Dumping syndrome

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Overview

Dumping syndrome (DS) occurs when the stomach empties food into the small bowel at a faster rate than normal. It is frequently related to the rapid emptying of hyperosmolar gastric content into the small bowel. Although the precise mechanism of DS is not known, dumping is a phenomenon usually caused by the destruction or bypass of the pyloric sphincter. DS can occur in post–gastric bypass patients when high levels of simple carbohydrates are ingested. The condition can also develop in people who have had esophageal surgery. Clinically significant dumping symptoms occur in about 20% of patients after pyloroplasty or distal gastrectomy. Patients younger than age 35 years or with a BMI <25 kg/m2 are more likely to be symptomatic than are older or more obese patients.1-3


It is believed that the osmotic gradient draws fluid into the intestine, and this may release one or more vasoactive hormones, such as serotonin and vasoactive intestinal polypeptide. Most people with DS develop abdominal cramps and diarrhea within 10 to 30 minutes after eating. Others experience such symptoms 1 to 3 hours after eating, and yet others experience both early and late symptoms.

Symptoms

Dumping syndrome has two phases, each with its own set of symptoms. You may experience one or both phases.


Early dumping syndrome symptoms occur within 10 to 30 minutes after you've finished eating. You may experience:


Nausea.

Vomiting.

Diarrhea.

Abdominal pain and cramping.

A distended abdomen.

Feeling bloated.

Dizzy spells.

Heart rate accelerations.

Late dumping syndrome begins to show signs about two to three hours after you’ve finished eating. You may experience:


Weakness.

Fatigue.

Jitters or shakiness.

Rapid or irregular heartbeat.

Cold sweats.

Face flushing.

Brain fog.

Hunger.

Causes

Surgical causes include:


Gastrectomy. Surgery to remove part or all of the stomach.

Bariatric surgery for weight loss, such as gastric bypass.

Pyloroplasty. An operation on the pyloric valve at the bottom of your stomach.

Esophagectomy. Surgery to remove part or all of the esophagus.

Vagotomy. Surgery to cut the vagus nerve in the stomach to reduce stomach acid.

Nissen fundoplication. Surgery to sew the top of the stomach around the esophagus.

Disease-related causes include:


Diabetes mellitus.

Exocrine pancreatic insufficiency.

Duodenal ulcers.

Zollinger-Ellison syndrome.

Functional dyspepsia.

Cannabis hyperemesis syndrome.

Risk factors

This is most often related to changes in your stomach associated with surgery, including any stomach surgery or major esophageal surgery, such as removal of the esophagus (esophagectomy). But in rare cases, dumping syndrome can develop without a history of surgery or other obvious causes.

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Complications

Dumping syndrome is a condition in which food, especially food high in sugar, moves from your stomach into your small bowel too quickly after you eat. Sometimes called rapid gastric emptying, dumping syndrome most often occurs as a result of surgery on your stomach or esophagus.

Prevention

Generally, you can help prevent dumping syndrome by changing your diet after surgery. Changes might include eating smaller meals and limiting high-sugar foods. In more-serious cases of dumping syndrome, you may need medications or surgery.

Eat smaller meals more frequently. ...

Avoid simple sugars, carbohydrates and milk products. ...

Eat more protein and healthy fats to replace carbohydrates in your diet. ...

Eat more dietary fiber to add bulk to your meal and slow down its transit time. ...

Lie down on your back for 30 minutes after eating.