Postgastrectomy syndromes

Pancreatic enzyme replacement or supplement when enzymes are absent or deficient, such as with chronic pancreatitis, cystic fibrosis, or ductal obstruction from cancer of the pancreas or common bile duct to reduce malabsorption treatment of steatorrhea associated with bowel resection or postgastrectomy syndrome PO 1-3 capsules ortablets before or with meals or snacks. May increase to 8 tablets/dose. 

R13. Rejman, F., Postgastrectomy syndrome. A clinical study based upon 100 patients. Ann. Chir. Gynaecol. 59, (Suppl. 70), 1-63 (1970). 

Seymour NE, Andersen DK. Surgery for peptic ulcer disease and postgastrectomy syndromes. In Yamada T, Aplers DH, Kaplowitz N, et al, eds. Textbook of Gastroenterology, 4th ed. Philadelphia, Lippincott Williams Wilkins, 2003 1441-1454. 

A loss of gastric receptive relaxation engendered by the vagotomy added to the problem of early satiety and, compounded with a variety of postgastrectomy syndromes, served to establish a patient group with an entirely new disease complex initiated by the sequelae of surgical intervention. 

The Billroth II anastomosis was used because it was a safer technical procedure than the Billroth I anastomosis. Although the Billroth I anastomosis often leaked, it more or less reproduced an anatomic likeness, even though the pylorus was absent. On the contrary, while the anastomosis of the jejunum to the stomach (Billroth II) rarely leaked, it produced a substantially different anatomic configuration with consequent major metabolic derangements, collectively referred to as the postgastrectomy syndrome. Unless acid-suppressive medication is unavailable, vagotomy is rarely used even if gastric resection is required. 

It has been used for migraine prophylaxis, vascular headaches, postgastrectomy dumping syndrome and also used to combat diarrhoea and malabsorption in carcinoid patients. 

As 5-HT antagonist it is used in controlling intestinal manifestations of carcinoid and postgastrectomy dumping syndrome. In addition, it has weak anticholinergic and sedative properties also. 

Parenteral therapy should be reserved for patients with documented iron deficiency who are unable to tolerate or absorb oral iron and for patients with extensive chronic anemia who cannot be maintained with oral iron alone. This includes patients with advanced chronic renal disease requiring hemodialysis and treatment with erythropoietin, various postgastrectomy conditions and previous small bowel resection, inflammatory bowel disease involving the proximal small bowel, and malabsorption syndromes. 

Cyproheptadine, a serotonin and histamine receptor- and muscarinic cholinergic receptorblocking agent, has been used in the treatment of postgastrectomy dumping syndrome and the intestinal hypermotility seen with carcinoid. 

The major clinical applications of cyproheptadine are in the treatment of the smooth muscle manifestations of carcinoid tumor and in the postgastrectomy dumping syndrome. It is also the preferred drug in cold-induced urticaria. The usual dosage in adults is 12-16 mg/d in three or four divided doses. 

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