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Absorption and Digestion After Surgery

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The following article is reprinted by kind permission of the Oesophageal Patients Association (OPA) and Stephanie Wakefield (article author).

Contact the OPA via their website - WWW.OPA.ORG.UK

Useful information on Vitamin Deficiency, Dumping and Blood Sugar levels for Upper GI Patients

The following is adapted from a talk entitled “Absorption and Digestion after Surgery” given by Stephanie Wakefield, a specialist Upper GI dietician from Imperial Collage Healthcare NHS Trust.  It is based on studies she has carried out for her Master’s degree which is due to be published early in 2012.  A text summary of information contained in her slides follows:

General Post-Operative Matters

Post-operative symptoms :
Reduced appetite
Nausea, reflux, regurgitation & vomiting
Taste disturbance & food aversions
Diarrhoea & steatorrhoea
Dumping syndrome
Tiredness & pain
Reduced intake and weight loss

Altered digestion
Decreased gastric lipase
Altered pH
Decreased surface area, resection of distal end
Duodenum bypassed with Roux-en-Y
Decreased pancreatic juice
Inadequate mixing
Decreased transit time
Small bowel bacterial overgrowth

Vitamin Deficiency Issues

Vitamin & mineral absorption
Fat soluble vitamins: A, D, E (antioxidant)
Water soluble vitamins: B1, B12, folic acid
Minerals: zinc, ferritin

Study results
Zinc levels decreased with age
Ferritin levels lowest in oesophagectomy
Vitamin D levels increased with time and levels higher in those drinking alcohol
Multivitamin reduced deficiencies
Chemotherapy had no impact on levels
PPI had no impact on levels


Regular screening for vitamin D, B12, ferritin and zinc should be considered
Prophylactic supplementation should also be considered to prevent deficiency
GP’s advice on both should be sought.

See graph below for mineral deficiencies that Upper GI patients are susceptible to.

Dumping Issues
a) Early dumping is within 30 minutes of eating. Carbohydrates enter the digestive tract quickly and disturb the osmotic balance (concentrations) causing dizziness, faintness, palpitations, low blood pressure, cramping and diarrhoea. Resting immediately after eating may help.

b) Late Dumping normally occurs 2 - 3 hours after eating or if a meal is missed. It is primarily caused by poorly timed insulin release for the amount of food entering the digestive system and results in feeling faint or sick and shaky. Consuming sugary food may help.

Recommendations for dumping
Avoid refined carbohydrate, chose lower glycaemic index foods
Include starchy foods as part of meals
Small, frequent & regular meals and snacks
Chew well eat slowly
Keep liquids separate from meals
Dry foods may help
Loperamide (Imodium) and Creon may help

Should we be eating Low Glycaemic Index Foods minimise dumping?
Not all carbohydrate foods behave the same way in our bodies, and the Glycaemic Index rates foods according to how much they affect our blood-glucose levels. So this can become very relevant if you suffer from dumping syndrome or diabetes. Ask your specialist dietician for advice about whether concentrating on low glycaemic index goods might be better for you.  The following table summarises the Glycaemic Index for some common groups of food.

PPIs after surgery

Protein Pump Inhibitors (tablets to reduce stomach acid) such as Lamprazole may be required after Oesophagectomy or subtotal gastrectomy, but should not be required after total gastrectomy

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