Postgastrectomy symptoms and treatment options
| Symptoms | Treatment |
|---|---|
| Early dumping (15–30 min after eating) | Modification of diet and eating habits |
| Late dumping (1.5–3 h after eating) | Modification of diet and eating habits |
| Lactose intolerance | Diet modifications, supplementation with lactase enzymes |
| Fat malabsorption | Pancreatic enzyme replacement may be necessary, especially fats and fat-soluble vitamins such as vitamin D 102 |
| Small bowel bacterial overgrowth/blind loop syndrome | Antibiotics, sometimes surgery |
| Dysphagia and anastomotic strictures | Modification of eating habits (more deliberate mastication and smaller bites) Upper endoscopy with balloon dilatation to widen the stricture Sometimes postsurgical intervention |
| Changing response to usage of alcohol | Alertness physician and patient |
| Absorption of medication can be affected | Alertness physician and patient |
| Monitoring deficiencies of iron, vitamin B12, folate and trace elements | Supplementing of vitamin B12 and/or folate.103–105 Intravenous iron infusions may become necessary if individuals are unable to tolerate iron orally, unable to absorb sufficient iron through the gut, or require rapid increase in iron levels to avoid other health complications or a blood transfusion |
| Hypocalcaemia, osteoporosis, osteopenia and osteomalacia | Calcium and vitamin D are required to reduce risk of bone disease. When levels cannot be maintained through consumption of calcium-rich foods, supplements such as vitamin D, calcium carbonate, calcium phosphate and calcium citrate can be used. Calcium citrate does not require acid for absorption, making it a strong choice of supplement106 |
| Bile reflux (due to the absence of the gastroesophageal valve) | Type of surgical procedure (appropriate length of the Roux limb) reduces the occurrence of bile reflux Use of wedge pillow for sleeping Limiting oral intake to 2–3 h before going to bed |