Gastrectomy, the surgical removal of part or all of the stomach, is performed for various serious health conditions. This procedure profoundly alters the body’s digestive process, requiring substantial adjustments to diet and lifestyle. Understanding how the body processes food and absorbs nutrients becomes essential.
Reasons for Stomach Removal
Gastrectomy addresses various medical conditions. Stomach cancer is the most common reason, as removing cancerous tissue treats the disease and prevents its spread.
Other reasons include severe peptic ulcers unresponsive to treatment, often due to complications like bleeding or perforation. Severe stomach trauma beyond repair can also necessitate removal. Additionally, certain bariatric surgeries, such as sleeve gastrectomy, involve removing a stomach portion for weight loss in individuals with severe obesity.
How Digestion Changes
The stomach plays several roles in digestion. It stores food, churning it with muscular contractions into a semi-liquid mixture called chyme. It releases hydrochloric acid and enzymes like pepsin to break down food, especially proteins, and kill bacteria. The stomach also regulates chyme release into the small intestine via the pyloric sphincter.
After gastrectomy, these functions are altered or bypassed. Food travels directly from the esophagus into the small intestine, bypassing the stomach’s storage and grinding. This faster passage can affect nutrient absorption. The lack of gastric acid impacts initial food breakdown, sterilization, and absorption of nutrients like iron and vitamin B12. The small intestine adapts to some of these roles, but its capacity is limited.
Life After Gastrectomy: Nutritional and Lifestyle Adjustments
Life after gastrectomy requires careful dietary modifications. Individuals must consume smaller, more frequent meals, often 6 to 8 daily, instead of three large ones. Chewing food thoroughly, ideally to a purée-like consistency, aids digestion since the stomach’s grinding action is absent. Fluids should be consumed between meals, about 30-60 minutes before or after, to prevent feeling overly full and rapid food transit.
Initially, foods high in sugar, very fibrous foods, or tough meats may be difficult to tolerate. Protein intake should be prioritized to support healing and minimize muscle loss. Due to impaired absorption, supplementation of specific vitamins and minerals is necessary. This commonly includes vitamin B12 (often via injection or specialized oral forms), iron, calcium, and vitamin D. A registered dietitian’s guidance helps tailor adjustments and ensure adequate nutrition.
Managing Potential Long-Term Effects
Despite dietary adjustments, individuals may experience long-term medical issues after gastrectomy. Dumping syndrome is a common complication, occurring when food, especially high-sugar items, moves too quickly from the stomach remnant or esophagus into the small intestine. Symptoms include nausea, bloating, pain, diarrhea, dizziness, and fatigue, appearing soon after eating (early dumping) or hours later (late dumping). Management often involves avoiding sugary foods, eating small meals, and separating liquids from solids.
Chronic nutrient deficiencies, particularly iron deficiency anemia and vitamin B12 deficiency, occur due to reduced absorption. Iron absorption is hindered by the lack of gastric acid and bypassing the duodenum, where most iron absorption occurs. Malabsorption can also lead to calcium and vitamin D deficiencies, increasing bone density loss risk. Weight loss is expected, with the most significant drop typically within the first 6 to 12 months, and maintaining a healthy weight can be challenging. Regular medical follow-ups are important for monitoring nutritional status, adjusting supplements, and addressing complications.