Gastric dumping syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 4, 2016
StartDiseasesGastric dumping syndrome

Gastric dumping syndrome or simply dumping syndrome involves gastric disturbances after eating which primarily affects those who have had gastric surgical procedures. Up to 75 percent of those undergoing gastrointestinal surgery may experience the condition. It is also known as rapid gastric emptying.

Contents

Definition & Facts

Sometimes problems arise with digesting food or storing it in the stomach after gastric surgery. Movement of food via the gastric system is called gastric motility. Gastric motility is controlled through hormonal activity and nerve responses via the enteric nervous system. Impairments such as nerve damage after bariatric surgery may cause dumping syndrome.

A lack of stomach acid in those who have not had surgery may eventually cause dumping syndrome. Esophageal surgery may initiate dumping syndrome, as well as diseases that cause damage to nerves in the gastrointestinal tract.

Symptoms & Complaints

If 'early dumping syndrome' is experienced, discomfort begins within ten to fifteen minutes of a meal. Vomiting may occur, as well as diarrhea, cramping, fatigue, and dizziness

Illness may begin two or three hours after ingestion of a meal as well in which case the condition is said to be 'late dumping syndrome'. When the stomach contents move into the intestines too quickly, too much sugar can be absorbed by the intestines which raises blood sugar levels resulting in hyperglycemia.

The pancreas responds by releasing insulin which then causes the blood sugar level to decrease markedly, resulting in hypoglycemia. Weakness, sweating, and dizziness are frequent reactions. This kind of hypoglycemia is referred to as alimentary hypoglycemia.

Some individuals will suffer from both early and late dumping syndrome. The small bowel may distend and hypovolemia, or a decrease in blood plasma volume, can occur. Salt depletion initiates hypovolemia through rapid electrolyte loss due to diarrhea or vomiting.

Causes

Dumping syndrome is usually associated with gastrointestinal surgery. Vagus nerve damage can be the cause of rapid transit dumping of undigested food into the large intestine. At times, there has been no demonstrable cause for the dysfunction of dumping syndrome in which case it is said to be idiopathic. Observations of patient history have revealed that some patients with idiopathic dumping syndrome had experienced gastroenteritis before the onset of dumping syndrome.

Smaller capacity of the gastric system is often the planned or necessary outcome of gastric surgery. The surgical procedures may involve gastric bypass surgery for weight loss or removal of parts or all of the stomach to treat cancer. The stomach acts as a reservoir for ingested food while it is slowly processed. If this reservoir is compromised, food, particularly sugar, can move undigested from the small intestine to the bowel very rapidly.

Diarrhea occurs as a function of fluids moving so quickly that the large intestine is unable to solidify waste at the proper rate. Starches may exacerbate the trouble. This series of events is sometimes labeled post-gastrectomy syndrome.

Diagnosis & Tests

A fluoroscopy involving barium swallows may be ordered. A barium medium is ingested by the patient, and X-rays are taken of the medium emptying from the stomach. Rapid transit and early dumping is easily recognized. 

Radionuclide scintigraphy is a similar procedure, but involves gamma rays rather than X-ray radiation. An isotope decays in the stomach, and a gamma camera picks up the photons given off. An activity plot or map of the stomach and gastric motility is made, and it is noted if the person shows abnormally swift emptying of gastric contents through the duodenum.

Treatment & Therapy

Dumping syndrome is manageable by avoiding certain foods that exacerbate the rapid transit of nutrients through the gastric system. Because some foods must be avoided, it is very important to receive adequate nutrition. In order to do so, a diet of dense nutrients will need to be implemented. Several small meals per day should be consumed, rather than larger, scheduled feedings.

Liquids should not be taken with meals, but rather, between meals. This slows the rapid food movement of gastric dumping. The foods eaten should be low on carbohydrates and simple sugars, as sugars are implicated in the hypoglycemic reactions typical of late dumping syndrome. If liquids must be consumed with meals because of choking incidents, small amounts may be taken. Fiber is very important to prevent premature emptying.

Medication is available for those with severe cases of dumping syndrome. Octreotide and cholestyramine or proton-pump inhibitors may be given to slow down gastric motility. Other cases of gastric dumping syndrome may benefit from focused therapies such as antimotility agents

Surgery may be recommended in some cases. Sometimes surgery will be used to convert one kind of gastric bypass maneuver into another, such as a gastrojejunostomy in anticipation of relief. Dumping syndrome often resolves itself as the body becomes accustomed to changes in the digestive tract.

Prevention & Prophylaxis

Prevention of major symptoms involves education about new eating habits after gastrointestinal surgery. Recommended eating habits to alleviate or prevent dumping syndrome after surgery are:

  • Six or eight small meals a day.
  • Consuming protein at each meal, such as meat, fish, eggs, poultry, cheese, yogurt, nuts or tofu.
  • Consuming liquids between meals, not with meals.
  • Avoiding sugars.
  • Eating a high fiber diet, including apples, oats, beans, beets, Brussels sprouts, beans and spinach.
  • A small amount of butter, vegetable oils and salad dressing will slow digestion.
  • Chewing slowly and relaxing while eating.

Gastric dumping syndrome is a difficult condition that causes depression and anxiety in many people. It is a disorder of the digestive system that can be managed with appropriate diet, sometimes medication, and less commonly through surgery. Symptoms often ameliorate with time as the body adjusts to an altered digestive system post-surgery.