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The postgastrectomy symptoms described above are collectively called the dumping syndrome. Because all or part of the stomach is removed, an ingested meal will be delivered to the small intestine more quickly than normal. The large increase in tonicity in the small intestine causes an osmotic fluid shift from the extracellular fluid (plasma) into the lumen of the gut. The increased distention of the small intestine increases motility through reflex mechanisms and causes diarrhea. The blood volume contraction and concomitant release of vasoactive substances such as bradykinin and/or vasoactive intestinal peptide can create hypotension and reflex tachycardia. Patients should be instructed to eat more frequent, smaller meals to reduce the osmotic and/or carbohydrate load that is delivered to the small intestine. Furthermore, since fats are the slowest to be absorbed, a diet that is higher in fat will also reduce the problem of rapid absorption
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