Abstract
Prophylactic total gastrectomy is recommended to prolong life in individuals who carry the CDH1 variants associated with early diffuse gastric cancer. Loss of the stomach requires life-long changes in diet and poses a risk for select vitamin and mineral deficiencies that require supplementation and monitoring. This review covers the physiology of the stomach and the pathobiology and management of individuals post-gastrectomy with altered small bowel anatomy. Enhanced recovery after surgery guidelines (ERAS) for total gastrectomy reduces complication rates, enhances healing, and lessens hospital stay. Oral vitamin B12 in pharmacologic doses is equally effective to parenteral B12 supplementation post-gastrectomy. Glucagon-like peptide 1 (GLP-1) is an important hormone involved in the vasomotor symptoms of dumping syndrome that holds promise as a target for therapy. Although the stomach is not a vital organ, its motor and physiologic functions are important for nutrition and quality of life. Prevention of malnutrition and improving quality of life are accomplished by diet education, supplementation of vitamin B12 and other at risk vitamins and minerals, and monitoring throughout life.
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