Effect of Ingestion of Hyperosmotic Glucose Solutions on the Systemic and Splanchnic Circulation in Partially Gastrectomized Patients with Histories of Dumping Syndrome

Abstract

The circulatory pattern during a provoked dumping reaction in the sitting position was studied in eleven partially gastrectomized patients. The splanchnic blood flow (BSP technique), the cardiac output (direct Fick method) and the pressures in the pulmonary and brachial arteries were repeatedly monitored before and after an oral glucose test meal. Five patients responded with marked symptoms, including one with syncope, and six responded with slight symptoms. All of those with marked symptoms exhibited an arterial pressure fall in spite of augmented cardiac outputs, elevated stroke volumes and increased heart rates. In four cases the pressure fall was outside the range observed in the group with slight symptoms. Five of the six patients with slight symptoms had an increased cardiac output and slight, albeit significant decreases of the arterial blood pressure. One patient showed a slight increase in arterial blood pressure. Coincident determinations of cardiac output and splanchnic blood flow in seven cases showed that in two of them the increase of cardiac output was commensurate with that of the splanchnic blood flow. In the remaining five cases the cardiac output increased more than the splanchnic blood flow. The implications of these hemodynamic data for the pathophysiology of the dumping syndrome are discussed.