Delayed-onset dumping syndrome

　　1, Changes in blood sugar and blood volume

　　After gastric resection, patients lose the regulatory function of the pylorus, the residual gastric volume is reduced, and the vagotomy after resection affects the relaxation of the postprandial stomach, leading to a sudden influx of a large amount of hypertonic food residue into the duodenum or jejunum. The rapid exchange of hypertonic glucose in the intestinal lumen and extracellular fluid in the intestinal wall occurs to maintain the osmotic balance between the intestinal content and the intestinal wall, resulting in a significant increase in blood sugar and a decrease in blood volume. In a short period of time, up to 1/4 of the effective circulating blood volume of fluid can渗入肠腔， causing blood to concentrate, leading to symptoms such as accelerated pulse and fainting.

　　2, The role of gastrointestinal hormones

　　(1) Bradykinin-kinin The serum bradykinin level increases in patients with dumping syndrome, but not in those without. The administration of bradykinin to normal individuals can produce symptoms related to the bradykinin-kinin level in the blood. Bradykinin can increase peripheral blood flow and capillary permeability, and can also increase the contraction of gastrointestinal smooth muscle, thus causing vasodilation and gastrointestinal symptoms. Therefore, some people believe that the occurrence of the symptoms of this syndrome is related to the activity of the bradykinin-kinin system.

　　(2) Vasoactive intestinal peptide The level of vasoactive intestinal peptide in the blood of patients after gastric resection is significantly increased, especially in those with dumping syndrome, and the administration of vasoactive intestinal peptide to normal individuals can produce symptoms similar to dumping syndrome.

　　In addition, it has been considered that gastrin, motilin, serotonin, P substance, and others may be related to the occurrence of this disease, but there is no definitive conclusion at present.

　　3, Mental and neurological factors

　　Clinical observations have found that the mental state of patients before surgery is of the excitable or tense type, and it is more likely to develop dumping syndrome after surgery. Factors such as mental and neurological factors can cause the pyloric regulatory dysfunction, leading to faster gastric emptying, and dumping syndrome can also occur in individuals who have not undergone gastric resection.

　　1, Symptoms such as dizziness, palpitations, tachycardia, extreme weakness, excessive sweating, trembling, pale or flushed complexion may occur, and in severe cases, blood pressure may drop and fainting may occur.

　　2, Late dumping syndrome usually 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, even mental confusion, and fainting.

　　1. The onset occurs within 2-3 hours after a meal, manifested as weakness, dizziness, palpitations, tremors, and cold sweat, which can be severe enough to cause loss of consciousness.

　　2. Eating high carbohydrate foods and drinks, exercise, and emotional excitement can induce or worsen symptoms.

　　3. Some patients may first have symptoms of dumping syndrome, followed by postprandial hypoglycemia.

　　The method of prevention is that the stomach resection during surgery should not be too much, the remaining stomach should not be too small, and the anastomosis should be moderate in size, generally with a width of 4 centimeters being appropriate. After eating, if there are symptoms, lie flat and try to eat high-nutrient and easily digestible solid food, eat less and more frequently, and avoid sweet, salty, strong-tasting food and dairy products. Water and liquid can be taken between meals but not during meals. The postoperative early postprandial symptom complex is usually mild in most patients, and after a period of gastrointestinal adaptation and dietary adjustment, the symptoms can disappear or be easily controlled.

　　1. There is a history of stomach surgery, which occurs a few weeks to a few months after the operation.

　　2. The onset occurs within 2-3 hours after a meal, and hypoglycemia occurs.

　　3. The insulin level before an attack is often 3-4 times higher than that of a normal person, and the blood sugar level significantly decreases during the attack.

　　Eat less and more frequently, chew slowly, avoid large intake of sweet and hot liquid food, and lie flat for 10-20 minutes after meals. Among these, the control of dietary composition and meal frequency is the most important link in all treatments, and he suggests that the total daily food intake be divided into 6 meals, and the dietary intake should be low sugar and high protein food.

　　First, the principle of treatment

　　1. Diet adjustment.

　　2. Adjust the position.

　　3. Correct hypoglycemia.

　　Second, the principle of medication

　　1. The prevention and treatment of this condition mainly starts with diet, with small and frequent meals, avoiding high carbohydrate diet, increasing protein and fat intake, lying down for half an hour after meals, and short-term use of auxiliary drugs such as fat emulsion.

　　2. Drink sugar water during an attack, and the symptoms can be relieved. In severe hypoglycemia, 50% G.S 40ml can be injected intravenously.