After resection of the stomach for peptic ulcer of the stomach and duodenum, post-resection disorders often develop . The most commonly observed dumping syndrome.
With dumping syndrome, a special type of metabolic disturbances is noted, which are based on shifts in biochemical homeostasis associated with a breakdown of the neurohumoral regulatory activity of the body. With a frequent repetition of expressed vegetative reactions, serious metabolic status disorders occur – metabolic maladaptation , as a result of which the coordinated and synchronous activity of the organs of the gastrointestinal tract is disturbed. With functional disorders of the liver and pancreas, a decrease in enzymatic activity and micro-changes in the mucous membrane of the gut with the development of conditionally pathogenic microflora in the intestinal lumen and a decrease in the acid-producing function of the gastric stump, these metabolic disorders can lead to poor absorption and absorption of nutrients. Patients have asthenia, weight loss, anemia, hypovitaminosis, as well as a change in neuropsychic status.
Some patients have marked metabolic disorders with the development of alimentary dystrophy.
The neurohumoral disorders detected in patients with dumping syndrome, pathophysiological changes in the digestive system, metabolic changes are the theoretical justification for the development of the principles of differentiated dietary therapy for these patients, taking into account different periods after surgery, the severity of dumping syndrome, the nature of the accompanying diseases and the consequences of reconstructive operations. Its main principle is the appointment of frequent high-calorie meals in fractional portions. The protein content is increased to 2-2.2 g per 1 kg of body weight, easily digestible carbohydrates significantly limit. The content of fat and complex carbohydrates is provided within normal limits.
After partial resection of the stomach, the secretion of gastric enzymes, pepsin and gastricin , is significantly upset , which can lead to violations of protein digestion in the stomach. Given this factor, it is necessary to include crushed protein dishes in the diet of patients, which are easier to digest and are attacked by pancreatic and small intestine enzymes.
In the very first days after the operation, when it is possible to start feeding the patient, protein dishes are included in the diet, protein entit is
administered. The appointment of an increased amount of protein in the early postoperative period is necessary due to a tendency to catabolic processes, as well as an electrolyte imbalance.
The high protein content in the diet provides the body with enough fat. Patients with dumping syndrome tolerate fat in protein products well. The amount of fat is reduced to the lower limit of the norm with concomitant pancreatitis.
Recommendations to increase the proportion of fat in the diet of patients with dumping syndrome to the upper limit of the norm are due to biologically important properties of fat (rich in vitamins, lipotropic substances, fatty acids, participation in the synthesis of a number of hormones, enzymes and biologically active substances, the ability to improve the taste of food). Due to frequent complications from the biliary tract and gall bladder, as well as a tendency to lipidemia, patients should not abuse fats. Refractory fats and fat breakdown products must be limited.
The content of complex carbohydrates should be within the lower limit of normal (for patients with severe dumping syndrome no more than 300 g per day). A sufficient amount of polysaccharides provides the correct ratio in the diet of basic nutrients, increases the calorie intake and is well tolerated by patients. Complex carbohydrates, being slowly absorbed, do not cause sharp changes in enzyme and hormonal systems. 1 Enpits are new drugs intended for the enteral nutrition of seriously ill patients, developed by the Institute of Nutrition of the Academy of Medical Sciences.
Along with all the above principles, the diet should contain the maximum possible number of food factors that stimulate hematopoiesis . It is important to ensure a sufficient intake of iron with food.
In the first 2-4 months after surgery, in connection with the postoperative inflammatory process, it is recommended to observe the principle of mechanical dizziness . In the long term in the presence of peptic ulcers, pancreatitis, aiastomositis , enteritis, food should also be mechanically sparing. In all other cases, you need to give unprotected food, it is better tolerated by patients with dumping syndrome, and the assimilation of peppermint food is not much different from the assimilation of rubbed.
It is better to cook food with a viscous or jelly-like consistency, limit the amount of liquid during meals, since mostly liquid food containing readily soluble nutrients causes dumping syndrome. Such a diet has the least irritating effect on the receptors of the mucous membrane of the small intestine, thereby preventing the development of a dumping reaction. In addition, opa promotes the formation of adaptation mechanisms to new digestive conditions.
Given the changes in the hepatobiliary system, small intestine, pancreas, stomach stump, anastomosis, in the preparation of diets for patients demping- sipdromom the principle of moderate chemical schazheniya , t. E. Chemical irritants are eliminated gastrointestinal secretion and harsh stimulants, as well as limited foods containing coarse fiber are limited.
For patients with dumping syndrome with a deficit of body weight, an increase in the calorie content of the diet is provided.
When preparing medical nutrition, dishes and products that provoke the occurrence of dumping syndrome are excluded.
Diet therapy is built differentially and in stages, depending on the clinical picture of the syndrome, the presence of concomitant diseases, and the time elapsed after the operation.
For patients with peptic ulcer who underwent a resection of the stomach, several diet options are offered: with mechanical sparing , without mechanical pressing , with severe form of dumping syndrome, for patients with concomitant pancreatitis, in the early postoperative period, etc. In all recommended dietary options, the principle of chemical sparing , the patient’s daily need for vitamins, minerals and essential amino acids is provided.