Dietary Recommendations After a Gastrectomy

A gastrectomy is a surgical procedure in which all or part of the stomach is removed:

• Partial or subtotal gastrectomy: part of the stomach is removed. In some cases, lymph nodes and other nearby organs or tissues may also be removed.
• Total gastrectomy: the stomach is completely removed. Lymph nodes and other nearby organs or tissues may also be removed. This procedure requires the oesophagus to be joined to the small intestine so that the patient can eat and swallow.

The stomach plays many important roles in the digestive system. Its main function involves the mechanical and chemical digestion of ingested food. Once the food has been chewed and lubricated with saliva, it travels down the throat, passes through the oesophagus and enters the stomach, where it mixes with gastric juices, which help digest and disintegrate the food. This food will then reach the small intestine, where the different nutrients will be absorbed. The stomach also releases several hormones which are responsible for sending hunger and fullness signals to the brain. A total or partial gastrectomy alters these functions, resulting in:

• Lower capacity to hold food.
• Lower or no secretion of gastric juice, making digesting food difficult.
• Alteration of the motility (movements) of the stomach and the emptying of its contents into the intestine.
• Decreased ability to absorb some nutrients from food effectively, which may result in malabsorption of nutrients such as fats; vitamins such as B2 (riboflavin), B3 (niacin), B9 (folic acid), B12 (cyanocobalamin), D and E; and minerals such as iron, calcium and zinc.
• Alteration of hunger signals.

The consequences of these altered functions are:

• Premature fullness and lack of appetite:the loss or reduction of the stomach can produce a greater sensation of fullness more quickly, sometimes accompanied by pain after meals.
• Rapid emptying syndrome (dumping syndrome):due to the elimination of the function of the pylorus (sphincter connecting the stomach to the small intestine), the contents of the stomach empty into the small intestine more quickly than normal, leading to a series of uncomfortable symptoms after eating.
• Diarrhoea:This may appear after any gastrectomy, one to two hours after meals. The stools are usually watery and in many cases particularly foul-smelling, yellowish and greasy in appearance. Diarrhoea tends to gradually decrease over time, six months to a year after surgery.
• Anaemia:Anaemia is one of the important long-term after-effects following a gastrectomy and develops gradually over years. It is due to iron and/or vitamin B12 or folic acid (B9) deficiency as a consequence of low intake or reduced absorption of nutrients due to surgery. The referring medical team will assess the need for supplements.
• Bone disease:Gastrectomy favours the development of osteoporosis and/or osteomalacia in the long term by destroying bone tissue due to malabsorption of vitamin D and calcium, as well as a lower intake of foods rich in calcium and vitamin D.
• Weight loss:Premature fullness and malabsorption of nutrients may contribute to weight loss. This is primarily a loss of fat rather than muscle mass, and it can be gradual, between three and six months post-surgery, until it stabilises.

A few days after the surgery has been performed, the patient will be able to start eating progressively, according to individual tolerance, starting with a liquid diet, and then progressing to a semi-liquid, crushed, semi-solid, easily digestible diet, up to a diet that is as normal as possible. It is recommended to keep a food journal that lists everything eaten and drunk and any symptoms they cause in order to identify food tolerance and progress appropriately on a personalised basis.