Endocrine Abstracts (2017) 49 EP633 | DOI: 10.1530/endoabs.49.EP633

Dumping syndrome post total gastrectomy

Samir Ait Abderrahmane, Soumia Abdelkrim, Fadoua Boucelma, Lila Brakni & Brahim Oudjit

HCA, Kouba, Algeria.

Introduction: Dumping syndrome, also known as rapid gastric emptying, is a relatively rare disorder. It is conventionally due to the brutal flooding of the small bowel by a hyperosmolar food bolus and to the release of various digestive hormones whose real responsibility in the syndrome remains poorly known. It is usually a complication of the gastrectomy (10 to 40% of the cases). Hypoglycemia after surgery for digestive cancer is sometimes severe, but rare, and revealed by the monitoring of blood glucose, and then more frequent. The variability of the definitions in the studies supports a single definition, Whipple, with a blood glucose level below 0.55 g/l.

Observations: We report the case of a patient, aged 32 years with a personal history of total gastrectomy for gastric adenocarcinoma, regularly followed surgery consultation, a family history of diabetes and hypertension. The onset of the disorders dates back to a postoperative month marked by the appearance of signs of adrenergic hypoglycemia without glycogenic signs in late postprandial periods i.e. 2–3 h after a meal. Capillary glucose levels were made with regard to clinical symptomatology Have returned to <0.50 g/l. Patient in average general condition with a normal BMI of 19 kg/m2. Remainder of the review is without peculiarities. On the biological level, GAJ: 0.79,. GR 3.6, Hb 10.3, VGM 91, CCMH 31%, GB 5360, Correct renal count: MDRD at 107. Hepatic balance without abnormalities. Malabsorption balance: Normal calcium an 2.28 mmol/l, Phosphoremia: 1.46 mmol/l, Serum iron: 9.65 mmol/l. ECG and Telthorax without abnormality. Glycemic variability is high in our patient, with hypoglycemia and abnormalities in the glycemic Holter (CGMS) or even recording.The symptoms disappeared following a dietary treatment with improvement of the quality of life of the patient, without any medicinal intervention.

Discussions: Hypoglycemia of the syndrome is hyperinsulinic, by histological abnormalities of the pancreas (neisidioblastosis), and/or by stimulation of insulin secretion by incretin, including glucagon-like peptide-1 (GLP-1). The absorption of glucose is both accelerated and exaggerated due to direct communication between the stomach and duodenum. It is an exaggeration after the surgery of a phenomenon of adaptation which exists in the non-operated ones to whom the glucose is infused directly in the duodenum. Patient semiology is not always accompanied by biological abnormalities. However, if hypoglycaemia is severe and neuroglucopenic symptoms, hyperinsulinemia is constant. For the other cases, the possibility that stress and physical exercise increase the semiology. The treatment consists of dietary measures: split the diet into 5 or 6 meals, slow down gastric emptying, reduce glycemic load and glycemic index of food, avoid stress at mealtime. Acarbose is also effective; other treatments (insulin, glucagon, calcium channel blockers, hyperglycaemic sulfamides, somatostatin analogs, GLP-1 analogues) have not been validated on a sufficient number of subjects to be recommended.

Conclusion: It is necessary to educate the patients operated on for gastric surgery, after the resumption of the oral feeding, so that he learns how to manage his functional disorders, that he understands the interest of a supplementation, of fat soluble vitamins and Calcium and accepts the idea of regular clinical, biological and ideally osteodensitometric monitoring, unlimited in time.

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