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Dumping syndrome, also known as rapid gastric emptying, is a condition that causes the stomach to empty its contents into the small intestine more quickly than it should. This condition typically results from surgery on the stomach or esophagus. It can lead to nausea, bloating, pains in the abdomen, and diarrhea.
Normally, the stomach gradually and carefully transfers digesting contents into the small intestine. With dumping syndrome, food, especially those heavy on sugar, passes from the stomach into the small intestine too quickly. In most cases, symptoms like stomach cramps and diarrhea develop within 10 to 30 minutes of eating. Some may have symptoms appearing 1 to 3 hours after eating.
Milder forms of dumping syndrome typically get better within three months. The recovery process could take 12 to 18 months for more severe patients. Changing the diet after surgery is generally a good way to prevent dumping syndrome. One could require medication or surgery for dumping syndrome in more severe forms.
Symptoms
There are two phases of dumping syndrome, the early and late dumping syndrome. Each has its unique set of symptoms. Some individuals exhibit both early and late symptoms.
The signs and symptoms of early dumping syndrome typically appear shortly after eating, particularly after a meal high in table sugar and fruit sugar. They may experience:
- Cramps and pain in the abdomen
- After eating, feeling bloated or overstuffed
- Heart rate accelerations
- Nausea
- Vomiting
- Diarrhea
- Flushing
- Dizzy spells, or lightheadedness
- Enlarged abdomen
After one has finished eating, late dumping syndrome symptoms start to appear, usually two to three hours later. This may include:
- Irregular or rapid heartbeat
- Flushing
- Sweating, or cold sweats
- Jitters or trembling
- Lightheadedness and dizziness
- Weaknes
- Fatigue
- Brain fog
- Hunger
If you find that any of the signs and symptoms continue to persist, it is essential to seek advice from a healthcare professional for a thorough diagnosis and appropriate treatment. This becomes even more crucial if you haven’t undergone surgery but are experiencing these symptoms, if dietary adjustments have proven ineffective for controlling your symptoms, or if you’re experiencing significant weight loss as a result of dumping syndrome. In such cases, a registered dietitian may develop a customized dietary plan to assist in managing the condition.
Causes
In dumping syndrome, there is an uncontrolled, abnormally rapid movement of food and gastric secretions from the stomach to the small intestine.
Dumping syndrome can sometimes manifest without clear underlying causes. However, it most commonly occurs as a complication following surgical procedures involving the stomach or the section of the esophagus that connects to the stomach. These surgeries often include esophagectomy, gastrectomy, bariatric surgery, pyloroplasty, vagotomy, and Nissen fundoplication.
The condition can also be attributed to diseases or medical conditions, including but not limited to diabetes mellitus, cyclic vomiting syndrome, autonomic dysfunction, exocrine pancreatic insufficiency, duodenal ulcers, Zollinger-Ellison syndrome, functional dyspepsia, and cannabis hyperemesis syndrome.
Risk factors
Approximately 20% to 50% of individuals who undergo stomach surgery encounter symptoms of dumping syndrome. In rare instances, it can also occur in association with certain gastrointestinal conditions. Stomach surgeries are primarily performed to address obesity, although they can also serve as treatments for esophageal cancer, stomach cancer, and various other disorders. These surgical procedures typically involve:
- Bariatric surgery: This is for morbid obesity treatment, such as gastric bypass or sleeve gastrectomy.
- Gastrectomy: Involving the removal of part or all of the stomach.
- Esophagectomy: Surgical procedure to remove the esophagus completely or partially.
- Nissen Fundoplication: Surgery to treat hiatal hernia and gastroesophageal reflux disease (GERD).
- Vagotomy: Surgery that cuts a nerve in the stomach to reduce stomach acid.
- Pyloroplasty: A procedure performed to widen stomach’s pyloric valve, facilitating the passage of food.
Diagnosis
Diagnosing dumping syndrome involves a comprehensive approach that includes reviewing one’s medical history, evaluating symptoms, and conducting a series of tests. In cases where an individual has previously undergone stomach surgery, even if it was many years ago, healthcare providers may recognize the condition based on the symptoms alone. Additionally, a self-assessment questionnaire known as the Dumping Symptom Rating Scale may be administered to gauge the severity of symptoms.
In order to confirm the diagnosis or rule out other potential reasons of the symptoms, these tests may be required:
- Oral glucose tolerance test: This test assesses your blood glucose levels during the most symptomatic period to aid in verifying the diagnosis. In this test, the blood sugar levels are measured both before and after consuming a glucose solution. After consuming the glucose, a rise in hematocrit shows that significant amounts of fluid are entering the intestines from the bloodstream. One to three hours later, a decrease in blood sugar indicates late dumping syndrome.
- Gastric emptying test: This test observes how quickly food travels through the stomach by including a tiny amount of radioactive substance in the meal and then using a specialized scanner to monitor the meal’s progression through the stomach.
- Hydrogen breath test: This is a method used to measure the amount of hydrogen in the breath after drinking a glucose solution. If the test shows a positive result for hydrogen, it indicates that the small intestine was too overloaded and did not absorb the glucose effectively.
- Upper GI series: This procedure assesses how quickly the solution moves through the esophagus, stomach, and upper small intestine. The progression of a contrast solution is tracked through video X-rays.
- Upper endoscopy: This procedure utilizes a flexible tube with a camera and light to look inside the esophagus, stomach, and duodenum, aiding in the detection of structural problems and potential reasons for the symptoms.
Treatment
The treatment approach for dumping syndrome is contingent upon the severity of its symptoms. Early dumping syndrome typically resolves spontaneously within three months. In many cases, dietary modifications prove to be effective in effectively managing dumping syndrome. If symptoms persist despite dietary changes, healthcare professionals may suggest medications or surgical interventions as potential treatment options.
- Dietary recommendations:
- Opt for frequent, smaller meals throughout the day, aiming for six instead of three. Consume your food slowly and chew it thoroughly.
- Avoid simple sugars, carbohydrates, and dairy products to prevent rapid fluctuations in blood sugar levels. Choose complex carbohydrates like whole grains.
- Increase your intake of protein and healthy fats as a substitute for carbohydrates in your diet. Fats slow down the digestive process and provide a more stable source of energy.
- Add more dietary fiber to your meals to add bulk and slow down the transit time. Fiber helps regulate the absorption of sugar in your digestive system.
- After eating, recline on your back for 30 minutes. This practice may help slow gastric emptying and maintain stable blood pressure during digestion.
- Avoid consuming liquids within 30 minutes before or after your meals, as fluids can stimulate digestive motility.
- Medications: Early and late dumping syndrome symptoms can be reduced with the use of specific drugs, such as octreotide and acarbose. However, drugs can have negative side effects and are not suggested for long-term use. Octreotide is an anti-diarrheal medication, which is injected beneath the skin that might delay the passage of food into the intestines. Acarbose may be prescribed to help control blood sugar levels by slowing down the rate at which the body absorbs carbohydrates. It has been found to be effective in decreasing the occurrence of low blood sugar (hypoglycemia) in individuals with late dumping syndrome.
- Surgery: If dumping syndrome develops after surgery and all other therapies have failed, additional surgery may be recommended to address the issue. Depending on your specific circumstances, surgical interventions for managing dumping syndrome may involve procedures such as pyloric reconstruction or reversing gastric bypass surgery.
