Department of Medicine, Division of Endocrinology and Metabolism, Shiga University of Medical Science, Otsu 520-2192, Japan.
Endocr J. 2013;60(7):847-53. doi: 10.1507/endocrj.ej12-0288. Epub 2013 Apr 3.
Dumping syndrome, or rapid gastric emptying, is a frequent complication after gastric surgery. In this case, the patient was a 47-year-old woman who 10 years previously had undergone distal gastrectomy with Billroth I reconstruction for early-stage gastric cancer. She presented with symptoms of weakness, headache, palpitation, sweating, dizziness and significant fatigue between one and two hours after a meal. Because a 75 g oral glucose tolerance test (75 g-OGTT) induced both acute postprandial tachycardia (within 1 hour) and postprandial hypoglycemia, we diagnosed this patient with early and late dumping syndrome. Dietary measures and acarbose improved symptoms of late dumping syndrome but did not prevent the symptoms of early dumping syndrome such as postprandial tachycardia, weakness, headache, palpitation, and dizziness. We therefore used the somatostatin analogue octreotide, which has been reported as an effective therapy for early dumping syndrome. Octreotide prevented the symptoms of early dumping syndrome, especially postprandial tachycardia, but caused postprandial hyperglycemia. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were completely suppressed during the 75 g-OGTT following subcutaneous injection of octreotide. No change was observed in vasoactive intestinal polypeptide (VIP), which is the gastrointestinal peptide hormone generally responsible for early dumping syndrome, suggesting possible contribution of incretins in early dumping syndrome of this patient.
倾倒综合征，又称“胃排空过速”，是胃手术后常见的并发症。本例患者为 47 岁女性，10 年前因早期胃癌行远端胃大部切除毕Ⅰ式吻合术。她表现为餐后 1~2 小时出现乏力、头痛、心悸、出汗、头晕和明显疲劳等症状。因 75 g 口服葡萄糖耐量试验（75 g-OGTT）可同时引起餐后即刻心动过速（1 小时内）和餐后低血糖，我们诊断该患者为早、晚期倾倒综合征。饮食和阿卡波糖改善了晚期倾倒综合征的症状，但未能预防餐后心动过速、乏力、头痛、心悸和头晕等早期倾倒综合征症状。我们随后使用了生长抑素类似物奥曲肽，该药物已被报道为治疗早期倾倒综合征的有效疗法。奥曲肽预防了早期倾倒综合征的症状，尤其是餐后心动过速，但引起了餐后高血糖。奥曲肽皮下注射后，75 g-OGTT 期间完全抑制了胰高血糖素样肽-1（GLP-1）和葡萄糖依赖性胰岛素释放肽（GIP），而血管活性肠肽（VIP）没有变化，VIP 通常被认为是引起早期倾倒综合征的胃肠肽激素，这表明该患者的早期倾倒综合征可能与肠促胰岛素有关。
