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Dumping Syndrome

Dumping Syndromes

Dumping syndrome is a condition that majorly occurs in individuals after surgical procedures to remove all or some part of the stomach. Such a type of a condition also occurs when individuals have opted for bypass surgery of the stomach to lose weight.


Presentation

Symptoms usually begin 15 to 20 minutes after a meal. Patients usually suffer from gastrointestinal and cardiovascular symptoms [6]. The common symptoms of dumping syndrome include nausea, diarrhea, abdominal cramps, vomiting and feeling of fullness after meal. In addition, patients also complain of palpitations, flushing, lightheadedness and rapid heart rate.

In other instances, signs and symptoms of dumping syndrome can develop after 1 to 3 hours of eating food; this condition is known as late dumping. Such a phenomenon occurs when huge amount of sugar is dumped into the small intestine, giving rise to condition known as hyperglycemia. Due to this, the body produces insulin to absorb the excess sugar and this in turn causes hypoglycemia [7] [8]. Symptoms of late dumping include rapid heartbeat, palpitations, confusion, dizziness, and sweating, fatigue and hunger pangs.

Pallor
  • He presented with periods of abdominal distension and pallor, recurrent convulsions, glucosuria and refusal of feeding. After changing the diet the symptoms disappeared. Although dumping syndrome in children is rare, early recognition is important.[ncbi.nlm.nih.gov]
  • Symptoms occurred soon after the operation and included post-prandial pallor, sweating, lethargy and diarrhoea. Failure to thrive was a prominent feature.[ncbi.nlm.nih.gov]
  • Both infants were fed postoperatively via a gastrostomy and showed the typical clinical picture of dumping with failure to thrive, intermittent diarrhea, lethargy and pallor postprandially.[ncbi.nlm.nih.gov]
  • Early dumping symptoms such as irritability, pallor, sweating, abdominal distension and watery diarrhoea were observed postoperatively after bolus feeding.[ncbi.nlm.nih.gov]
  • The vasomotor component actually distinguishes "dumping" from other postgastrectomy syndromes and may be manifested by weakness, dizziness, pallor, tachycardia, sweating, palpitation, and a desire to lie down.[jamanetwork.com]
Asymptomatic
  • Ten patients showed asymptomatic hypoglycemia, as a sign of the late dumping syndrome associated with a significant (p 0.001) increase of insulin, gastric inhibitory peptide and glucagon levels.[ncbi.nlm.nih.gov]
  • The reason why some patients remain asymptomatic after gastric surgery whereas others develop severe symptoms remains elusive.[emedicine.com]
Hunting
  • A Roux-en-Y jejunal pouch (Hunt-Lawrence) was formed at 22 months and 10 months respectively. Weight gain was immediate in both patients and has been sustained for 6 months and 8 years respectively.[ncbi.nlm.nih.gov]
Diarrhea
  • Five (10.5%) patients with unexplained abdominal pain and diarrhea had the working diagnosis of irritable bowel syndrome.[ncbi.nlm.nih.gov]
  • This has not been associated with dumping symptoms or diarrhea. Three patients with severe malnutrition from the dumping syndrome were given the supplement over a six month period.[ncbi.nlm.nih.gov]
  • Both infants were fed postoperatively via a gastrostomy and showed the typical clinical picture of dumping with failure to thrive, intermittent diarrhea, lethargy and pallor postprandially.[ncbi.nlm.nih.gov]
  • Many patients also complain of post-cholycystectomy diarrhea.[medhelp.org]
  • The rapid movement of the undigested contents causes the concerned individual to suffer from nausea, diarrhea and abdominal cramps.[symptoma.com]
Nausea
  • AIMS: To investigate the current incidence and identify the current etiologies of rapid gastric emptying (dumping syndrome) in patients with a spectrum of gastrointestinal symptoms, including nausea, vomiting, abdominal pain, or diarrhea.[ncbi.nlm.nih.gov]
  • Another 7 % had problems with nausea and 6 % had problems with fainting esteem. The DSRS is a reliable screening tool to identify these patients.[ncbi.nlm.nih.gov]
  • The rapid movement of the undigested contents causes the concerned individual to suffer from nausea, diarrhea and abdominal cramps.[symptoma.com]
  • […] dumping syndrome nausea, weakness, sweating, palpitation, syncope, often a sensation of warmth, and sometimes diarrhea, occurring after ingestion of food in patients who have had partial gastrectomy (see surgery of the stomach at stomach ).[medical-dictionary.thefreedictionary.com]
  • This may cause cramps, nausea, racing heart, sweating, bloating, diarrhoea or dizziness. This is called dumping syndrome. Symptoms usually begin 15–30 minutes after eating. Sometimes symptoms occur 1–2 hours after a meal.[cancercouncil.com.au]
Vomiting
  • AIMS: To investigate the current incidence and identify the current etiologies of rapid gastric emptying (dumping syndrome) in patients with a spectrum of gastrointestinal symptoms, including nausea, vomiting, abdominal pain, or diarrhea.[ncbi.nlm.nih.gov]
  • Malabsorptive procedures, poor postoperative nutrient intake, recurrent vomiting and poor compliance with vitamin supplement intake and regular follow-up are important risk factors.[ncbi.nlm.nih.gov]
  • In one patient due to persisting vomiting, after a few months, a gastrojejunal tube (PEG-J) was inserted. Hypoglycemia was revealed by routine blood tests, without evidence of specific symptoms.[ncbi.nlm.nih.gov]
  • Some may confuse lactose intolerance, an irritated pouch, inability to tolerate certain foods, and simply diarrhea or vomiting with "dumping".[thinnertimesforum.com]
  • This might be followed by loose stools and even vomiting. It is not dangerous, but it can be frightening to the uneducated patient. Late dumping "Late" dumping happens 1 to 3 hours after eating.[ec-cafe.org]
Abdominal Cramps
  • Symptoms include abdominal pain, bloating, abdominal cramping, diarrhea, and dizziness.[drdonnica.com]
  • The rapid movement of the undigested contents causes the concerned individual to suffer from nausea, diarrhea and abdominal cramps.[symptoma.com]
  • Would dumping syndrome that resulted from gb removal cause bad lower abdominal cramping along with diarrhea and nausea? Dear Ruth, Abdominal symptoms after gallbladder removal (cholycystectomy) have been reported in ranges from 5%-40%.[medhelp.org]
  • Most people with dumping syndrome develop signs and symptoms, such as abdominal cramps and diarrhea, 10 to 30 minutes after eating. Other people have symptoms one to three hours after eating, and still others have both early and late symptoms.[mayoclinic.org]
Abdominal Pain
  • Five (10.5%) patients with unexplained abdominal pain and diarrhea had the working diagnosis of irritable bowel syndrome.[ncbi.nlm.nih.gov]
  • This causes symptoms due to the shift of fluid into the intestinal lumen, with plasma volume contraction and acute intestinal distention. [3] Osmotic diarrhea, distension of the small bowel leading to crampy abdominal pain, and reduced blood volume can[en.wikipedia.org]
  • Other patients have right sided or mid abdominal pain. Many patients also complain of post-cholycystectomy diarrhea.[medhelp.org]
  • ‘A dumping syndrome also may occur with gastric bypass, which includes symptoms of flushing, abdominal pain, and diarrhea after rapid emptying of food into the jejunum.’[en.oxforddictionaries.com]
  • pain flatus hypotension Treatment Manage with dietary changes Please rate topic.[step2.medbullets.com]
Palpitations
  • She presented with symptoms of weakness, headache, palpitation, sweating, dizziness and significant fatigue between one and two hours after a meal.[ncbi.nlm.nih.gov]
  • Symptoms of late dumping include rapid heartbeat, palpitations, confusion, dizziness, and sweating, fatigue and hunger pangs.[symptoma.com]
  • Early dumping syndrome characterized by palpitation, dizziness, cold sweat, feebleness, and abdominal symptoms, occurs within 30 minutes after meals in patients who have undergone gastrectomy.[ncbi.nlm.nih.gov]
  • Octreotide reduced diarrhea, lightheadedness and palpitations after 75 g of glucose, compared with placebo (P .001).[ncbi.nlm.nih.gov]
  • All patients had late dumping-related symptoms, such as weakness, palpitation and dizziness before the induction of alpha-glucosidase inhibitor treatment.[ncbi.nlm.nih.gov]
Tachycardia
  • Octreotide prevented the symptoms of early dumping syndrome, especially postprandial tachycardia, but caused postprandial hyperglycemia.[ncbi.nlm.nih.gov]
  • Tachycardia and marked peripheral vasodilatation were demonstrated in 'dumpers' by Doppler ultrasound measurements of the arterial blood flow signal. The dumping reaction was not detectably altered by the addition of guar to the meal.[ncbi.nlm.nih.gov]
  • Symptoms included postprandial tachycardia, diaphoresis, lethargy, severe retching, meteorism or gas-bloat syndrome, watery diarrhea, refusal to eat with failure to thrive, and developmental delay.[ncbi.nlm.nih.gov]
  • One hour after eating meals, the patient exhibits diaphoresis, tachycardia, and hypotension. In addition, the patient reports feeling abdominal cramps, weakness, and nausea.[registerednursern.com]
Orthostatic Hypotension
  • Hypovolemia: [orthostatic hypotension, tachycardia, sweating, flushing, vertigo] Epigastric pain Syncope [due to hypovolemia] Nausea, diarrhea Hyperactive BS Feeling of abdominal fullness and abdominal cramping [Due to fluid shift into the gut causing[quizlet.com]
Flushing
  • The symptoms of late dumping syndrome may include: [1] hypoglycemia flushing About 75 percent of people with dumping syndrome report symptoms of early dumping syndrome and about 25 percent report symptoms of late dumping syndrome.[en.wikipedia.org]
  • […] the patient to lie down and relax for about 30 minutes after eating. dump·ing syn·drome the syndrome that occurs after eating, most often seen in patients with shunts of the upper alimentary canal that bypass or remove the pylorus; characterized by flushing[medical-dictionary.thefreedictionary.com]
  • At that point, water flushes into the small intestine to dilute the food. If the food that the diabetic ate was high in sugar, more water dumps into the intestine. When this process happens, it is called early dumping syndrome.[battlediabetes.com]
  • Symptoms: Symptoms of dumping syndrome include nausea, diarrhea, palpitations, rapid heart rate, sweating, confusion, dizziness, flushing and lightheadedness.[symptoma.com]
  • […] dump·ing syndrome \ ˈdəm-piŋ- \ Medical Definition of dumping syndrome : a condition characterized by weakness, dizziness, flushing and warmth, nausea, and palpitation immediately or shortly after eating and produced by abnormally rapid emptying of the[merriam-webster.com]

Workup

The following methods would be employed for diagnosing dumping syndrome [9]:

  • Medical history: A careful evaluation of the signs and symptoms followed by medical history of the patient is done at the preliminary level. If the individual has undergone an abdominal surgery, then the diagnosis of dumping syndrome stands confirmed.
  • Blood test: Blood tests to analyze the glucose levels would be done, as hypoglycemia is a common feature of dumping syndrome. For this, oral glucose tolerance test would be carried out to evaluate the blood sugar levels.
  • Gastric emptying scintigraphy test: Such a kind of test is done to measure how quickly the food leaves the stomach. For this, a radioactive material is added to the food to measure the rate of gastric emptying.
Glucose Decreased
  • Orthostatic pulse increases after glucose decreased from 36 /- 6 beats/min after placebo to 9 /- 5 beats/min after octreotide (P .05), and standing blood pressure decreases after glucose were abolished (P .05), but octreotide had no effect on increase[ncbi.nlm.nih.gov]
Liver Biopsy
  • Liver biopsy revealed hepatocellular glycogenosis by light and electron microscopy. Further evaluation showed no evidence of diabetes mellitus, glycogen storage disease, or corticosteroid use.[ncbi.nlm.nih.gov]

Treatment

Various methods are required for treating dumping syndrome. The following are employed to treat the condition:

  • Changes in dietary pattern: This is one of the common methods to effectively manage the condition of dumping syndrome. In this, the individuals are asked to adhere to small and frequent meal pattern. Liquid intake is allowed 30 minutes after meal. A diet rich in fiber, protein and complex carbohydrates is advised. Simple sugars are to be avoided as this would cause a sudden rise in blood glucose levels.
  • Medications: Medications such as acarbose and octreotide are recommended for treating dumping syndrome. These medications delay the digestion process and slow down the gastric emptying rate.
  • Surgery: This is often the last resort and employed only when other treatment modes did not bring about any desired effect. Surgical procedures are done to reverse the process of bypass surgery or to reconstruct the pylorus [10].

Prognosis

The severity of the symptoms gradually tends to get better with time. However, 1 to 2% individuals continue to experience the unfavorable symptoms even for several months after surgery. With long term treatment, there is considerable improvement in the condition of the patient. In addition, following strict dietary modifications and medications also significantly improves the symptoms [5].

Etiology

Dumping syndrome primarily occurs due to surgical procedures that involves removal of the pylorus. Such an event causes rapid gastric emptying which in turn gives rise to occurrence of unfavorable symptoms. Another major causative factor that causes dumping syndrome to occur is the procedure of esophagectomy. In this process, the esophagus is removed which also is known to favor rapid gastric emptying.

Of late, gastric bypass surgery is one of the most preferred methods for weight loss. This is also considered to be one of the major and most common factors for development of dumping syndrome. The condition usually occurs after 2 to 3 weeks of surgery, but many times it occurs immediately after the individual returns to normal diet. In many cases, dumping syndrome becomes a chronic condition [2].

Epidemiology

The extent of gastric surgery directly affects the severity of the symptoms. It has been estimated that about 15 to 20% of individuals who have undergone gastric bypass surgery, suffer from dumping syndrome. Of these, only 1 to 5% individuals are reported to experience debilitating symptoms. Statistics have also revealed that about, 6 to 14% of individuals who have undergone truncal vagotomy and drainage suffer from dumping syndrome. On the other hand, 14 to 20% individuals are reported to suffer from symptoms of dumping after procedure of partial gastrectomy [3]. Females are at an increased risk of developing the condition compared to males.

Sex distribution
Age distribution

Pathophysiology

Anatomically, the stomach contains the pylorus which is the opening between the stomach and the small intestine. Under normal conditions, the pylorus controls the emptying of the stomach contents. In condition of dumping syndrome, when there has been a surgery wherein the pylorus has been removed, the content of the stomach rapidly empties into the small intestine. The dumping syndrome primarily occurs due to 3 major phenomenons which are disturbed or abnormal functioning of the gastric motor after the surgery, improper pyloric emptying and altered function of the gastric reservoir function. The accompanying symptoms that occur as a result of rapid gastric emptying, primarily take effect due to increased secretion of insulin and release of hormones in the intestine [4].

Prevention

Changes in the dietary habits are the best way to prevent the onset of dumping syndrome. Individuals are advised not to sip in liquids during meals. Avoiding simple sugars is also required in order to prevent the phenomenon of rapid gastric emptying from occurring.

Summary

Dumping syndrome is also referred to as rapid gastric emptying, which essentially occurs when the undigested contents of the stomach rapidly move down the small intestine. The rapid movement of the undigested contents causes the concerned individual to suffer from nausea, diarrhea and abdominal cramps. The changes that occur in the anatomy and physiology of the stomach due to surgery of the organ, promotes the development of dumping syndrome [1].

Patient Information

  • Definition: Dumping syndrome is a condition that occurs due to rapid gastric emptying after meals, in individuals who have undergone surgery of the stomach. Individuals who have considered surgery to correct obesity are also at an increased risk of developing dumping syndrome.
  • Cause: Abdominal surgery wherein the pylorus has been removed, predisposes an individual to develop dumping syndrome. In addition, patients who have undergone esophagectomy to remove the esophagus can also suffer from dumping syndrome.
  • Symptoms: Symptoms of dumping syndrome include nausea, diarrhea, palpitations, rapid heart rate, sweating, confusion, dizziness, flushing and lightheadedness.
  • Diagnosis: Dumping syndrome is diagnosed by taking a detailed medical history of the individual followed by measurement of blood glucose levels. In addition, the scintigraphy test to measure the rate at which gastric emptying occurs is also done.
  • Treatment: Dumping syndrome is treated by making necessary changes in the dietary pattern. Individuals are also put on medications to delay the gastric emptying and also to effectively manage the symptoms. Surgery is the last resort and is opted only when other methods do not seem to produce desired results.

References

Article

  1. Wyllys E, Andrews E, Mix CL. "Dumping stomach" and other results of gastrojejunostomy: Operative cure by disconnecting old stoma. Surg Clin Chicago. 1920;4:879-92.
  2. Schneider BE, Villegas L, Blackburn GL, et al. Laparoscopic gastric bypass surgery: outcomes. J Laparoendosc Adv Surg Tech A 2003; 13:247.
  3. Z'graggen K, Guweidhi A, Steffen R, et al. Severe recurrent hypoglycemia after gastric bypass surgery.Obes Surg. Aug 2008;18(8):981-8.
  4. Sanyal AJ, Sugerman HJ, Kellum JM, et al. Stomal complications of gastric bypass: incidence and outcome of therapy. Am J Gastroenterol 1992; 87:1165.
  5. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract 2005; 20:517.
  6. Duthie HL, Irvine WT, Kerr JW. Cardiovascular changes in post-gastrectomy syndrome. Br J Surg. 1959;46:350.
  7. Holdsworth CD, Turner D, McIntyre N. Pathophysiology of post-gastrectomy hypoglycaemia. Br Med J. Nov 1 1969;4(5678):257-9.
  8. Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med 2005; 353:249.
  9. Abell TL, Minocha A. Gastrointestinal complications of bariatric surgery: diagnosis and therapy. Am J Med Sci. Apr 2006;331(4):214-8.
  10. Koruth NM, Krukowski ZH, Matheson NA. Pyloric reconstruction. Br J Surg. Oct 1985;72(10):808-10.

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Last updated: 2019-07-11 21:46