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Postprandial Changes in Gastrointestinal Hormones and Hemodynamics after Gastrectomy in Terms of Early Dumping Syndrome

Journal of Gastric Cancer 2020년 20권 3호 p.256 ~ 266
양준영, 이혁준, Alzahrani Fadhel, 최승준, 이운기, 공성호, 박도중, 양한광,
소속 상세정보
양준영 ( Yang Jun-Young ) - Gachon University Gil Medical Center Department of Surgery
이혁준 ( Lee Hyuk-Joon ) - Seoul National University Hospital Department of Surgery
 ( Alzahrani Fadhel ) - King Faisal Hospital Department of Surgery
최승준 ( Choi Seung-Joon ) - Gachon University Gil Medical Center Department of Radiology
이운기 ( Lee Woon-Kee ) - Gachon University Gil Medical Center Department of Surgery
공성호 ( Kong Seong-Ho ) - Seoul National University Hospital Department of Surgery
박도중 ( Park Do-Joong ) - Seoul National University Hospital Department of Surgery
양한광 ( Yang Han-Kwang ) - Seoul National University Hospital Department of Surgery

Abstract


Purpose: This study aimed to examine the early postprandial changes in gastrointestinal (GI) hormones and hemodynamics in terms of early dumping syndrome after gastrectomy for gastric cancer.

Materials and Methods: Forty patients who underwent gastrectomy for gastric cancer and 18 controls without previous abdominal surgery were enrolled. Before and 20 minutes after liquid meal ingestion, blood glucose, glucagon-like peptide-1 (GLP-1), and GLP-2 concentrations and superior mesenteric artery (SMA) and renal blood flow were measured. The patients' heart rates were recorded at 5-minute intervals. All subjects were examined for dumping syndrome using a questionnaire based on Sigstad's clinical diagnostic index.

Results: The postprandial increases in blood glucose, GLP-1, and GLP-2 levels as well as SMA blood flow and heart rate were greater in patients who underwent gastrectomy than in controls (all P<0.010). Patients who underwent gastrectomy showed a significantly decreased renal blood flow (P<0.001). Among patients who underwent gastrectomy, distal gastrectomy was a significant clinical factor associated with a lower risk of early dumping syndrome than total gastrectomy (hazard ratio, 0.092; 95% confidence interval, 0.013?0.649; P=0.017). Patients who underwent total gastrectomy showed a greater postprandial increase in blood glucose (P<0.001), GLP-1 (P=0.030), and GLP-2 (P=0.002) levels as well as and heart rate (P=0.013) compared to those who underwent distal gastrectomy.

Conclusions: Early postprandial changes in GI hormones and hemodynamics were greater in patients who underwent gastrectomy than in controls, especially after total gastrectomy, suggesting that these changes play a crucial role in the pathophysiology of early dumping syndrome.

키워드

Gastrectomy; Dumping syndrome; Glucose; Gastrointestinal hormones; Splanchnic circulation

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