{"id":8054,"date":"2024-09-07T13:30:44","date_gmt":"2024-09-07T11:30:44","guid":{"rendered":"https:\/\/gastropedia.pub\/es\/?p=8054"},"modified":"2025-05-10T00:33:46","modified_gmt":"2025-05-09T22:33:46","slug":"sindrome-de-dumping","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/es\/cirugia\/sindrome-de-dumping\/","title":{"rendered":"S\u00edndrome de Dumping"},"content":{"rendered":"
El S\u00edndrome de Dumping es una combinaci\u00f3n de s\u00edntomas gastrointestinales y vasomotores debido al vaciado g\u00e1strico postprandial r\u00e1pido<\/p>\n
\n
Los s\u00edntomas gastrointestinales<\/strong> incluyen dolor abdominal, saciedad temprana, n\u00e1usea, v\u00f3mito, diarrea y distensi\u00f3n abdominal.<\/li>\n
Los s\u00edntomas vasomotores<\/strong> sist\u00e9micos incluyen sudoraci\u00f3n, taquicardia, palpitaciones, dolor de cabeza y s\u00edncope.<\/li>\n<\/ul>\n
Este s\u00edndrome puede desarrollarse despu\u00e9s de cualquier operaci\u00f3n en el est\u00f3mago, pero es m\u00e1s com\u00fan despu\u00e9s de la gastrectom\u00eda parcial con la reconstrucci\u00f3n de Billroth II. Tambi\u00e9n puede ocurrir despu\u00e9s de la gastroplastia reductora (bypass) con una incidencia entre el 10-20%. Es menos com\u00fan despu\u00e9s de la reconstrucci\u00f3n a Billroth I y la Gastrectom\u00eda Vertical (Sleeve). A\u00fan no existen datos confiables sobre la prevalencia exacta del s\u00edndrome de dumping en el postoperatorio. Se estima que el 5 a 10% de los pacientes con Sd dumping presentan una forma incapacitante grave.<\/p>\n
Fisiopatolog\u00eda<\/strong><\/h2>\n
El S\u00edndrome de Dumping puede dividirse en precoz y tard\u00edo.<\/p>\n
El S\u00edndrome de Dumping<\/strong> precoz<\/strong> ocurre dentro de los 30 minutos despu\u00e9s de la comida y es el resultado del paso r\u00e1pido de alimentos de alta osmolaridad del est\u00f3mago al intestino delgado.<\/p>\n
Esto ocurre porque la gastrectom\u00eda (o cualquier interrupci\u00f3n del mecanismo del esf\u00ednter pil\u00f3rico), impide que el est\u00f3mago prepare su contenido y los entregue al intestino proximal en forma de peque\u00f1as part\u00edculas en soluci\u00f3n isot\u00f3nica. El bolo alimenticio hipert\u00f3nico pasa al intestino delgado, induciendo:<\/p>\n
\n
un r\u00e1pido desplazamiento de l\u00edquido extracelular hacia el lumen intestinal para alcanzar isotonicidad. El desplazamiento del l\u00edquido extracelular provoca distensi\u00f3n luminal e induce los s\u00edntomas gastrointestinales.<\/li>\n
liberaci\u00f3n de varios hormonas gastrointestinales, como tales como sustancias vasoactivas (neurotensina, p\u00e9ptido vasoactivo intestinal (VIP), incretinas (GIP, GLP1) y moduladores de la glucosa (insulina, glucag\u00f3n), que inducen s\u00edntomas vasomotores (ver abajo).<\/li>\n<\/ul>\nS\u00edndrome de dumping precoz<\/em><\/figcaption><\/figure>\n
El S\u00edndrome de Dumping tard\u00edo<\/strong> ocurre de 1 a 3 horas despu\u00e9s de una comida y es menos com\u00fan (corresponde al 25% de las s\u00edndromes de dumping). La causa del S\u00edndrome de Dumping tard\u00edo tambi\u00e9n es el vaciado g\u00e1strico r\u00e1pido, sin embargo, est\u00e1 relacionado espec\u00edficamente con la llegada r\u00e1pida de carbohidratos al intestino proximal.<\/p>\n
Cuando los carbohidratos llegan al intestino delgado, son r\u00e1pidamente absorbidos, resultando en hiperglucemia, que desencadena la liberaci\u00f3n de grandes cantidades de insulina para controlar el aumento del nivel de az\u00facar en la sangre. Esta supercompensaci\u00f3n resulta en hipoglucemia, causando s\u00edntomas neuroglicop\u00e9nicos (ver abajo). La hipoglucemia estimula la gl\u00e1ndula adrenal a liberar catecolaminas, resultando en sudoraci\u00f3n, temblores, mareos, taquicardia y confusi\u00f3n (reactividad auton\u00f3mica).<\/p>\n
S\u00edntomas<\/strong><\/h2>\n
Los s\u00edntomas de dumping precoz y tard\u00edo presentan algunas diferencias.<\/p>\n
Dumping precoz:<\/em><\/strong><\/p>\n
\n
ocurre dentro de 1 h, t\u00edpicamente 30 min despu\u00e9s de la ingesti\u00f3n de una comida<\/li>\n
s\u00edntomas vasomotores: fatiga, deseo de acostarse, rubor, palpitaciones, transpiraci\u00f3n, taquicardia, hipotensi\u00f3n y s\u00edncope (raro)<\/li>\n<\/ul>\n
Dumping tard\u00edo:<\/strong><\/em><\/p>\n
\n
1-3 h despu\u00e9s de la comida<\/li>\n
S\u00edntomas neuroglicop\u00e9nicos: fatiga, debilidad, confusi\u00f3n, hambre y s\u00edncope<\/li>\n
reactividad auton\u00f3mica: transpiraci\u00f3n, palpitaciones, temblor e irritabilidad<\/li>\n<\/ul>\n
Debido a la superposici\u00f3n de s\u00edntomas en la presentaci\u00f3n cl\u00ednica, a menudo es dif\u00edcil diferenciar entre las dos presentaciones, y la co-ocurrencia es frecuentemente encontrada.<\/p>\n
Tratamiento<\/strong><\/h2>\n
Medidas diet\u00e9ticas<\/strong> generalmente son suficientes para tratar a la mayor\u00eda de los pacientes.<\/p>\n
\n
evitar alimentos con grandes cantidades de az\u00facar<\/li>\n
alimentarse con mayor frecuencia (6\/d\u00eda) con peque\u00f1as comidas ricas en prote\u00ednas, grasas y fibras<\/li>\n
separar l\u00edquidos de s\u00f3lidos durante la comida. La ingesti\u00f3n de l\u00edquidos debe ser retrasada al menos 30 minutos.<\/li>\n<\/ul>\n
En algunos pacientes sin respuesta a medidas diet\u00e9ticas, tratamientos farmacol\u00f3gicos dirigidos a s\u00edntomas espec\u00edficos pueden ser eficaces, como loperamida <\/strong>para diarrea y antiem\u00e9ticos <\/strong>para n\u00e1useas.<\/p>\n
Los anticolin\u00e9rgicos <\/strong>(diciclomina, hiosciamina, propantelina) pueden retardar el vaciado g\u00e1strico y tratar espasmos.<\/p>\n
An\u00e1logos de la somatostatina<\/strong> pueden mejorar el s\u00edndrome de dumping por medio de varios mecanismos:<\/p>\n
\n
retardando el vaciado g\u00e1strico<\/li>\n
disminuci\u00f3n del tr\u00e1nsito del intestino delgado<\/li>\n
disminuci\u00f3n de la liberaci\u00f3n de hormonas gastrointestinales, incluyendo la secreci\u00f3n de insulina<\/li>\n
inhibici\u00f3n de la vasodilataci\u00f3n postprandial<\/li>\n<\/ul>\n
An\u00e1logos de la somastotatina (ej: octreotide<\/strong>) pueden ser administrados v\u00eda subcut\u00e1nea (acci\u00f3n corta) inmediatamente antes de las comidas (3x\/d\u00eda) o a trav\u00e9s de una formulaci\u00f3n intramuscular de larga duraci\u00f3n (cada 2-4 semanas). Octreotide es el medicamento m\u00e1s estudiado para el s\u00edndrome de dumping y puede ser muy eficaz. Sin embargo, los p\u00e9ptidos son caros y, por lo tanto, normalmente no son considerados tratamiento de primera l\u00ednea.<\/p>\n
La acarbose <\/strong>es un inhibidor de la alfa-glucosidasa que disminuye la digesti\u00f3n intraluminal de carbohidratos en el duodeno. Por lo tanto, es usado para tratar la hipoglucemia postprandial en el s\u00edndrome de dumping tard\u00edo.<\/p>\n
Los pacientes con s\u00edntomas graves pueden necesitar una reoperaci\u00f3n <\/strong>si el tratamiento conservador es infructuoso. La elecci\u00f3n de la cirug\u00eda depende de la cirug\u00eda g\u00e1strica original.<\/p>\n
\n
En pacientes con gastrectom\u00eda distal se recomienda la conversi\u00f3n de una gastrojejunostom\u00eda en asa para una reconstrucci\u00f3n en Y-de-Roux<\/li>\n
Para pacientes con gastrojejunostom\u00eda sin gastrectom\u00eda, el desmontaje de la gastrojejunostom\u00eda puede ser realizada si la funci\u00f3n del p\u00edloro est\u00e1 mantenida.<\/li>\n<\/ul>\n
Referencias:<\/strong><\/h2>\n\n
Mahvi, DA y Mahvi, DM. En Sabiston: Textbook of Surgery, 21\u00aa. Edici\u00f3n.<\/li>\n
Emous M, Wolffenbuttel BHR, Tott\u00e9 E, van Beek AP. The short- to mid-term symptom prevalence of dumping syndrome after primary gastric-bypass surgery and its impact on health-related quality of life. Surg Obes Relat Dis. 2017 Sep;13(9):1489-1500.<\/li>\n
Vavricka SR, Greuter T. Gastroparesis and Dumping Syndrome: Current Concepts and Management. J Clin Med. 2019 Jul 29;8(8):1127. doi: 10.3390\/jcm8081127. PMID: 31362413; PMCID: PMC6723467.<\/li>\n<\/ol>\n
C\u00f3mo citar este art\u00edculo<\/strong><\/h2>\n
El S\u00edndrome de Dumping es una combinaci\u00f3n de s\u00edntomas gastrointestinales y vasomotores debido al vaciado g\u00e1strico postprandial r\u00e1pido Los s\u00edntomas gastrointestinales incluyen dolor abdominal, saciedad temprana, n\u00e1usea, v\u00f3mito, diarrea y…<\/p>\n","protected":false},"author":722,"featured_media":8796,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"categories":[24,27,30],"tags":[],"ano":[395],"tipo":[121],"volumen":[44],"class_list":["post-8054","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cirugia","category-esofago-estomago-duodeno","category-obesidad","ano-395","tipo-temas-generales","volumen-volume-ii"],"yoast_head":"\n
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