Studies in dumping syndrome

Abstract

In 310 patients with tuberculosis—38 of whom had been subjected to partial gastrectomy because of duodenal or gastric ulcers—46 social, clinical, and laboratory parameters were recorded, and a correlation matrix consisting of 11,000 correlations between them was calculated. Results showed that tuberculosis occurred significantly more often and that it was more widely extended in gastrectomized patients with dumping syndrome than in patients with normal stomachs. The lower the intestinal absorptions and serum concentrations of nutrients, the more bacilli were found in the sputum, and the more frequently tuberculous relapses occurred in such patients. In addition, the worse the social conditions, the earlier the onset of tuberculosis, and the greater its extent. In Stockholm, the “typical” tuberculosis patient is an alcoholic, divorced, poorly housed, gastrectomized man. Patients with poorer initial social and medical conditions proved more amenable to treatment in terms of increasing weight, reducing erythrocyte sedimentation rate, and improving leucocyte response. On the other hand, the more often the patient is hospitalized with a relapse, the more resistant bacilli become to chemotherapy (or vice versa), causing poor response to treatment, greater extent of disease, and higher mortality. The fact that tuberculosis is frequent among the gastrectomized and the socially indigent, and that it is amenable to treatment in them, motivates the attempt to initiate systematic controls and perhaps even prophylactic treatment.