Coughing and retching after gastrectomy is a quite common, but rather unpleasant symptom in stomach cancer patients who have had surgery.
The reason for this can vary, but most the most plausible reason is the loss of the sphincter mechanism that normally prevents acid reflux from occurring.
When your stomach is removed, you no longer produce acid as you have no stomach.
However, the intestine which is connected to your lower esophagus produces intestinal juice and also bile is still secreted in to your small bowel.
Both intestinal secretions and bile can reflux back up the esophagus and cause irritation to your upper airway as well as causing sickness.
Also, saliva that you are always subconsciously swallowing can come back up as well.
If you are suffering from this, you have probably noticed a lot of “froth” coming back up.
Other causes of these symptoms may include:
Treatment of coughing and retching after gastrectomy really depends on the cause, but reflux of secretions is by far the most common reason.
This can be treated with a variety of different approaches including:
Make sure that you have small, regular feeds rather than large feeds. Avoid feeds in the hour before bedtime.
Make sure that the food has consistency as sloppy or liquid foods are more likely to reflux.
Drinks can easily reflux back up the esophagus.
This can be lessened by thickening your fluids with a thickener such as “Thick and Easy” by Fresenius Kabi.
By thickening your fluids, it provides more stickiness to stay down rather than reflux.
Drug therapy can be helpful for coughing and retching after gastrectomy, but a lot of doctors don’t really understand the true reasons for the symptoms occurring, nor the correct therapies for this.
You are likely to be offered standard anti-sickness medications such as metoclopramide or domperidone which work as “prokinetics”.
Whilst these drugs are helpful when you have a stomach, they have less effect without one!
They work by increasing stomach emptying and also increasing intestinal movements.
Whilst the latter still applies, this can increase your risk of developing dumping syndrome because of faster transit or movement of your food through the small bowel.
Better options are to coat the secretions with a protective gel, such as gaviscon advance, which will reduce reflux.
Too much gaviscon advance can cause diarrhea, so if you are experiencing this do cut back on the amount you are having.
Bile reflux is common after gastrectomy. Sucralfate can reduce this and is available as a tablet or liquid. The normal dose is 1 – 2 grams twice a day.
Three other drugs that can be used in bile reflux are:
Cholestyramine Light – A powder you mix in water and can be taken anything from 1 to six times a day.
Colestipol – granules mixed in water and normally given at a dose of 5G twice a day, increasing up to 30G a day in divided doses.
Colesevelam – A tablet normally prescribed at a dose of 3.75G a day in divided doses.
Another option is to try methylcellulose. This treatment soaks up liquid like a sponge and provides “bulk”.
You can buy this without prescription and is manufactured as Celevac. It is best though if you discuss it with your doctors first as this can, in theory, cause an obstruction, although I have never seen this.
You may be offered cough medications such as codeine, but this can increase the problem as it stops your gut from contracting so making reflux more likely.