What is the dumping syndrome?
The dumping syndrome can occur after almost all stomach operations. Due to the very short stomach passage, food reaches the small intestine too quickly. It comes to a sudden stretching of the small intestine.
Especially problematic are foods that contain a lot of sugar. These are hyperosmolar. This means that they draw a lot of fluid from the intestinal wall into the intestine.This effect can be so strong that there is a sudden lack of fluid in the vessels, which in turn can lead to a large drop in blood pressure with accompanying fainting.
Other symptoms are abdominal pain, nausea and diarrhoea. This is called early dumping. But there is also late dumping, which only occurs after two to three hours.
The problem here is the too fast and too much sugar absorption in the small intestine. This increases the blood sugar, which can result in cold sweat, nausea and in severe cases also in shock symptoms. Normally, the food pulp is portioned through the stomach, whereby the sugar is absorbed evenly. With a gastric bypass, there is no more portioned delivery.
What happens with vitamin intake after gastric bypass?
As already mentioned, some vitamins must be supplemented. In principle, however, all vitamins are absorbed in the small intestine, but due to the shortened small intestine the absorption may no longer be sufficient. Vitamin B12 is an important exception.
This is also absorbed in the small intestine. However, for its absorption, a protein is necessary which is produced in the stomach. For this reason, this vitamin can no longer be absorbed by the body in the small intestine and must therefore be injected.
What are the alternatives of a gastric bypass?
Operative alternatives to gastric bypass are the tubular stomach, gastric band and gastric balloon. Although the procedures are not as extensive as with gastric bypass, the measures do not achieve such strong effects. In any case, they should be discussed as an alternative, as they may be sufficient and also carry a lower risk.
Of course, lifestyle and dietary changes also represent an alternative to surgery. However, this requires a lot of discipline and only shows long-term success in a few cases. The gastric band is tied around the stomach, creating a small stomach with a much smaller volume.
Due to the reduced absorption capacity, a feeling of satiety is created early on when eating. The procedure is very low-risk and reversible. However, there is a risk that the band will slip, that the pre-stomach stretches and that the implant will become infected with bacteria.
If the vagina is distended, surgery is often performed and a tubular stomach is inserted. The gastric balloon is positioned in the stomach via the esophagus. There the balloon is inflated and thereby reduces the stomach volume, so that earlier saturation occurs.
No surgery is necessary for this procedure. However, the intragastric balloon can remain in the stomach for a maximum of 6 months. After that, the material will wear out.
It becomes brittle and material can be discharged into the intestine. Expired balloon material can lead to an intestinal ileus (intestinal obstruction). The intragastric balloon is used especially in patients for whom general anesthesia would be too dangerous.
In contrast to a gastric bypass, the food passage is not changed in a tubular stomach. The food continues to pass through the stomach and through the stomach outlet into the duodenum. Furthermore, the tubular stomach does not shorten the passage through the small intestine.
With the tubular stomach, only the volume of the stomach is reduced by partially removing the stomach and suturing it narrower. This creates a kind of tube. The aim of the operation is to achieve an earlier feeling of fullness when eating.
In addition, the feeling of hunger is reduced, because parts of the stomach are removed during the operation, which produce the so-called hunger hormone Grehlin. Tube gastric surgery has similar risks and side effects to gastric bypass, but the side effects are not as severe or frequent. With a tube stomach, malabsorption occurs less frequently (insufficient intake of certain nutrients).
The dumping syndrome normally never occurs in gizzards. However, the long-term success rates are slightly worse in the gizzard. Permanent overeating causes the stomach to expand and increase its volume. The gizzard can later be operated on for a gastric bypass. In Germany, gastric bypass is operated on more often than the tube stomach.
