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.

• Disability

  A case of a 72-year-old man with a long-standing disabling dumping syndrome and close to 90% gastric resection is described. [ncbi.nlm.nih.gov]

  ‘Disabling (ie, through pyloroplasty or pyloromyotomy) or bypassing the valve results in dumping syndrome because of unregulated emptying of high solute concentration liquids, specifically sweets, into the small bowel.’ [en.oxforddictionaries.com]

• Pallor

  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]

• Intravenous Administration

  Enteral glucose administration induces enhanced insulin release relative to intravenous administration, which is the so-called incretin effect. [nature.com]

• Diarrhea

  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. [uspharmacist.com]

  This increased volume causes peristalsis and diarrhea. The loss of fluid from capillaries causes hypotension with resulting weakness and dizziness. [medical-dictionary.thefreedictionary.com]

  This bariatric surgery side effect with a double meaning causes your stomach contents to be dumped quickly into your intestines, causing uncontrollable diarrhea. Learn how to manage this uncomfortable situation. [everydayhealth.com]

  Serotonin, histamine and prostaglandins are then released and thought to cause the cramping and diarrhea associated with the dumping syndrome. [livestrong.com]

• Nausea

  […] 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]

  All patients presented with unexplained nausea, fifteen (50%) had early satiety, and fifteen (50%) had bloating. [journals.lww.com]

  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 stomach especially in individuals who have had part of the stomach removed [merriam-webster.com]

  Such early symptoms include bloating, vomiting, diarrhoea, heart palpitations, nausea, sweating, dizziness and a rapid heart rate. Late dumping is a form of hypoglycaemia (low blood sugar). [phoenix-health.co.uk]

• 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]

  […] syndrome distinguishing factors clinical presentation of intense vomiting episodes separated by symptom-free periods history of cannabinoid use Gastroparesis distinguishing factors scintigraphic gastric emptying study would demonstrate delayed gastric [step2.medbullets.com]

  Early dumping syndrome symptoms include: Nausea Vomiting Abdominal pain, cramps Diarrhea Dizziness, lightheadedness Bloating, belching Fatigue Heart palpitations, rapid heart rate Late dumping: 1-3 hours after eating Late dumping syndrome is caused by [healthierweight.co.uk]

  Symptoms Symptoms of dumping syndrome can include: Sickness and vomiting Cramping Diarrhea Bloating Dizziness Rapid heart rate Symptoms of late dumping can include: Sweating Hunger Tiredness Faintness Confusion Rapid heart rate Dizziness Causes Dumping [humanitas.net]

• Abdominal Cramps

  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]

  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]

  They include: Feeling bloated or too full after eating Nausea Vomiting Abdominal cramps Diarrhea Flushing Dizziness, lightheadedness Rapid heart rate Late dumping syndrome starts 1 to 3 hours after you eat a high-sugar meal. [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]

  She endorses nausea and palpitations during these episodes but denies weight changes, fever, abdominal pain, or diarrhea. Her past medical history is significant for a gastric bypass surgery 3 months ago for weight reduction. [step2.medbullets.com]

  Patients often present with cramping, abdominal pain, diarrhea, nausea, and tachycardia, as well as vasomotor symptoms such as diaphoresis, palpitations, and flushing.3 Dietary modifications (TABLE 1) are typically recommended as part of treatment. [uspharmacist.com]

  Early dumping syndrome symptoms include: Nausea Vomiting Abdominal pain, cramps Diarrhea Dizziness, lightheadedness Bloating, belching Fatigue Heart palpitations, rapid heart rate Late dumping: 1-3 hours after eating Late dumping syndrome is caused by [healthierweight.co.uk]

  Other patients have right sided or mid abdominal pain. Many patients also complain of post-cholycystectomy diarrhea. [medhelp.org]

• Palpitations

  […] 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]

  Early dumping syndrome symptoms include: Nausea Vomiting Abdominal pain, cramps Diarrhea Dizziness, lightheadedness Bloating, belching Fatigue Heart palpitations, rapid heart rate Late dumping: 1-3 hours after eating Late dumping syndrome is caused by [healthierweight.co.uk]

  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 stomach especially in individuals who have had part of the stomach removed [merriam-webster.com]

  Such early symptoms include bloating, vomiting, diarrhoea, heart palpitations, nausea, sweating, dizziness and a rapid heart rate. Late dumping is a form of hypoglycaemia (low blood sugar). [phoenix-health.co.uk]

• Tachycardia

  Octreotide prevented the symptoms of early dumping syndrome, especially postprandial tachycardia, but caused postprandial hyperglycemia. [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]

• Arthritis

  […] is the only satisfactory long-term treatment for severe obesity (body mass index [BMI] 40 kg/m² or greater, or 35 kg/m² or greater with severe obesity-associated comorbidities, such as diabetes, obstructive sleep apnea, or debilitating degenerative arthritis [emedicine.medscape.com]

• Flushing

  […] 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]

  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 stomach especially in individuals who have had part of the stomach removed [merriam-webster.com]

  Snapshot A 48-year-old woman presents to the clinic for complaints for flushing and diarrhea for the past 2 weeks. She reports that these symptoms often occur 15 minutes after a meal and usually resolves within hours. [step2.medbullets.com]

  Patients often present with cramping, abdominal pain, diarrhea, nausea, and tachycardia, as well as vasomotor symptoms such as diaphoresis, palpitations, and flushing.3 Dietary modifications (TABLE 1) are typically recommended as part of treatment. [uspharmacist.com]

  Symptoms: Symptoms of dumping syndrome include nausea, diarrhea, palpitations, rapid heart rate, sweating, confusion, dizziness, flushing and lightheadedness. [symptoma.com]

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.

• Bowel Distention

  Fluid shifts from the intravascular compartment into the bowel lumen lead to rapid small bowel distention and an increased peristalsis (early dumping). [unboundmedicine.com]

  This leads to fluid shifts from the intravascular compartment into the bowel lumen, resulting in rapid small bowel distention and an increase in the frequency of bowel contractions. [emedicine.medscape.com]

• Hypoglycemia

  Liraglutide may be a novel treatment option for postprandial hyperinsulinemic hypoglycemia after gastric surgery. [ncbi.nlm.nih.gov]

  This phenomenon is not strictly due to alterations of osmotic gradients across the GI tract, but rather is thought to result from hypoglycemia following a postprandial insulin peak. [uspharmacist.com]

  This leads to a plethora of complications including cardiovascular, gastrointestinal (GI) and postprandial hypoglycemia. [news-medical.net]

  Pancreatic islet cell hyperplasia, rather than late dumping, is thought to be the underlying mechanism for hyperinsulinemic hypoglycemia with nesidioblastosis after gastric bypass. [unboundmedicine.com]

• Hyperinsulinemia

  Insulinoma, the most common cause of endogenous hyperinsulinemia, should be investigated in these patients, since it is a tumor that can be cured. [ncbi.nlm.nih.gov]

  To counter the effects of high glucose concentrations, the body secretes more insulin than usual (hyperinsulinemia) which remains for an extended period, causing hypoglycemia. [news-medical.net]

• 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]

• Helicobacter Pylori

  Helicobacter pylori treatment and eradication in patients with peptic ulcer disease have further decreased the need for surgery. [emedicine.medscape.com]

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].

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].

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].

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.

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].

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.

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].

• 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.

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