Among the adverse effects of gastric resection and vagotomy, there are dumping syndrome, afferent loop syndrome, agastric asthenia, enteral syndrome, peptic ulcer of the anastomosis, gastritis of the stomach stump..

Nutrition for dumping syndrome.

The occurrence of dumping syndrome is associated with the rapid transition (dumping) of insufficiently digested food from the stomach stump directly into the small intestine, bypassing the duodenum removed during the operation..

The rapid passage of chyme through the small intestine with inadequate osmotic and reflex effects provokes violations of humoral regulation due to changes in the intrasecretory function of the pancreas (insulin, glucagon), activation of the sympathetic-adrenal system.

As a result, pathological reflex reactions of increased functional activity of many organs and systems occur.. Symptoms of dumping syndrome with its pronounced form are quite typical and vivid..

A few minutes after eating, especially with carbohydrate and dairy foods, severe weakness, a feeling of heat, profuse sweating, a decrease (rarely an increase) in blood pressure, palpitations, tremors, nervous tension, a feeling of fear, headache occur.. Some patients also experience pain and rumbling in the abdomen, often ending in profuse diarrhea..

There are three degrees of severity of the dumping syndrome.

Mild severity is characterized by the fact that attacks occur only after a heavy meal or food rich in simple carbohydrates.. The attack is accompanied by mild vasomotor and intestinal symptoms, which quickly disappear when the patient is lying down.. These patients are able to work.

The average severity of the dumping syndrome is manifested by severe vasomotor disorders and intestinal symptoms that occur daily.. The patient is forced to take a horizontal position, which improves his well-being. The general performance of the patient is reduced.

A severe form of dumping syndrome is manifested by pronounced attacks after almost every meal, sometimes with fainting, which chains the patient to bed for 1-2 hours. The working capacity of patients is sharply reduced or completely lost.

General recommendations on nutrition in case of dumping syndrome have been formulated:.

The liquid is consumed 30-60 minutes after eating no more than 1 cup at a time. Milk and carbohydrate drinks are not recommended.

Small frequent meals are recommended. The frequency of meals depends on the tolerance of the patient. Food should be chewed slowly and thoroughly..

The diet should contain almost no simple carbohydrates, include an increased amount of complex carbohydrates and protein, a moderate quota of fat.

Food and drinks must be warm.

After eating, the patient should take a supine position for 20-30 minutes..

Food should contain enough pectin (vegetables and fruits).

With mild to moderate dumping syndrome, the main treatment is strict adherence to the principles of the P diet..

Sharply limit foods and dishes containing simple (quickly absorbed) carbohydrates - sweet liquid milk porridges, especially semolina, rice, sweet milk, sweet tea. Patients are contraindicated in cold and very hot dishes..

Separate intake of the liquid and solid parts of the diet is recommended, and the liquid should be consumed 30 minutes after ingestion of solid food, and during lunch, you must first eat the second dish, and then the first..

In severe dumping syndrome, eating in a horizontal position of the patient has an effect, preferably on the left side.. For such patients, a diet option has been developed, intermediate between mashed and non-mashed.

This diet has the same chemical composition as the main variants of the P diet, only the technological processing of food changes: fish, meat are given in chopped, and side dishes in an unmashed form, a viscous consistency (porridge-smear, mashed potatoes). Salads, fresh fruits and vegetables are excluded, only stale white bread and white crackers are also given (table. 40. 3).

Table 40. Approximate one-day menu for a patient with dumping syndrome 1st breakfast: steam protein omelet, sugar-free buckwheat porridge, tea 2nd breakfast: steamed meat cutlets, baked apple without sugar Lunch: vegetarian oatmeal soup, boiled chicken with mashed potatoes, jelly.

According to order No. 330 of the Ministry of Health (MH) of the Russian Federation dated 5. 08. 2003. when eating in medical institutions (HCF), patients after gastric resection (for peptic ulcer) after 2-4 months with dumping syndrome, a diet with an increased amount of protein (high-protein diet) is recommended.

Brief description of the diet A diet high in protein, normal amounts of fats, complex carbohydrates and restriction of easily digestible carbohydrates. Refined carbohydrates (sugar) are excluded.

Salt is limited (6-8 g / day), chemical and mechanical irritants of the stomach, biliary tract. Dishes are cooked in boiled, stewed, baked, mashed and unmashed, steamed. Food temperature - from 15 to 6065 ° C. Free liquid - 1.5-2 l. The rhythm of nutrition is fractional, 4-6 times a day.

Chemical composition: proteins - 110-130 g (animals - 45-50 g); carbohydrates 250-300 (refined carbohydrates are excluded), fats 70-100 g (vegetable - 25-30 g), energy intensity 2080-2690 kcal.

Patients with severe dumping syndrome should be transferred to a special diet option (Table. 40. four).

Table 40. An approximate one-day menu for a patient with severe dumping syndrome (in the late period of the post-stationary stage of rehabilitation) 1st breakfast: boiled meat, sauerkraut salad in vegetable oil, half a glass of tea without sugar 2nd breakfast: crumbly buckwheat porridge 3rd breakfast:.

All dishes are cooked boiled or steamed, the food is not crushed. Food is given warm, very hot and cold dishes are excluded. Fractional diet - 6-7 times a day.

Chemical composition: proteins - 130 g, fats - 100 g, carbohydrates - 320 g, energy value - 2650 kcal.

6-12 months after gastric resection, in the presence of dumping syndrome, patients are transferred to the variant of an unmashed diet without chemical sparing (Table. 40. five).

Table 40. Approximate one-day menu of an unmashed diet P without chemical sparing 1st breakfast: fried meatballs, fresh cabbage salad in vegetable oil, friable buckwheat porridge, tea with milk 2nd breakfast: cheese 50 g, fresh apple Lunch: cabbage soup in meat broth. Chemical stimulants are introduced into the diet. Exclude difficult to tolerate fatty foods: goose meat, duck, fatty pork, lamb, various types of fat. Culinary treatment according to the principle of numbered diet No. 15, fried foods are allowed, but without a rough crust.

Chemical composition: proteins - 140 g, fats - 110 g, carbohydrates - 420 g, energy value - 3100 kcal.

Therapeutic nutrition, which is the main factor in restoring the function of the digestive organs during the entire long-term rehabilitation of patients who have undergone surgery on the gastrointestinal tract, should be given sufficient attention even after 1.5-2 years after surgery..

At this stage of rehabilitation treatment, in the absence of complications from the digestive organs, the patient can eat food prepared according to the type of a common table (the main version of the standard diet according to Order No. 330 of the Ministry of Health of the Russian Federation dated 5. 08. 2003. or numbered diet No. 15), but in compliance with the principles of fragmentation of nutrition and restriction of foods and dishes that provoke dumping syndrome.

Nutrition for various post-gastroresection complications.

The pathogenesis of the afferent loop syndrome is based on a violation of the evacuation of the contents from the afferent loop due to its kinks, the formation of adhesions, impaired motor function due to changes in normal anatomical relationships..

At the same time, the functional connections of the duodenum, biliary tract, liver and pancreas are disrupted, leading to discoordination of the motility of the afferent loop and the entire gastroenteroanastomosis. Adductor loop syndrome usually develops within the first year after surgery..

It is manifested by severe pain in the epigastrium and right hypochondrium, vomiting of bile after eating. In the intervals between meals, patients experience a feeling of heaviness in the upper abdomen as a result of the reflux of intestinal contents back into the stomach, the accumulation of fluid and food in the afferent loop and in the stomach stump..

The tactics of restorative treatment and dietary nutrition in afferent loop syndrome are the same as in dumping syndrome..

Asthenic syndrome is a late postoperative complication of gastric resection.. The frequency of its occurrence is directly dependent on the level of gastrectomy. Of great importance in the pathogenesis of this condition is a violation of the secretory and motor functions of the stump of the resected stomach, a change in the secretion of bile and pancreatic juice.. In addition, most patients after resection of the stomach according to Billroth II develop disorders of intestinal digestion and absorption..

In pathogenesis, rapid passage through the jejunum, malabsorption of iron and vitamins is of certain importance.. Patients are characterized by fatigue, general malaise, weight loss, signs of hypovitaminosis, a tendency to hypotension and fainting, neuropsychiatric disorders.. General weakness increases most often after eating, especially rich in carbohydrates.

Various dyspeptic phenomena are observed: decreased appetite, belching, regurgitation of a bitter liquid, a feeling of heaviness in the epigastric region. A characteristic symptom is a disorder of intestinal activity, expressed in the appearance (especially after dairy and fatty foods) of loud intestinal noises and diarrhea..

Dietary recommendations for patients with agastric asthenia include the appointment of a high-protein diet (rehabilitation diet P), the individualization of which is achieved by the exclusion of intolerable foods, the enrichment of the diet with well-digestible protein-vitamin soy supplements, mixtures for enteral nutrition and high-calorie dietary products.

In the mechanisms of development of peptic ulcers of the anastomosis and gastritis of the gastric stump, the aggressive action of gastric juice, Helicobacter pylori infection and concomitant changes in the mucous membrane that took place even before surgery are of paramount importance..

In addition, the throwing of duodenal and intestinal contents into the stomach, the absence of the obturator function of the fistula, the weak peristaltic function of the stump and its rapid emptying after eating are important.. The clinic of a peptic ulcer of anastomosis is similar to that of a peptic ulcer, but the symptoms of the disease are usually more intense, the periods of exacerbation are longer than with an ulcer for which an operation was performed. Decreased appetite, weight loss.

Therapeutic measures in the post-stationary rehabilitation period with the development of anastomotic ulcers and gastritis of the stomach stump should be as follows. Patients should be transferred to clinical nutrition for a diet with an increased amount of protein (diet P, pureed version) for up to 4 months, depending on the rate of regression of the clinical manifestations of the complication and morphological (endoscopically or radiologically verified) changes in the mucous membrane of the stomach stump. In the future, patients may be recommended diet No. 1P.

Baranovsky medbe. en.