Dumping Syndrome

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.

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.

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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