The late (hypoglycemic) variant of the syndrome develops 2-3 hours after a meal.:
- Its mechanism is associated with an increase in the level of glucose in the blood during the early dumping reaction and the subsequent excessive secretion of insulin, which reduces the concentration of sugar in the blood to subnormal values.
- At the time of the attack, there is a sharp weakness, a feeling of hunger, trembling, profuse sweating, dizziness, hypotension, bradycardia, and acute pain in the epigastrium.
- These symptoms quickly disappear after eating a carbohydrate meal. Dumping attack lasts from 30 minutes. up to 1 hour.
- Dumping syndrome is diagnosed on the basis of anamnesis data (gastric resection), subjective and objective manifestations.
- When radiography of the stomach is determined by the rapid emptying of the operated stomach from the contrast suspension.
- In the course of radiography of the passage of barium through the small intestine, accelerated progression of barium, dyskinesia of the small intestine is noted.
- In the diagnosis, provocative tests are used. dumping reaction can be caused by taking a concentrated glucose solution or sweet syrup. Of the laboratory tests used to determine the level of cheap generic paxil glucose, insulin, albumin.
Differential diagnosis of dumping syndrome is carried out with insulinoma, neuroendocrine tumors, Crohn's disease, partial intestinal obstruction, chronic enteritis, secretory pancreatic insufficiency. Patients suffering from this disorder need to consult a neurologist to identify and correct vegetative-vascular and neuropsychiatric disorders.
With a mild degree of pathology, a diet based on high-calorie fractional nutrition, fluid and carbohydrate restriction, and a complete vitamin composition of food is recommended. Dumping syndrome of moderate severity requires the use of medications that reduce the peristalsis of the small intestine (ganglion blockers, atropine preparations, local anesthetics), general strengthening therapy (administration of glucose solution with insulin, parenteral vitamin therapy), the appointment of replacement therapy (intake of gastric juice, hydrochloric acid , enzymes - pancreatin). Apply novocaine blockade of the lumbar region, multi-channel electrical stimulation. With psychoneurological disorders, the use of neuroleptics is indicated.
With severe dumping syndrome, ineffectiveness of diet therapy and complex drug therapy, surgical treatment is performed - reconstructive gastrojejunoduodenoplasty. The essence of the surgical intervention is the interposition of a segment of the small intestine (graft from the efferent loop of the jejunum) between the duodenum and the stomach stump. Due to the imposition of gastrojejunoduodenoanastomosis, the passage of food through the duodenum is restored, food reflexes are normalized, the functions of enzyme and bile excretion, and the passage of food masses in the jejunum is slowed down.
Most often, dumping syndrome develops in the first six months after surgery. in 50% of patients over time, it becomes less pronounced, in 25% it does not progress, in another 25% it increases over the years. Progressive or severe pathology leads to permanent disability. Dumping syndrome, which occurs in relatively healthy people or after abdominal surgery, leads to severe life-threatening pathologies. However, if you know the causes of occurrence and ways to deal with it, you can prevent hypoglycemic coma, collapse states, serious neuropsychiatric disorders and maintain working capacity.
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