J.Jpn. Surg. Soc.. 61(4): 514-524, 1960

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THE CLINICAL PHASE OF THE EARLY POSTPRANDIAL SYMPTOM IN PATIENTS SUBJECTED TO GASTRECTOMY, TOTAL OR PARTIAL

Partial or total loss of the stomach as reservoir of the food ingested- an inevitable result of partial or total gastrectomy- gives rise to the development of several sequala , including the dumping syndrome. The dumping syndrome is of two types: The early postprandial symptom and the late postprandial symptom. The late postprandial sympton is manifested, as is generally known, as hypoglycemia.
My clinical observation of the development of the early postprandial symptom led to this conclusion.
1. 30 individuals subjected to total or partial gastrectomy stated in answer to my inquiry that they experienced the early postprandial symptom within 30 minutes after meals.
2. This symptom was 41.9% (39 out of 93 cases) in incidence among those subjected to total gastrectomy and leading an ordinary life- 43 .5% (30 of 69 cases) when the technique used was Tomoda's, 40.0% (2 of 5 cases) when the technique was esophagoduodenostomy, and 36.8% (7 of 19 cases) when it was esophagojejunostomy, showing that the incidence is not much varied according to the technique used. The incidence of the same disorder was 30.1 % (55 of 183 cases) among those subjected to partial gastrectomy- slightly lower after partial than after total gastrectomy- 30.6% (22 of 72 cases) when the technique used was Billroth's I, and 29.7% (33 of 111 cases when it was Billroth's II, these two techniques of Billroth producing no notable difference in the incidence.
3. The early postprandial symptom was manifested as general languor or general weakness in 93.3% of those cases, as fullness of the upper abdomen in 70.0%, as drowsiness in 38.3%, as palpitation in 30.0%, as perspiration in 26.7%, as nausea in 26.7%, as cold sweat in 23.3%, as heaviness of the head in 16.7%, as headache in 16.7%, and as belching in 13.3%, according to what 30 patients complaining, of this symptom told me personally in answer to my inquiry after total or partial gastrectomy, and also similarly according to what 94 patients with this symptom, inclusive of the former 30, told me by correspondence.
4. Another statistical survey of this symptom developing after total gastrectomy in 93 cases and partial gastrectomy in 183 cases- in 276 cases in all disclosed that the development of the early postprandial symptom was of more frequent occurrence before than after the 5th postoperative year, namely that the symptom in question was likely to persist for a long time after operation.
5. The kinds of food most provocative of the symptom in question were boiled rice, bread, sugar, and sweat meats, each containing carbohydrate in a large proportion, in 13 of 25 patients with the symptom (total gastrectomy performed in 12, partial gastrectomy in 13).
6. Comparison of the pre-and the postoperative body weight in 172 persons subjected to gastrectomy (total and partial gastrectomy in 70 and 102 of them, respectively) showed that the percentage of cases in which the body weight increased postoperatively was smaller for those with the symptom developed in them than for those free from it.
(Author's abstract)

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