Gastric emptying after peptic ulcer surgery. Some pathophysiological mechanisms of the dumping syndrome

In 76 patients before or after different operations for peptic ulceration, the gastric emptying and changes in plasma volume and blood glucose were studied after ingestion of a radionuclide-labelled hypertonic glucose meal. The patients were divided into three clinical categories in accordance with their spontaneous symptoms of dumping after ordinary meals: (a) 26 postoperative patients formed a dumping group, (b) 30 postoperative patients formed a non-dumping group, and (c) 20 preoperative patients formed a control group. A precipitous early phase of gastric emptying was the only specific finding in patients with spontaneous symptoms of dumping. This early fraction of precipitous emptying was not present preoperatively or in patients without symptoms. It is concluded that the excessively rapid delivery of the hypertonic solution into the upper intestine is the primary stimulus leading to the changes in plasma volume and blood glucose observed in the dumping syndrome. The response of the jejunum with regard to the blood glucose and haematocrit rises is considered proportionate to the given stimulus.