Table 2

Postgastrectomy symptoms and treatment options

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 intoleranceDiet modifications, supplementation with lactase enzymes
Fat malabsorptionPancreatic enzyme replacement may be necessary, especially fats and fat-soluble vitamins such as vitamin D 102
Small bowel bacterial overgrowth/blind loop syndromeAntibiotics, sometimes surgery
Dysphagia and anastomotic stricturesModification 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 alcoholAlertness physician and patient
Absorption of medication can be affectedAlertness physician and patient
Monitoring deficiencies of iron, vitamin B12, folate and trace elementsSupplementing 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 osteomalaciaCalcium 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