J Gastric Cancer.  2020 Sep;20(3):256-266. 10.5230/jgc.2020.20.e24.

Postprandial Changes in Gastrointestinal Hormones and Hemodynamics after Gastrectomy in Terms of Early Dumping Syndrome

Affiliations
  • 1Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
  • 2Department of Surgery, Seoul National University Hospital, Seoul, Korea
  • 3Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
  • 4Department of Surgery, King Faisal Hospital, Makkah, Saudi Arabia
  • 5Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea

Abstract

Purpose
This study aimed to examine the early postprandial changes in gastrointestinal (GI) hormones and hemodynamics in terms of early dumping syndrome after gastrectomy for gastric cancer.
Materials and Methods
Forty patients who underwent gastrectomy for gastric cancer and 18 controls without previous abdominal surgery were enrolled. Before and 20 minutes after liquid meal ingestion, blood glucose, glucagon-like peptide-1 (GLP-1), and GLP-2 concentrations and superior mesenteric artery (SMA) and renal blood flow were measured. The patients' heart rates were recorded at 5-minute intervals. All subjects were examined for dumping syndrome using a questionnaire based on Sigstad's clinical diagnostic index.
Results
The postprandial increases in blood glucose, GLP-1, and GLP-2 levels as well as SMA blood flow and heart rate were greater in patients who underwent gastrectomy than in controls (all P<0.010). Patients who underwent gastrectomy showed a significantly decreased renal blood flow (P<0.001). Among patients who underwent gastrectomy, distal gastrectomy was a significant clinical factor associated with a lower risk of early dumping syndrome than total gastrectomy (hazard ratio, 0.092; 95% confidence interval, 0.013–0.649; P=0.017). Patients who underwent total gastrectomy showed a greater postprandial increase in blood glucose (P<0.001), GLP-1 (P=0.030), and GLP-2 (P=0.002) levels as well as and heart rate (P=0.013) compared to those who underwent distal gastrectomy.
Conclusions
Early postprandial changes in GI hormones and hemodynamics were greater in patients who underwent gastrectomy than in controls, especially after total gastrectomy, suggesting that these changes play a crucial role in the pathophysiology of early dumping syndrome.

Keyword

Gastrectomy; Dumping syndrome; Glucose; Gastrointestinal hormones; Splanchnic circulation
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