A 35-year-old CEO underwent an antrectomy and vagotomy for a bleeding ulcer. Although usually careful with his diet, he ate a large meal during a business lunch. Within 1 hour, he felt lightheaded and developed abdominal cramping and diarrhea. His symptoms may be attributed to:

Post gastrectomy syndromes collectively refer to complications that can occur after gastric surgery. This constellation of syndromes includes delayed gastric emptying, recurrent ulcers, diarrhea, anemia, jejunogastric intussusception, afferent loop syndrome, alkaline reflux gastritis, and dumping syndrome. There are two types of dumping syndrome, early and late. Early dumping occurs within 30 minutes and is caused by rapid gastric emptying of a hyperosmolar load into the small bowel. Late (hypoglycemic) dumping occurs 1-3 hours after eating. Symptoms are mostly vasomotor. They are related to the excessive release of insulin in response to the rapid rise in postprandial glucose