Yang, Jun-Young
(Department of Surgery, Gachon University Gil Medical Center)
,
Lee, Hyuk-Joon
(Department of Surgery, Seoul National University Hospital)
,
Alzahrani, Fadhel
(Department of Surgery, King Faisal Hospital)
,
Choi, Seung Joon
(Department of Radiology, Gachon University Gil Medical Center)
,
Lee, Woon Kee
(Department of Surgery, Gachon University Gil Medical Center)
,
Kong, Seong-Ho
(Department of Surgery, Seoul National University Hospital)
,
Park, Do-Joong
(Department of Surgery, Seoul National University Hospital)
,
Yang, Han-Kwang
(Department of Surgery, Seoul National University Hospital)
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 p...
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.
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.
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문제 정의
Previous studies reported higher incidences of early dumping syndrome in patients who underwent total gastrectomy than those in patients who underwent distal gastrectomy due to more accelerated nutrient delivery into the small intestine [1,29]. To our knowledge, this is the first study to identify a significant difference in the degree of postprandial changes in GI hormones and hemodynamics between patients who underwent distal or total gastrectomy. As early dumping syndrome is clinically characterized by GI and vasomotor symptoms related to accelerated nutrient delivery into the small intestine, the accelerated postprandial changes in GI hormones and hemodynamics after gastrectomy, especially for total gastrectomy, might be an underlying pathophysiology.
가설 설정
As inferred from the coordinated nature of regional and systemic hemodynamics, some investigators considered meal-induced increases in splanchnic blood flow to be an initial event for systemic postprandial hemodynamic changes [24-26]. The researchers suggested that meal-induced splanchnic blood pooling influences systemic hypotensive stress ensued by tachycardia, hypotension, drowsiness, and restlessness, which are the main vasomotor symptoms of early dumping syndrome. Furthermore, meal-induced splanchnic vasodilatation was accompanied by renal vasoconstriction as a homeostatic response of the kidney to prevent systemic hypotension [27,28].
제안 방법
In all subjects, after 8 hours of fasting, baseline venous blood samples were taken for measurements of glucose and GI hormone levels. After blood sampling, baseline Doppler measurements of the superior mesenteric artery (SMA) and intrarenal artery were performed with the subjects in a supine position. After the baseline examinations, the subjects ingested a 400-kcal liquid meal (New Care, DaeSang, Seoul, South Korea; 60 g carbohydrate, 14 g protein, and 12 g lipid) within 5 minutes while in a sitting position, followed by bed rest.
After post-meal measurements, all subjects were examined directly by the investigator (JYY) using a questionnaire on the syndrome (Supplementary Table 1) based on Sigstad's clinical diagnostic index [13].
1. Meal-induced changes in (A) glucose, (B) GLP-1, (C) GLP-2, (D) superior mesenteric artery RI, (E) renal RI, and (F) heart rate in patients who underwent gastrectomy (solid line) and controls (dotted line). Values are means±2 standard deviation.
To our knowledge, no report has investigated GI hormone level and splanchnic blood flow concomitantly in patients who underwent gastrectomy for gastric cancer. Thus, this study examined the early postprandial changes in blood glucose level, GI hormone levels, and hemodynamics including splanchnic blood flow in terms of early dumping syndrome after gastrectomy for gastric cancer.
대상 데이터
Forty patients who had undergone gastrectomy for gastric cancer and 18 controls who had undergone operations other than gastrectomy (inguinal hernia repair [n=14] and subcutaneous mass excision [n=4]) in the past 12 months at a single institution (Gachon University Gil Medical Center) were enrolled. None of the patients or controls had a history of abdominal surgery, except for gastrectomy, diabetes, chronic renal disease, or ongoing adjuvant chemotherapy.
The statistical analysis in this study was supported by the Medical Research Collaborating Center, Seoul National University Hospital.
데이터처리
The meal-induced changes in biochemical and hemodynamic variables within each subject group were analyzed using paired Student's t-tests.
성능/효과
In conclusion, the early postprandial changes in GI hormones and hemodynamics were greater in patients who underwent gastrectomy compared to those in controls. Among patients who underwent gastrectomy, these changes were more prominent after total gastrectomy than after distal gastrectomy, which was associated with a lower risk of early dumping syndrome.
The results of our study showed significantly greater meal-induced changes in GI hormones and hemodynamics in patients who underwent gastrectomy for gastric cancer than those in controls. Among patients who underwent gastrectomy, these changes were more prominent after total gastrectomy compared to after distal gastrectomy.
Recently, as the number of cases of bariatric surgery has increased, studies have reported on the postoperative changes in GI hormone secretion [7-10]. The results of these studies suggested that altered GI hormone profiles induce postprandial symptoms such as bloating, nausea, and anxiety, which result in reduced food intake and weight loss. While these postprandial symptoms could be considered to have a “therapeutic effect” after bariatric surgery, they are, rather, the main constituents of troublesome early dumping syndrome [8].
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