subtotal gastrectomy and outcomes

Y underwent a subtotal (85%) gastrectomy and was rigged with a Roux-en-Y gastrojejunostomy.This occurred in the fall of 2001.Some negative results of this procedure were weakness, dizziness, rapid heart rate, sweats, and diarrhea, perhaps due to malabsorption and the effects of early and late dumping syndrome. Y learned how to eat small amounts, chew well, and limit simple CHO's,dairy,and fat intake at one sitting. At medical visits to reexamine Y's condition (04/02 and 07/02) Y states to feel good, energy level is back to normal, can work all day without any problems, can eat full meals without any difficulty except when adding a sweet desert at the end , appetite has returned to normal,and denies any loose bowels or diarrhea.Y regained some of the lost weight and is stablized at a loss of 20% of pre-op weight.

If Y follows the appropriate dietary regimen, gets B12 shots, and takes a vitamin/mineral supplement, what are the chances of major reversion? Is it probable that Y will feel weak and dizzy, and feel rapid heart beats and sweats after every meal? Could Y now feel abdominal pain either before, during, and after a meal, or sometimes all three? How long do the adverse conditions of  dumping syndrome usually last post op? If you get a handle on it, is it possible for the problems to raise their head again, regardless of appropriate feeding technique? Can Y feel ever present fatigue in light of what was said in April and July of 2002?

In your judgement, how difficult is it for Y to absorb iron, folate, thiamin, calcium, and Vit D? How frequently would malabsorption of any of these nutrients occur (amongst all subtotal gastrectomy outcomes) considering dietary intake and supplementation, and no other complicating medical condition?

Thanks for your considerations.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Regarding the dumping syndrome, many gastric bypass patients become less tolerant of foods high in refined sugar and fats.  This is because these types of foods enter the small intestine very quickly, and in some patients, may cause symptoms such as nausea, weakness, dizziness, and sweating.  The effects can be indefinite.  Many surgeons view the dumping syndrome as a potential benefit, limiting the sweet intake.

B vitamin and folate deficiencies are known complications of Roux-en-Y.  As Y is doing, proper supplementation can alleviate these problems.  Supplementation may continue indefinitely.  

Regarding the abdominal pain, rapid weight loss is associated with an increased risk of gallstones - tests to evaluate this (i.e. with an abdominal ultrasound) should be considered.

The palpitations and sweats are likely manifestations of the dumping syndrome and would need continued modification of your diet to minimize your symptoms.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

It sounds as if Y is doing very well (you didn't state the reason for the gastrectomy). It's most likely that the measures Y has undertaken to stabilize the symptoms will need to be done forever. However, Y could try to add this or that food if strongly desired, and see how it goes. The malabsorption will always need to be addressed; it sounds as if the supplements are taking care of it well, and will always be needed, most likely.

[moby11377]

A related discussion, surgery was started.