Pathophysiological Studies of the Effect of Isoperistaltic Jejunal Interposition in the Treatment of the Incapacitating Dumping Syndrome

Abstract

In 22 patients operated upon for incapacitating dumping symptoms with isoperistaltic jejunal interposition, including five patients who were cured, oral and direct intraintestinal provocation using 280 ml 18% glucose (50 g/250 ml water) was carried out preoperatively and at least one year postoperatively. A highly statistically significant correlation was found between the experimental result of the test meal and the clinical evaluation. The severity of the dumping symptoms depends on the gastric emptying rate. With this test meal it must be as slow as one to two hours, if the dumping symptoms are to be effectively curbed. This rate is so slow that it borders on total obstruction. A clinical cure is in this material not due to a slower gastric emptying rate after the operation, but is due to a considerable reduction in the sensitivity of the small intestine. This change only occurred in patients in whom the afferent loop was removed during the reconstructional operation, and it was not found in patients with a Billroth I resection.

Key-words:

• Dumping syndrome
• duodenal ulcer
• gastric emptying
• pathophysiology