Survivorship: Health Concerns After Gastrectomy
Removal of all (gastrectomy) or part of the stomach (partial gastrectomy) leads to changes in the absorption of nutrients (vitamins in your food) and digestion. Survivors should be followed by a dietitian who can help with GI symptoms and food choices.
Absorption of Nutrients
Vitamin B12 and iron are normally absorbed by the stomach. You will need to get shots of B12 regularly for life. Low iron levels cause iron deficiency anemia and may be treated with iron pills or infusions. You may also have low levels of calcium, vitamin D, copper, and folate. You will have these levels checked with blood tests and may need to take supplements (pills) of these nutrients. Osteoporosis or osteopenia (weak bones) can develop as a result of poor calcium absorption. You should also not smoke, not drink excessive alcohol, and do weight-bearing exercises to help keep your bones strong.
When your stomach is removed, the esophagus (swallowing tube) is connected directly to the small bowel, changing the way your food is digested. You will need to eat smaller, more frequent meals, with more proteins and fewer sugars and carbohydrates. This will help prevent issues such as nausea, vomiting, and diarrhea.
Dumping syndrome is a common issue that causes nausea and abdominal cramping followed by diarrhea, shortly after eating. This can often be managed with dietary changes including:
- Eating small, frequent meals (6-8 per day), slowly.
- Meals should be high in protein and low in carbohydrates (sugars).
- Take in minimal fluids when eating food to not flush out the food before nutrients are absorbed. It is a good idea to sip fluids often in between meals to stay hydrated.
- Eat sitting upright.
- Work with a registered dietitian to help with learning how to eat to minimize problems.
- Talk with your care team about medications that can help with dumping syndrome.
You may have heartburn or reflux, especially in the months following treatment. It may be helpful to stay in an upright, sitting position for at least one hour after meals to help prevent reflux. Medications can also help with reducing reflux and keeping your esophagus healthy.
You may find it hard to maintain your weight and get adequate nutrition. A dietitian can help with adapting to changes in your diet. These changes can sometimes become less restrictive over time. Keeping track of your weight is important so that you can notify your provider if you lose weight.
Other Health Concerns
If you did not have your gall bladder removed, you could be at a higher risk of developing gall stones. If you develop abdominal pain, contact your provider.
Abdominal surgeries can increase your risk for bowel obstructions (due to scar tissue), hernia (due to cutting the abdominal muscle), and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications. If you develop constipation with abdominal pain, nausea and vomiting, or notice a bulging area in your abdomen, contact your care team.
Cleveland Clinic. Post-Gastrectomy Syndrome Symptoms. Found at: https://my.clevelandclinic.org/health/diseases/17377-post-gastrectomy-syndrome
Karanicolas, P. J., Graham, D., Gönen, M., Strong, V. E., Brennan, M. F., & Coit, D. G. (2013). Quality of Life After Gastrectomy for Adenocarcinoma: A Prospective Cohort Study. Annals of Surgery, 257(6), 1039–1046.
Mangano, A., Rausei, S., Lianos, G. D., & Dionigi, G. (2015). Quality of life after gastrectomy for adenocarcinoma: a prospective cohort study. Annals of surgery, 262(6), e110.
Samrat, R., Naimish, M., & Samiran, N. (2020). Post-Gastrectomy Complications—An Overview. Chirurgia, 115(4), 423. https://doi.org/10.21614/chirurgia.115.4.423