recommended to lie down and rest for about 20 minutes before assuming a free position.

　　5. After meals, follow the doctor's advice to take some medications, such as digestive drugs, vitamin B12, folic acid, etc., which help with digestion and absorption and prevent anemia from occurring.

　　In addition, some foods that are strong irritants to the stomach should be restricted: first, fried, spicy, and irritating foods, as well as raw, cold, and hard foods should be avoided. Foods that are too hot, too sweet, or too salty should also be limited appropriately.

　　Residual Antrum Syndrome is a postoperative遗留问题，therefore the main treatment method is surgery treatment.：In treatment, it is necessary to completely resect the residual antrum of the stomach and restore the normal, physiological duodenal passage, that is, to change from BillrochⅡtoⅠtype, such as performing end-to-end anastomosis between the stomach and duodenum and free jejunal loop replacement surgery; some people advocate performing bilateral vagus nerve trunk sectioning at the same time.