Surgery for Severe Obesity
James M. Rippe in Lifestyle Medicine, 2019
Patients with symptoms of dumping syndrome can usually be managed by dietary modification, including avoidance of concentrated sweets and simple sugars, consumption of small frequent meals, and inclusion of protein at every meal. Patients with symptoms suggestive of postprandial hypoglycemia that are not ameliorated by dietary modification should undergo evaluation for the presence of endogenous (or “post-bypass”) hyperinsulinemic hypoglycemia.10,48 Patients with more severe neuroglycopenic symptoms (such as confusion or loss of consciousness) should also undergo evaluation for this condition, which can occur after gastric bypass. For most patients with post-bypass hypoglycemia, dietary modification, including carbohydrate restriction to less than 30 grams per meal, can significantly reduce the frequency and severity of symptoms.49 However, when symptoms persist, pharmacologic therapies, such as acarbose, diazoxide, somatostatin analogs, and calcium channel blockers, may be required.
Weight Loss by Surgical Intervention
Nathalie Bergeron, Patty W. Siri-Tarino, George A. Bray, Ronald M. Krauss in Nutrition and Cardiometabolic Health, 2017
Whether by choice, via influence from a dietician or surgeon, or stemming directly from the anatomical alterations in the gastrointestinal tract, eating behavior is significantly modified after surgery. A multitiered dietary template is employed after bariatric surgery to facilitate healing through optimal nutritional intake, minimize loss of fat-free mass (FFM), reduce gastrointestinal symptoms, and potentiate weight loss (Aills et al. 2008). At the outset, ingestion of liquid-based or soft-texture foods predominates due to inflammation and edema, which impede the passage of food (Bock 2003; Moize et al. 2003). Diets progress, in order, from a clear liquid (1–2 days [d]) to full liquid (10–14 d) to pureed (10–14 + d) to mechanically modified soft diet (≥14 d), and finally a regular diet is recommended (Aills et al. 2008). Osmolality and caloric density gradually increase as diets change. To avoid dumping syndrome and facilitate weight loss, avoidance of fruit juices, liquids during meals (Halverson and Koehler 1981), sugar, and saturated fat–laden food products is recommended (Aills et al. 2008). Dumping syndrome, especially in Roux-en-Y gastric bypass, frequently occurs acutely post-surgery and represents a constellation of symptoms, which include diarrhea, bloating, abdominal pain, nausea, tachycardia, syncope, palpitations, and sweating (Laurenius et al. 2013).
Noninsulinoma pancreatogenous hypoglycemia syndrome and postbariatric hypoglycemia
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
RYGB, which is the most commonly performed bariatric surgery, alters glucose fluxes and metabolism [21]. RYGB leads to a higher and earlier peak of plasma glucose concentration, as well as lower nadir glucose levels postprandially [22]. In addition, the secretion of insulin and glucagon-like peptide 1 (GLP-1) is accentuated and occurs earlier during the postprandial period [22]. Approximately 10%–15% of patients who have undergone RYGB surgery may present with symptoms such as diaphoresis, weakness, dizziness, and palpitations in the postoperative period. These nonspecific symptoms, known as Dumping syndrome, typically occur within 15–30 minutes of consuming high levels of simple carbohydrates and are caused by rapid emptying of partially digested foods, with mechanical distention, and altered secretion of intestinal hormones, including glucagon [23] and GLP-1 [23, 24]. Together, these changes may lead to fluid shifts into the gastrointestinal tract and subsequent intravascular volume contraction, adrenergic stimulation, and postprandial hypoglycemia [25]. Postprandial symptoms without Whipple’s triad, previously called “reactive hypoglycaemia,” indicate a functional disorder in which symptoms are not due to hypoglycemia and for which an oral glucose tolerance test is not indicated [26, 27]. Patients who have undergone RYGB may have many postprandial symptoms, many of which could be incorrectly attributed to hypoglycemia. Therefore, the criteria of Whipple’s triad need to be rigorously applied before proceeding with further evaluation.
Oral Nutritional Supplementation Following Upper Gastrointestinal Cancer Surgery: A Prospective Analysis Exploring Potential Barriers to Compliance
Published in Journal of the American College of Nutrition, 2020
Irene Lidoriki, Dimitrios Schizas, Konstantinos S. Mylonas, Maximos Frountzas, Aikaterini Mastoraki, Emmanouil Pikoulis, Theodoros Liakakos, Ioannis Karavokyros
Malnutrition is common in oncologic patients due to the debilitating nature of their disease (1). Chemotherapy and radiation treatment can further aggravate nutritional deficiencies (2). In upper gastrointestinal (GI) cancer, malnutrition is also related to tumor location as these lesions tend to mechanically obstruct normal oral intake (3). Malnutrition occurs in 60–85% of patients with upper GI malignancies (4–6) while as many as 33% experience involuntary weight loss (at least 15%) in the first 3 years following surgical intervention (7, 8), highlighting the importance of timely nutritional consultation and support in this population. The main problems patients encounter postoperatively are premature satiety, anorexia, dysphagia, reflux, and postprandial dumping syndrome (9). In a survey of gastric cancer patients after gastrectomy, the incidence of at least one symptom of early dumping syndrome was greater than 60%, whereas the incidence of late dumping syndrome was ∼50% (10). Moreover, dumping syndrome, diarrhea or regurgitation persisted for more than 10 years in 33% of patients who underwent esophagectomy (11).
Long-Term Nutritional Outcome and Health Related Quality of Life of Patients Following Esophageal Cancer Surgery: A Meta-Analysis
Published in Nutrition and Cancer, 2018
Trang Thuy Soriano, Guy D. Eslick, Thiru Vanniasinkam
Despite similarities in the overall quality of life scores to reported general population, patients' gastrointestinal symptom scores are significantly worse and continue for an extended period after surgery. Esophagectomy is a complex procedure and involves resection of the proximal one third to half of the stomach as well as at least two thirds of the esophagus. Gastro-intestinal continuity is created by using the remnant stomach as a conduit, it is “pulled up” into the chest and anastomosed to the proximal esophagus (2,8). The surgery often results in a number of postoperative nutrition impact symptoms. Common symptoms described include appetite loss, diarrhea, eating problems, reflux, taste problems, vomiting and nausea, and dumping syndrome. These symptoms are attributed to the extensive anatomical changes as a result of surgery, the reconstruction of the upper gastrointestinal tract, the division of the vagal nerve, and the absence of the esophageal sphincter. Several studies report symptoms commonly at 6 months and long term studies report that these symptoms can persists after many years. For example, the longest study period looking at nutrition impact symptoms or gastrointestinal symptoms was 10 years post esophagectomy. At 3 years or greater after surgery, patient still reported gastrointestinal symptoms such dysphagia, diarrhea, nausea, reflux, and dumping syndrome.
OverStitch Sx Endoscopic suturing system in minimally invasive endoscopic procedures: overview of its safety and efficacy and comparison to oversticthTM
Published in Expert Review of Medical Devices, 2022
Tara Keihanian, Mohamed O Othman
Dilated gastric pouch post Roux-en-Y gastric bypass not only leads to weight gain, it is also associated with accelerated pouch emptying and dumping syndrome. OverStitch can be used to limit the pouch size for both bariatric intension and for symptomatic relief in those with dumping syndrome. 14 patients with significant dumping syndrome post Roux-en-Y gastric bypass underwent pouch reduction with OverStitch, 13 of the 14 patients did not experience further symptoms related to dumping syndrome 1 month post procedure and all patients had regular emptying of gastrografin upper gastrointestinal series [65]
Related Knowledge Centers
- Bloating
- Diabetes
- Gastrointestinal Tract
- Pancreas
- Hypovolemia
- Insulin
- Duodenum
- Reactive Hypoglycemia
- Blood Sugar Level
- Glucose Tolerance Test