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a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
selling goods abroad at a price below that charged in the domestic market

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(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態
(ごみなどの)投げ捨て,投げ降ロシ,投下 / (特に外国貿易において)商品の投げ売り,ダイビング

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/03/14 03:24:56」(JST)

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Gastric dumping syndrome, or rapid gastric emptying is a condition where ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested. It happens when the small intestine expands too quickly due to the presence of hyperosmolar (having increased osmolarity) contents from the stomach. This causes symptoms due to the fluid shift into the gut lumen with plasma volume contraction and acute intestinal distention.^[1] "Early" dumping begins concurrently within 15 to 30 minutes from ingestion of a meal.^[1] Symptoms of early dumping include nausea, vomiting, bloating, cramping, diarrhea, dizziness, and fatigue. "Late" dumping happens one to three hours after eating. Symptoms of late dumping include weakness, sweating, and dizziness. Many people have both types. The syndrome is most often associated with gastric bypass (Roux-en-Y) surgery.

Rapid loading of the small intestine with hypertonic stomach contents can lead to rapid entry of water into the intestinal lumen. Osmotic diarrhea, distension of the small bowel (leading to crampy abdominal pain), and hypovolemia can result.

In addition, people with this syndrome often suffer from low blood sugar, or hypoglycemia, because the rapid "dumping" of food triggers the pancreas to release excessive amounts of insulin into the bloodstream. This type of hypoglycemia is referred to as "alimentary hypoglycemia."

Diagnosis[edit]

Physicians diagnose dumping syndrome primarily on the basis of symptoms in patients who have had gastric surgery. Tests may be needed to exclude other conditions that have similar symptoms. Two ways of determining if a patient has dumping syndrome include barium fluoroscopy and radionuclide scintigraphy. In the first procedure, a contrast of barium-labeled medium is ingested and x-ray images are taken; early dumping can be easily recognized by premature emptying of the contrast medium from the stomach.

The second method, scintigraphy (or radionuclide scanning), involves a similar procedure in which a labeled medium containing ^99mTc (or other radionuclide) colloid or chelate is ingested. The ^99mTc isotope decays in the stomach, and the gamma photons emitted are detected by a gamma camera; the radioactivity of the area of interest (the stomach) can then be plotted against time on a graph. Patients with dumping syndrome generally exhibit steep drops in their activity plots, corresponding to abnormally rapid emptying of gastric contents into the duodenum.

Treatment[edit]

Dumping syndrome is largely avoidable by avoiding certain foods that are likely to cause it; therefore, having a bigger digestive tract balanced diet is important. Treatment includes changes in eating habits and medication. People who have gastric dumping syndrome need to eat several small meals a day that are low in carbohydrates, avoiding simple sugars, and should drink liquids between meals, not with them. Fiber delays gastric emptying and reduces insulin peaks. People with severe cases take medicine (such as octreotide and cholestyramine) or proton pump inhibitors (such as pantoprazole and omeprazole) to slow their digestion. Doctors may also recommend surgery. Surgical intervention may include conversion of a Billroth I to a Roux-en Y gastrojejunostomy.

References[edit]

^ ^a ^b John Del Valle (chapter author) (2010-01-21). "293. Peptic Ulcer Disease and Related Disorders". Harrison's Principles of Internal Medicine (18th ed.). Accessmedicine.com. Retrieved 2014-02-01. (subscription required)

http://digestive.niddk.nih.gov/ddiseases/pubs/rapidgastricemptying/index.htm

UpToDate Contents

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1. 肥満手術後患者の内科的マネージメント medical management of patients after bariatric surgery
2. 食後の（反応性）低血糖 postprandial reactive hypoglycemia
3. 肥満手術の合併症 complications of bariatric surgery
4. 消化性潰瘍のマネージメントにおける外科手術の役割 role of surgery in the management of peptic ulcer disease
5. 胃排出遅延の病因および診断 etiology and diagnosis of delayed gastric emptying

English Journal

Functional disorders and quality of life after esophagectomy and gastric tube reconstruction for cancer.

Poghosyan T, Gaujoux S, Chirica M, Munoz-Bongrand N, Sarfati E, Cattan P.SourceService de chirurgie generale, digestive et endocrinienne, hopital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Unite de therapie cellulaire, Inserm UMR 940, hopital Saint-Louis, 75010 Paris, France.
Journal of visceral surgery.J Visc Surg.2011 Oct 21. [Epub ahead of print]
Functional disorders such as delayed gastric emptying, dumping syndrome or duodeno-gastro-esophageal reflux occur in half of the patients who undergo esophagectomy and gastric tube reconstruction for cancer. The potential role for pyloroplasty in the prevention of functional disorders is still debat
PMID 22019835

Laparoscopic duodenojejunal bypass with sleeve gastrectomy: preliminary results of a prospective series from India.

Praveen Raj P, Kumaravel R, Chandramaliteeswaran C, Vaithiswaran V, Palanivelu C.SourceDepartment of Minimal Access Bariatric and Metabolic Surgery, Gem Hospital and Research Centre, 45 Pankaja Mill Road, Coimbatore, 641045, Tamil Nadu, India, praveenraj@me.com.
Surgical endoscopy.Surg Endosc.2011 Oct 13. [Epub ahead of print]
BACKGROUND: Bariatric surgeries are now redefined as metabolic surgeries given the excellent resolution of metabolic derangements accompanying obesity. Duodenojejunal bypass (DJB) is a novel metabolic surgery based on foregut hypothesis. Reports describe DJB as a stand-alone procedure for the treatm
PMID 21993937

Japanese Journal

症例報告胃亜全摘術後、後期ダンピング症候群を伴う妊婦の血糖管理にCGMが有効であった1例

葛谷実和,和栗雅子,小森綾乃 [他]
糖尿病と妊娠 : 日本糖尿病・妊娠学会誌 14(1), 120-125, 2014
NAID 40020200762

Using miglitol at 30 min before meal is effective in hyperinsulinemic hypoglycemia after a total gastrectomy

, , , , , , ,
Endocrine Journal 61(11), 1115-1123, 2014
A 45-year-old woman who had undergone total gastrectomy for gastric cancer presented with a history of postprandial hypoglycemic episodes with loss of consciousness after meals. Laboratory findings r …
NAID 130004677955

Octreotide improves early dumping syndrome potentially through incretins : a case report

SATO Daisuke,MORINO Katsutaro,OHASHI Natsuko,UEDA Emi,IKEDA Kazuhiro,YAMAMOTO Hideka,UGI Satoshi,YAMAMOTO Hiroshi,ARAKI Shinichi,MAEGAWA Hiroshi
Endocrine journal 60(7), 847-853, 2013-07-01
NAID 10031195752

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リンク元	「ダンピング症候群」
関連記事	「syndrome」

「ダンピング症候群」

Gastric dumping syndrome
	Classification and external resources
ICD-10	K91.1
ICD-9	564.2
DiseasesDB	31227
eMedicine	med/589
MeSH	D004377

　　[★]

英: dumping syndrome
関: 胃切除後症候群

概念

胃切除術を受けた患者の食後に見られる種々の腹部症状と全身症状。
胃の食塊保持機能が喪失されるためであり、胃切除後の他、幽門の機能が失われても同様の症状が起こりうる。
症状の出る時間帯で2つに分類され、一つは早期症状で高浸透圧の食塊の腸管への流入による腸管の拡張と高浸透圧による血管運動症状、もう一つは後期症状で、急激な高血糖に対して生じたインスリン過剰分泌による低血糖症状である。

早期症状

食後20-30分以内に起こりうる。

食後5-30分：冷や汗、動悸、顔面紅潮、頭痛、めまいなど。

小腸内に多量に流入した高張な食物により、直接・間接的に血管作動性物質が分泌される。血管作動性物質にはセロトニン、ブラジキニン、ヒスタミン、　GIPなどがある。

食後30-60分：悪心・嘔吐、腹痛、腹部膨満感、下痢など。上部空腸の過伸展、蠕動亢進による

後期症状/晩期症状

2-3時間後に起こる。

全身倦怠感、めまい、心悸亢進、発汗、悪心など

急激な糖分の吸収により高血糖をきたし、これに対するインスリン過剰分泌により低血糖をきたすために起こる。

治療・予防

後期症状に対しては速やかに糖分摂取
ダンピング症候群自体の予防として、単糖類への分解を阻害する薬剤の同時摂取により高血糖を予防する試みがある。

「syndrome」

　　[★]

n.

症候群

[:0-1] John Del Valle (chapter author) (2010-01-21). "293. Peptic Ulcer Disease and Related Disorders". Harrison's Principles of Internal Medicine (18th ed.). Accessmedicine.com. Retrieved 2014-02-01. (subscription required)

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案内

案内

dumping syndrome