Postgastrectomy syndromes

The most important common postgastrectomy syndromes are dumping, alkaline reflux gastritis, and gastric stasis. Less common postgastrectomy syndromes include small stomach syndrome, postvagotomy diarrhea, afferent loop syndrome, efferent loop syndrome, and recurrent ulcer. Most patients also develop iron deficiency anemia likely caused by exclusion of the duodenum from the enteral stream. The duodenum is the primary site of iron absorption. Poor mixing of the bile and food can result in malabsorption. B12 and folate deficiencies are common nutritional complications. Owing to the hypochlorhydria following vagotomy, postgastrectomy patients may be at greater risk for developing cancer in the gastric remnant. The incidence of postgastrectomy syndromes has decreased overall as a result of the marked decrease in the number of gastric surgeries performed, especially for peptic ulcer disease. This is mainly because of the recognition of H. pylori and its causal relationship with peptic ulcer disease. Postgastrectomy syndromes have been reported in 5% to 50% of patients, in most studies the incidence is near 25% (6). For unknown reasons, females have a higher incidence of postgastrectomy syndromes.

Efferent Loop Gastrectomy
Fig. 8. Dumping syndrome. Rapid gastric emptying after truncal vagotomy, partial gastrectomy, and gastrojejunostomy.

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