DOI QR코드

DOI QR Code

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

  • Received : 2020.05.27
  • Accepted : 2020.07.17
  • Published : 2020.09.30

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.

Keywords

References

  1. Mine S, Sano T, Tsutsumi K, Murakami Y, Ehara K, Saka M, et al. Large-scale investigation into dumping syndrome after gastrectomy for gastric cancer. J Am Coll Surg 2010;211:628-636. https://doi.org/10.1016/j.jamcollsurg.2010.07.003
  2. Sasako M. Progress in the treatment of gastric cancer in Japan over the last 50 years. Ann Gastroenterol Surg 2020;4:21-29. https://doi.org/10.1002/ags3.12306
  3. Eom BW, Kim S, Kim JY, Yoon HM, Kim MJ, Nam BH, et al. Survival benefit of perioperative chemotherapy in patients with locally advanced gastric cancer: a propensity score matched analysis. J Gastric Cancer 2018;18:69-81. https://doi.org/10.5230/jgc.2018.18.e9
  4. van Beek AP, Emous M, Laville M, Tack J. Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obes Rev 2017;18:68-85. https://doi.org/10.1111/obr.12467
  5. Tomita R, Fujisaki S, Tanjoh K, Fukuzawa M. Studies on gastrointestinal hormone and jejunal interdigestive migrating motor complex in patients with or without early dumping syndrome after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer. Am J Surg 2003;185:354-359. https://doi.org/10.1016/S0002-9610(02)01423-X
  6. Lee JH, Lee HJ, Choi YS, Kim TH, Huh YJ, Suh YS, et al. Postoperative quality of life after total gastrectomy compared with partial gastrectomy: longitudinal evaluation by European Organization for Research and Treatment of Cancer-OG25 and STO 22. J Gastric Cancer 2016;16:230-239. https://doi.org/10.5230/jgc.2016.16.4.230
  7. Svane MS, Bojsen-Moller KN, Martinussen C, Dirksen C, Madsen JL, Reitelseder S, et al. Postprandial nutrient handling and gastrointestinal hormone secretion after Roux-en-Y gastric bypass vs sleeve gastrectomy. Gastroenterology 2019;156:1627-1641.e1. https://doi.org/10.1053/j.gastro.2019.01.262
  8. Nguyen NQ, Debreceni TL, Burgstad CM, Wishart JM, Bellon M, Rayner CK, et al. Effects of posture and meal volume on gastric emptying, intestinal transit, oral glucose tolerance, blood pressure and gastrointestinal symptoms after Roux-en-Y gastric bypass. Obes Surg 2015;25:1392-1400. https://doi.org/10.1007/s11695-014-1531-4
  9. Honka H, Koffert J, Kauhanen S, Teuho J, Hurme S, Mari A, et al. Bariatric surgery enhances splanchnic vascular responses in patients with type 2 diabetes. Diabetes 2017;66:880-885. https://doi.org/10.2337/db16-0762
  10. Cazzo E, Pareja JC, Geloneze B, Chaim EA, Barreto MR, Magro DO. Postprandial GLP-2 levels are increased after biliopancreatic diversion in diabetic individuals with class I obesity: a prospective study. Obes Surg 2017;27:1809-1814. https://doi.org/10.1007/s11695-017-2554-4
  11. Aldoori MI, Qamar MI, Read AE, Williamson RC. Increased flow in the superior mesenteric artery in dumping syndrome. Br J Surg 1985;72:389-390. https://doi.org/10.1002/bjs.1800720518
  12. Vecht J, van Oostayen JA, Lamers CB, Masclee AA. Measurement of superior mesenteric artery flow by means of Doppler ultrasound in early dumping syndrome. Am J Gastroenterol 1998;93:2380-2384. https://doi.org/10.1111/j.1572-0241.1998.00691.x
  13. Sigstad H. A clinical diagnostic index in the diagnosis of the dumping syndrome. Changes in plasma volume and blood sugar after a test meal. Acta Med Scand 1970;188:479-486. https://doi.org/10.1111/j.0954-6820.1970.tb08072.x
  14. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract 2005;20:517-525. https://doi.org/10.1177/0115426505020005517
  15. American Diabetes Association. Postprandial blood glucose. Diabetes Care 2001;24:775-778. https://doi.org/10.2337/diacare.24.4.775
  16. Holst JJ, Gribble F, Horowitz M, Rayner CK. Roles of the gut in glucose homeostasis. Diabetes Care 2016;39:884-892. https://doi.org/10.2337/dc16-0351
  17. Nguyen NQ, Debreceni TL, Bambrick JE, Bellon M, Wishart J, Standfield S, et al. Rapid gastric and intestinal transit is a major determinant of changes in blood glucose, intestinal hormones, glucose absorption and postprandial symptoms after gastric bypass. Obesity (Silver Spring) 2014;22:2003-2009. https://doi.org/10.1002/oby.20791
  18. Fujii M, Murakami Y, Karasawa Y, Sumitomo Y, Fujita S, Koyama M, et al. Logical design of oral glucose ingestion pattern minimizing blood glucose in humans. NPJ Syst Biol Appl 2019;5:31. https://doi.org/10.1038/s41540-019-0108-1
  19. Ionut V, Burch M, Youdim A, Bergman RN. Gastrointestinal hormones and bariatric surgery-induced weight loss. Obesity (Silver Spring) 2013;21:1093-1103. https://doi.org/10.1002/oby.20364
  20. Meek CL, Lewis HB, Reimann F, Gribble FM, Park AJ. The effect of bariatric surgery on gastrointestinal and pancreatic peptide hormones. Peptides 2016;77:28-37. https://doi.org/10.1016/j.peptides.2015.08.013
  21. Yamamoto H, Mori T, Tsuchihashi H, Akabori H, Naito H, Tani T. A possible role of GLP-1 in the pathophysiology of early dumping syndrome. Dig Dis Sci 2005;50:2263-2267. https://doi.org/10.1007/s10620-005-3046-2
  22. Hansen LB. GLP-2 and mesenteric blood flow. Dan Med J 2013;60:B4634.
  23. le Roux CW, Borg C, Wallis K, Vincent RP, Bueter M, Goodlad R, et al. Gut hypertrophy after gastric bypass is associated with increased glucagon-like peptide 2 and intestinal crypt cell proliferation. Ann Surg 2010;252:50-56. https://doi.org/10.1097/SLA.0b013e3181d3d21f
  24. Vanis L, Gentilcore D, Rayner CK, Wishart JM, Horowitz M, Feinle-Bisset C, et al. Effects of small intestinal glucose load on blood pressure, splanchnic blood flow, glycemia, and GLP-1 release in healthy older subjects. Am J Physiol Regul Integr Comp Physiol 2011;300:R1524-R1531. https://doi.org/10.1152/ajpregu.00378.2010
  25. Perko MJ, Nielsen HB, Skak C, Clemmesen JO, Schroeder TV, Secher NH. Mesenteric, coeliac and splanchnic blood flow in humans during exercise. J Physiol 1998;513:907-913. https://doi.org/10.1111/j.1469-7793.1998.907ba.x
  26. Trahair LG, Horowitz M, Jones KL. Postprandial hypotension: a systematic review. J Am Med Dir Assoc 2014;15:394-409. https://doi.org/10.1016/j.jamda.2014.01.011
  27. Perney P, Taourel P, Gallix B, Dauzat M, Joomaye Z, Djafari M, et al. Changes in renal artery resistance after meal-induced splanchnic vasodilatation in cirrhotic patients. J Clin Ultrasound 2001;29:506-512. https://doi.org/10.1002/jcu.10016
  28. Iwao T, Oho K, Nakano R, Yamawaki M, Sakai T, Sato M, et al. Effect of meal induced splanchnic arterial vasodilatation on renal arterial haemodynamics in normal subjects and patients with cirrhosis. Gut 1998;43:843-848. https://doi.org/10.1136/gut.43.6.843
  29. Kubota T, Shoda K, Ushigome E, Kosuga T, Konishi H, Shiozaki A, et al. Utility of continuous glucose monitoring following gastrectomy. Gastric Cancer 2020;23:699-706. https://doi.org/10.1007/s10120-019-01036-5
  30. Corradi F, Brusasco C, Vezzani A, Palermo S, Altomonte F, Moscatelli P, et al. Hemorrhagic shock in polytrauma patients: early detection with renal Doppler resistive index measurements. Radiology 2011;260:112-118. https://doi.org/10.1148/radiol.11102338
  31. Zoli M, Merkel C, Sabba C, Sacerdoti D, Gaiani S, Ferraioli G, et al. Interobserver and inter-equipment variability of echo-Doppler sonographic evaluation of the superior mesenteric artery. J Ultrasound Med 1996;15:99-106. https://doi.org/10.7863/jum.1996.15.2.99
  32. Roldan-Alzate A, Frydrychowicz A, Said A, Johnson KM, Francois CJ, Wieben O, et al. Impaired regulation of portal venous flow in response to a meal challenge as quantified by 4D flow MRI. J Magn Reson Imaging 2015;42:1009-1017. https://doi.org/10.1002/jmri.24886