IMPORTANT! Eating information you WANT TO READ THIS!!!

Hello All,

I am a 7 year EC survivor. I am 39 years old. I wis my doctors had given me all this information. This explains a lot and will help you understand your new digestive system.

Godspeed,

David

Hillsboro, OH

SPECIAL EATING PROBLEMS FOR SOME ESOPHAGEAL CANCER PATIENTS

"Dumping Syndrome", an Esophagectomy Related Problem

" Dumping Syndrome" can result from an esophagectomy, a surgery that removes part or all of the esophagus, portions of the vagus nerve, and usually part of the stomach. Without the vagus nerve, the pyloric valve that regulates the passage of food out of the stomach and into the small intestine is unable to relax to let food go through. To solve this problem, the surgeon cuts the muscle of the pyloric valve during the esophagectomy. This will allow mostly undigested food to pass rapidly from the stomach into the first part of the small intestine, the duodenum. Dumping Syndrome often has two phases. The first phase occurs between fifteen and thirty minutes after a meal. One theory as to why the first phase of dumping may occur is that the large mass of mostly undigested food is "hyperosmolar". This means that large concentrations of undigested sugars, proteins and fat molecules are present without sufficient fluid to dilute them to normal levels. The body tries to correct this by absorbing fluid from the surrounding tissues and blood. This rapid absorption of fluid may lead to cramping, nausea, diarrhea, belching, increased heart rate, sweating, light-headedness and sometimes fainting.

The second phase may happen between ninety minutes and three hours after eating and results from abnormal insulin levels. The concentrated sugar molecules in the poorly digested food may result in excess secretion of insulin. Excess insulin will lower blood sugar levels. If blood sugar levels become too low, increased heart rate, heart palpitations, sweating, light-headedness and sometimes fainting may occur.

What can be done to stop or decrease the severity of these symptoms?

1. Eat many small meals – six or more! This will avoid overloading the new, much smaller stomach.

2. Avoid foods rich in simple sugars –sugar sweetened desserts, candies, etc. Simple sugar is especially problematic in the first phase of dumping described above.

3. Limit bulky foods like salads and bread products.

4. Fluids should be limited at mealtimes. Fluids are important, but drink them between meals to avoid pushing stomach contents through too rapidly.

5. Be prepared for diarrhea – know the location of a bathroom, if you’re away from home.

6. Keep a list of what you eat and the relative amounts for several weeks to months after esophagectomy. Record any symptoms that follow. You will begin to see a pattern of what particular foods bother you and learn to avoid them. Every one is affected differently.

7. Several prescription medications are available and often useful. Ask your physician or internist.

With time, experience, and knowledge of foods to avoid, many esophagectomy patients will find that "dumping" episodes decrease and may even become infrequent to rare.

(The preceding information was written by Richard Stienmier, M.D., an esophageal cancer patient who has personally experienced many of the problems related to an esophagectomy)