Signs and symptoms of malabsorption after surgical procedures can be subtle and recognized late. This article reviews some of the more common surgical procedures potentially associated with malabsorption and suggests techniques of nutrition intervention. Early recognition, and preferably preventative care, should result in improved patient outcome.
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References
1.
Radzuik J., Bondy DCAbnormal oral glucose tolerance and glucose malabsorption after vagotomy and pyloroplasty. Gastroenterol1982;83:1017-25.
2.
Shils ME, Gilat T.The effect of esophagectomy on absorption in man: clinical and metabolic observations . Gastroenterol1966;50:347-57.
3.
Wilson THIntestinal absorption. Philadelphia: WB Saunders Company, 1962.
4.
Ellison EHNutritional problems following gastric resection. Surg Clin North Am1955;35:1683-92.
5.
Johnson CFMalabsorption syndromes. Clinical and theoretical considerations. Postgrad Med1965;37:667-76.
6.
Wollaeger EE , Waugh JM, Power MHFat-assimilating capacity ofthe gastrointestinal tract after partial gastrectomy (Billroth I anastomosis) . Gastroenterology1963;44:25-32.
7.
Taylor TV, Lambert ME, Qureshi S., et al. Should cholecystectomy be combined with vagotomy and pyloroplasty ? Lancet1978;1:295-8.
8.
Leading Article.Osteomalacia after gastrectomy. Lancet1986;1:77-8.
9.
Hopman WPM , Wolberink RGJ , Lamers CBHW , et al. Treatment of the dumping syndrome with the somatostatin analogue SMS 201-995. Ann Surg1988;207:155-9.
10.
Beal JM, Briggs JD, Longmire WP Jr.Use of a jejunal segment to replace the stomach following total gastrectomy . Am J Surg1954;88:194-9.
11.
Longmire WP Jr, Beal JMConstruction of a substitute gastric reservoir following total gastrectomy. Ann Surg1952 ;135:637-45.
12.
Scott HW Jr, Weidner MGTotal gastrectomy with Roux-en-Y esophagojejunostomy in treatment of gastric cancer. Ann Surg1956 ;143:682-96.
13.
Bradley EL, Isaacs J., Hersh T., et al. Nutritional consequences of total gastrectomy. Ann Surg1975;182:415-29.
14.
Everson TCNutrition following total gastrectomy, with particular reference to fat and protein assimilation. Collective review. Surg Gynecol Obstet1952;95:209.
15.
Baldwin JN, Albo R., Jaffe B., et al. Metabolic effects of selective and total vagotomy. Surg Gynecol Obstet1965;120:777-83.
16.
Hayama T., Magee DF, White TTInfluence of automatic nerves on the daily secretion of pancreatic juice in dogs. Ann Surg1963;158:290-4.
17.
Farris JM, Smith GKVagotomy and pyloroplasty for bleeding duodenal ulcer. Am J Surg1963;105:388-95.
18.
Harkins HN, Stavney LS, Griffith CA, et al. Selective gastric vagotomy. Ann Surg1963;158:448-60.
19.
Koo J., Lam SK, Chan P., et al. Proximal gastric vagotomy, truncal vagotomy with drainage, and truncal vagotomy with antrectomy for chronic duodenal ulcer. A prospective, randomized controlled trial. Ann Surg1983;197:265-71.
20.
Knight CD, Van Heerden JA, Kelly KAProximal gastric vagotomy. Update. Ann Surg1983;197:22-6.
21.
Doty JE, Meyer JHVagotomy and antrectomy impairs canine fat absorption from solid but not liquid dietary sources. Gastroenterology1988;94:50-6.
22.
Fox HJ, Grimson KSDefective fat absorption following vagotomy. J Lab Clin Med1950;35:362-5.
23.
Losowsky MS, Walker BE, Kelleher J.Malabsorption in clinical practice. London: Churchill-Livingstone, 1974;191.
24.
Radziuk J., Bondy DCAbnormal oral glucose tolerance and glucose malabsorption after vagotomy and pyloroplasty. Gastroenterology1982;83:1017-25.
25.
Souba WW, Klimberg VS, Plumley DA, et al. The role of glutamine in maintaining a healthy gut and supporting the metabolic response to injury and infection. J Surg Res1990;48:383-91.
26.
Alverdy JA, Aoys E., Weiss-Carrington P., et al. The effect of glutamine-enriched TPN on gut immune cellularity . J Surg Res1992;52:34-8.
Inoue Y., Grant JP, Snyder PJEffect of glutamine- supplemented TPN on recovery of the small intestine after starvation atrophy. JPEN1993;17:165.
29.
Burke DJ, Alverdy JC, Aoys E., et al. Glutamine-supplemented total parenteral nutrition improves gut immune function. Arch Surg1989;124:1396.
30.
Compston JE , Ayers AB, Horton LWL, et al. Osteomalacia after small-intestinal resection. Lancet1978 ;1:9-12.
31.
Cattel RBMassive resection of the small intestine. Lahey Clin Bull1945;4:167.
32.
Haymond HEMassive resection of the small intestine: an analysis of 257 collected cases . Surg Gynecol Obstet935;61:693-705.
33.
Meyer HWAcute superior mesenteric artery thrombosis. Recovery following extensive resection of small and large intestines. Arch Surg1946;53:298-303.
34.
Todd WR, Ditterbrandt M., Montague JR, et al. Digestion and absorption in a man with all but three feet of the small intestine removed surgically. Am J Dig Dis1940;7:295-7.
35.
Weckesser EC , Chinn AB, Scott MW, et al. Extensive resection of the small intestine . Am J Surg1949;78:706-14.
36.
Williamson RCN , Chir M.Intestinal adaptation. N Engl J Med1978;298:1393-1402 and 1444-50.
37.
Singleton AO , Redmond DC, McMurray JEIleocecal resection and small bowel transit and absorption. Ann Surg1964;159:690-4.
38.
Frederick PL , Sizer JS, Osborne MPRelation of massive bowel resection to gastric secretion. N Engl J Med1965;272:509-14.
39.
Byrne TA, Persinger RL, Young LS, et al. A new treatment for patients with short-bowel syndrome. Growth hormone, glutamine, and a modified diet. Ann Surg1995;222:243-55.
40.
Cortot A., Fleming CR, Malagelada JRImproved nutrient absorption after cimetidine in short-bowel syndrome with gastric hypersecretion. N Engl J Med1979;300:79-80.
41.
Murphy JP Jr, King DR, Dubois A.Treatment of gastric hypersecretion with cimetidine in the short-bowel syndrome. N Engl J Med1979;300:80-1.
Rutgeerts P. , Ghoos Y., Vantrappen G., et al. Ileal dysfunction and bacterial overgrowth in patients with Crohn's disease. Eur J Clin Invest1981;11:199-206.
46.
Kim YS, Spritz N., Blum M., et al. The role of altered bile acid metabolism in the steatorrhea of experimental blind loop. J Clin Invest1966;45:956-62.
47.
Braga M., Cristallo M., DeFranchis R., et al. Correction of malnutrition and maldigestion with enzyme supplementation in patients with surgical suppression of exocrine pancreatic function. Surg Gynecol Obstet1988;167:485-92.
48.
Atkinson M., Nordin BEC, Sherlock S.Malabsorption and bone disease in prolonged obstructive jaundice. Q J Med1956;25:299-312.
49.
Sherlock S.Primary biliary cirrhosis (chronic intrahepatic obstructive jaundice). Gastroenterology1959 ;37:574-86.
Cerra FB, Cheung NK, Fischer JE, et al. Disease-specific amino acid infusion (F080) in hepatic encephalopathy: a prospective, randomized, double-blind, controlled trial. JPEN1985;9:288-95.
52.
Blackburn GL , O'Keefe SJD.Nutrition in liver failure . Gastroenterology1989;97:1049-51.
53.
Freund H., Dienstag J., Lehrich J., et al. Infusion of branched-chain enriched amino acid solution in patients with hepatic encephalopathy. Ann Surg1981 ;196:209-20.
54.
Strauss E.Treatment of hepatic encephalopathy: a randomized clinical trial comparing a branched-chain enriched amino acid solution to oral neomycin. Nutr Support Serv1986;6:18-23.
55.
Cerra FB, McMillen M., Angelico R., et al. Cirrhosis, encephalopathy, and improved results with metabolic support. Surgery1983;94:612-9.
56.
Rossi-Fanelli F., Riggo O., Cangiano C., et al. Branched-chain amino acids vs lactulose in the treatment of hepatic coma. A controlled study . Dig Dis Sci1982;27:929-35.
57.
Wahren J., Denis J., Desurmont P., et al. Is intravenous administration of branched chain amino acids effective in the treatment of hepatic encephalopathy? A multicenter study . Hepatology1983;3:475-80.
58.
Conn HOBranched chain amino acids in hepatic encephalopathy. Hepatology1986;6:148-50.
59.
Naveau S., Pelletier G., Poynard T., et al. A randomized clinical trial of supplementary parenteral nutrition in jaundiced alcoholic cirrhotic patients. Hepatology1986;6:270-4.
60.
Achord JLA prospective randomized clinical trial of peripheral amino acid-glucose supplementation in acute alcoholic hepatitis. Am J Gastroenterol1987;82:871-5.
61.
Calvey H., Davis M., Williams R.Controlled trial of nutritional supplementation, with and without branched chain amino acid enrichment, in treatment of acute alcoholic hepatitis . J Hepatol1985;1:141-51.
