Aim: Dumping syndrome is a well-known adverse outcome after gastrectomy, but the precise clinical features have not been described. The aim of this study was to examine global aspects of dumping syndrome and to explore factors affecting the intensity of dumping syndrome in a large cohort using a newly developed integrated questionnaire, the Post-Gastrectomy Syndrome Assessment Scale (PGSAS)-45. Methods: Eligible questionnaires retrieved from 2,368 patients after 6 types of gastrectomy were analyzed. The incidence, intensity and number of symptoms of early general, early abdominal and late dumping syndrome were examined across various types of gastrectomy, and clinical factors affecting the intensity of each category of dumping syndrome were identified by multiple regression analysis. Results: Dumping syndromes occurred most frequently and strongly in patients who underwent total gastrectomy with Roux-en-Y (TGRY), followed by proximal gastrectomy (PG), distal gastrectomy with Billroth-I, distal gastrectomy with Roux-en-Y, pylorus-preserving gastrectomy (PPG) and local resection (LR), in that order. Significant positive correlations among different categories of dumping syndromes were observed. TGRY, female sex, younger age, division of the celiac branch of the vagus nerve, PG and shorter postoperative period were independently related to worse dumping syndrome. Conclusions: Dumping syndromes were most common after TGRY and least common after PPG and LR among the various gastrectomy procedures. Type of gastrectomy and several clinical factors were related to the intensity of dumping syndrome. PGSAS-45 could offer a useful tool for evaluating dumping syndrome after gastrectomy.

1.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-2917.
2.
Custer MD Jr, Butt HR, Waugh JM: The so-called dumping syndrome after subtotal gastrectomy. Ann Surg 1946;123:410-418.
3.
Abbott WE, Krieger H, Levey S, Bradshaw J: The etiology and management of the dumping syndrome following a gastroenterostomy or subtotal gastrectomy. Gastroenterology 1960;39:12-27.
4.
Bender MA, Moore GE, Webber BM: Dumping syndrome; an evaluation of some current etiologic concepts. N Engl J Med 1957;256:285-289.
5.
Tack J, Arts J, Caenepeel P, De Wulf D, Bisschops R: Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol 2009;6:583-590.
6.
Nakada K, Ikeda M, Takahashi M, Kinami S, Yoshida M, Uenosono Y: Characteristics and clinical relevance of postgastrectomy syndrome assessment scale (PGSAS)-45: newly developed integrated questionnaires for assessment of living status and quality of life in post-gastrectomy patients. Gastric Cancer 2014;18:147-158.
7.
Takiguchi N, Takahashi M, Ikeda M, Inagawa S, Ueda S, Nobuoka T: Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by postgastrectomy syndrome assessment scale (PGSAS-45): a nationwide multi-institutional study. Gastric Cancer 2015;18:407-416.
8.
Ware J, Kosinski M, Dewey JE, Gandek B: How to Score and Interpret Single-Item Health Status Measures: A Manual for Users of the SF-8 Health Survey. Boston, QualityMetric Incorporated, 2001.
9.
Svedlund J, Sjödin I, Dotevall G: GSRS - a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 1988;33:129-134.
10.
Dimenäs E, Glise H, Hallerbäck B, Hernqvist H, Svedlund J, Wiklund I: Well-being and gastrointestinal symptoms among patients referred to endoscopy owing to suspected duodenal ulcer. Scand J Gastroenterol 1995;30:1046-1052.
11.
Ralphs DN, Thomson JP, Haynes S, Lawson-Smith C, Hobsley M, Le Quesne LP: The relationship between the rate of gastric emptying and the dumping syndrome. Br J Surg 1978;65:637-641.
12.
Eagon JC, Miedema BW, Kelly KA: Postgastrectomy syndromes. Surg Clin North Am 1992;72:445-465.
13.
Hertz AF: IV. The cause and treatment of certain unfavorable after-effects of gastro-enterostomy. Ann Surg 1913;58:466-472.
14.
Mix CL: Dumping stomch' following gastrojejunosyomy. Surg Clin North Am 1922;2:617-622.
15.
Davies J, Johnston D, Sue-Ling H, Young S, May J, Griffith J, et al: Total or subtotal gastrectomy for gastric carcinoma? A study of quality of life. World J Surg 1998;22:1048-1055.
16.
Bae JM, Kim S, Kim YW, Ryu KW, Lee JH, Noh JH, et al: Health-related quality of life among disease-free stomach cancer survivors in Korea. Qual Life Res 2006;15:1587-1596.
17.
Tyrväinen T, Sand J, Sintonen H, Nordback I: Quality of life in the long-term survivors after total gastrectomy for gastric carcinoma. J Surg Oncol 2008;97:121-124.
18.
Thybusch-Bernhardt A, Schmidt C, Küchler T, Schmid A, Henne-Bruns D, Kremer B: Quality of life following radical surgical treatment of gastric carcinoma. World J Surg 1999;23:503-508.
19.
Svedlund J, Sullivan M, Liedman B, Lundell L, Sjödin I: Quality of life after gastrectomy for gastric carcinoma: controlled study of reconstructive procedures. World J Surg 1997;21:422-433.
20.
Shibata C, Shiiba KI, Funayama Y, Ishii S, Fukushima K, Mizoi T, et al: Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg 2004;28:857-861.
21.
Takiguchi S, Yamamoto K, Hirao M, Imamura H, Fujita J, Yano M, et al: A comparison of postoperative quality of life and dysfunction after Billroth I and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer: results from a multi-institutional RCT. Gastric Cancer 2012;15:198-205.
22.
Tokunaga M, Hiki N, Ohyama S, Nunobe S, Miki A, Fukunaga T, et al: Effects of reconstruction methods on a patient's quality of life after a proximal gastrectomy: subjective symptoms evaluation using questionnaire survey. Langenbecks Arch Surg 2009;394:637-641.
23.
Namikawa T, Oki T, Kitagawa H, Okabayashi T, Kobayashi M, Hanazaki K: Impact of jejunal pouch interposition reconstruction after proximal gastrectomy for early gastric cancer on quality of life: short- and long-term consequences. Am J Surg 2012;204:203-209.
24.
Mine S, Sano T, Tsutsumi K, Murakami Y, Ehara K, Saka M, et al: Large-scale investigation into dumping syndrome after gastrectomy for gastric cancer. J Am Coll Surg 2010;211:628-636.
25.
Sano T, Aiko T: New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer 2011;14:97-100.
26.
Gertler R, Rosenberg R, Feith M, Schuster T, Friess H: Pouch vs. no pouch following total gastrectomy: meta-analysis and systematic review. Am J Gastroenterol 2009;104:2838-2851.
27.
Yamada H, Kojima K, Inokuchi M, Kawano T, Sugihara K: Efficacy of celiac branch preservation in Roux-en-y reconstruction after laparoscopy-assisted distal gastrectomy. Surgery 2011;149:22-28.
28.
Takiguchi S, Hiura Y, Takahashi T, Kurokawa Y, Yamasaki M, Nakajima K, et al: Preservation of the celiac branch of the vagus nerve during laparoscopy-assisted distal gastrectomy: impact on postprandial changes in ghrelin secretion. World J Surg 2013;37:2172-2179.
29.
Lippmann QK, Crockett SD, Dellon ES, Shaheen N: Quality of life in GERD and Barrett's esophagus is related to gender and manifestation of disease. Am J Gastroenterol 2009;104:2695-2703.
30.
Simrén M, Abrahamsson H, Svedlund J, Björnsson ES: Quality of life in patients with irritable bowel syndrome seen in referral centers versus primary care: the impact of gender and predominant bowel pattern. Scand J Gastroenterol 2001;36:545-552.
31.
Kurokawa Y, Sasako M, Sano T, Shibata T, Ito S, Nashimoto A, Kurita A, et al: Functional outcomes after extended surgery for gastric cancer. Br J Surg 2011;98:239-245.
32.
Kobayashi D, Kodera Y, Fujiwara M, Koike M, Nakayama G, Nakao A: Assessment of quality of life after gastrectomy using EORTC QLQ-C30 and STO22. World J Surg 2011;35:357-364.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.