Living without a stomach is possible, albeit very complicated. They do it approx 80 thousand Italians who have undergone partial or total gastrectomy surgery, then the removal of the whole organ or a part, following a tumor. For them, nutritional supports represent a fundamental safeguard because they allow them to have a balanced and correct diet. Just as they are indispensable sensors for monitoring blood glucose throughout the day which, in these people, often has very substantial changes that can lead to severe hypoglycemic crises. However, these aids are not yet reimbursed by the national health system to all patients who need them, with the only virtuous exception of Emilia Romagna which has decided to provide them free of charge to cancer patients, as is already the case for those with diabetes in all regions.
The study: ballerina glycaemia in 89% of patients
To demonstrate the need to keep blood sugar under control in those who no longer have the stomach after the operation for gastric cancer, there are also the preliminary data of an Italian study that investigates the phenomenon on this specific category of patients and highlights that blood glucose values could be too danceable in as many as 9 out of 10 patients. Until now, it was not known with what prevalence the symptoms reported by patients undergoing a partial or total gastrectomy following stomach cancer were related to dumping syndrome (a disorder that appears a few minutes to 3 hours after eating because the food reaches the small intestine too quickly) or isolated reactive hypoglycemia – explains Maurizio Muscaritoli, president of the Italian Society of Clinical Nutrition and Metabolism (SINuC) -. Our study, still in progress, is the first to try to give an answer. We involved 322 patients enrolled in the association “Living without a stomach, you can” and from the first observational phase, just concluded, it emerged that as many as 286, equal to 89% of the total, have symptoms that could be compatible with consistent fluctuations in blood sugar after meals. The participants in the research, promoted by SINuC in collaboration with the Italian Research Group on Gastric Cancer (GIRCG) and the association “Vivere senza stomach, si pu Onlus”, answered a specific questionnaire and the results show that 169 patients have a score compatible with a diagnosis of dumping syndrome, and as many as 117 with isolated reactive hypoglycemia.
Dangerous hypoglycemia: real risk of coma
The second phase of the study was launched to evaluate symptomatic and asymptomatic glycemic variability: patients will in fact be subjected to continuous monitoring of blood glucose through subcutaneous sensors. Excessive blood sugar changes are very dangerous for health and must be kept under control to prevent hypoglycemia – Clarifies Muscaritoli -. The too rapid passage of food in those without stomach can cause, especially if what is ingested contains sugar, a wide variety of symptoms such as abdominal pain and distension, nausea, vomiting, diarrhea, weakness, dizziness, sweating, hot flashes and sometimes syncope. While isolated reactive hypoglycemia occurs mainly with sweating, palpitations, tremors and weakness that appear within two to three hours after a meal. In both cases there can be a consistent glycemic variability which we know to be very harmful to health, because in diabetics for example increases the risk of complications and damage to the endothelium of the vessels. Also, a severe hypoglycemic episode can lead to coma and hospitalization, in addition to very frightening patients who end up having a real fear of eating, with imaginable consequences for their body weight.
The virtuous example of Emilia Romagna
Nutrition is a life-saving therapy even more necessary in those who undergo gastrectomy due to stomach cancer, because the malnutrition common to all cancer patients is compounded by the alterations of the digestive processes. 40% of patients stop chemotherapy because they are too weak, 20% do not get over the disease due to the consequences of malnutrition: for this you need a specialist evaluation by a clinical nutritionist from the first oncological visit, then a global care of the patient that includes adequate clinical nutrition interventions. The data of the study, suggesting an extremely high prevalence of glycemic variability in gastroresected patients, once again underline the need to plan to guarantee these people too. access to sensors for blood glucose monitoring, essential to avert the concrete risk of coma and hospitalization following a possible severe hypoglycemia – underlines Claudia Santangelo, president of the “Living without Stomach” Association -. As of today, these devices will be provided free of charge only in Emilia-Romagna, a virtuous example that should be followed in the future by all Regions. Our hope that initiatives like this, which today are sporadic, will be increasingly widespread to meet the needs of the sick, unfortunately often forgotten due to their relatively low number. The goal is to guarantee homogeneity and equality of access to care for all patients everywhere.
Beware of these symptoms: who risks the most
Stomach cancer gets sick over 14 thousand Italians every year. the fifth most frequent type of cancer in our country, but the 5-year survival reaches only 32%. Especially the fault of the fact that the disease is discovered late, when it is already in an advanced stage, because only then does it begin to show the first symptoms. Attention must be paid to a number of symptoms that may be vague or indicate minor problems, but it is better to speak to a doctor in case of: persistent digestive disturbances, loss of appetite, difficulty swallowing, weight loss, feeling of fullness after meals, nausea and vomiting, heartburn (burning behind the breastbone), blood in the stool or black stools; chronic fatigue, which could be due to anemia, caused by bleeding from the stomach wall. It can be cured if the tumor is identified early on and surgically removed, so it is important that, when these signs persist for many weeks, it is especially those who are most at risk of getting sick: people who suffer from atrophic gastritis (an inflammation of the stomach) or a chronic infection caused by Helicobacter pylori, responsible for ulcer and gastritis.
May 14, 2021 (change May 15, 2021 | 11:31)
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