Metabolic complications of subtotal gastrectomy with Billroth I or Billroth II reconstruction include:

B. Anemia

C. Reactive hypoglycemia.

D. Dumping syndrome.

E. Metabolic bone disease.

DISCUSSION: Anemia develops in as many as 30% of patients within 15 years of surgery. The cause is multifactorial and includes malabsorption of iron, folate, and vitamin B 12. A metabolic bone disease occurs in as many as 33% of patients, is similar to osteomalacia, and is probably a result of malabsorption of calcium and vitamin D. Reactive hypoglycemia occurs with rapid gastric emptying, resulting in increased glucose absorption immediately after a meal. Initially there is hyperglycemia, leading to hyperinsulinemia and subsequent rapid glucose clearance and symptomatic hypoglycemia. Dumping syndrome varies from very mild symptoms to significantly disabling ones. The severe syndrome occurs in fewer than 5% of patients. Small, frequent, dry meals of low osmolality reduces symptoms, and somatostatin analog has been of some clinical use.