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Just saying that if chewing food better doesn't improve your wife's condition then perhaps she should be checked for strictures and stomal stenosis if she hasn't already been. Hope she gets some relief soon from her dumping syndrome.
Vomiting and dumping syndrome Vomiting almost always occurs during the first few months after surgery and is often described as “spitting up food that is stuck.” It typically happens one to three times a week and is usually due to overeating or not chewing food adequately. Patients need to adjust to the much smaller gastric pouch that now receives food from the esophagus; bariatric surgery has diminished the stomach’s ability to grind food into small particles. Vomiting is well tolerated by most patients. If vomiting becomes more frequent, low potassium and/or low magnesium levels often occur, requiring oral replacement. Liquid forms of potassium are available but are not well tolerated by patients due to palatability; fortunately, by postoperative month 1, pills are usually able to pass through the anastomotic or restricted portion of the stomach. To ensure that the potassium can traverse the 1-cm anastomoses, smaller pills or capsules are often prescribed.
Vomiting can signal other problems and is associated with strictures and stomal stenosis. Intolerance for solid foods is a key symptom; if this develops, then endoscopic evaluation should be strongly considered. If intolerance to solid food develops 6 months after surgery, then the diagnosis of stenosis is very high. In one study, abnormal findings at endoscopy showed stomal stenosis in 39% of patients with nausea, vomiting, or dysphagia referred for endoscopy (3). Such stenosis can usually be treated by balloon dilation at the time of diagnosis. Many of these patients will require repeat dilations, determined by their ability to tolerate most solid foods.
Dumping syndrome is an extremely common, and somewhat intentional, problem
after gastric bypass. High-osmolarity foods (e.g., foods high in sugar
content), after bypassing much of the stomach undigested, cause an osmotic
overload upon entering the small intestine. This osmotic overload brings
fluid into the lumen of the small intestine, resulting in a vagal reaction.
Patients will often complain about lightheadedness and sweating after eating
a high-glucose meal or drinking fluid with a meal. This is a very
uncomfortable feeling and is accompanied by impressive fatigue. Diarrhea may
or may not occur, as there is usually sufficient distal bowel to absorb such
food, and nutritional problems are rare. Foods that are identified in our
clinic as causing dumping syndrome include ice cream and pastries.
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