Dumping syndrome

Dumping syndrome occurs when food moves too fast from the stomach into the small intestine.

Causes

Dumping syndrome can occur after surgery that involves the end of the stomach, the pyloric sphincter and the duodenum (first part of the small intestine). The pyloric sphincter is a ring of muscle that acts as a valve to control the emptying of stomach contents into the duodenum.

If the pyloric sphincter is removed during surgery, the control of food entering the duodenum is reduced.

Symptoms

Early dumping syndrome

Early dumping syndrome occurs about 15 minutes to 1 hour after a meal is eaten. The stomach releases undigested food into the duodenum very quickly. Fluid is pulled from surrounding tissues and blood vessels into the small intestine, which leads to:

bloating	vomiting
pain	flushing
cramping	rapid heartbeat
diarrhea	headache
sweating	light-headedness
dizziness

Late dumping syndrome

Late dumping syndrome occurs about 1 to 3 hours after a meal is eaten. Similar to early dumping syndrome, undigested food is released into the small intestine very quickly. Carbohydrates (sugars) are absorbed quickly and the blood sugar level rises. The body responds by releasing insulin. This, in turn, causes a drop in blood sugar level (hypoglycemia) and leads to symptoms that include:

sweating
shakiness
hunger
difficulty concentrating
decreased consciousness

Prevention and management

Changes in diet

Many cases of dumping syndrome can be treated or even prevented with the following diet changes:

Eat 6 to 8 small meals throughout the day rather than 3 larger meals.
Eat slowly and chew well.
Increase protein in the diet to slow down digestion.
Eat carbohydrates as part of a meal rather than by themselves, or eat a lower carbohydrate diet.
Limit the amount of beverages taken with a meal to reduce the volume in the stomach and decrease the chance of triggering the syndrome.
Limit foods that contain a lot of sugar.
Limit chocolate and peppermint.
Limit milk and milk products to small amounts at a time since these are usually not well tolerated.
Rest quietly for 30 minutes after a meal to allow the food to digest as much as possible.
No eating or drinking after 7:00 p.m. or 8:00 p.m. may help.
Slowly increase the amount of fibre in the diet to help reduce late dumping syndrome (fibre binds with water to help form the stool and slows the absorption of sugars).

Medication

If dietary changes are not effective in treating dumping syndrome, certain medications may be offered. These include:

acarbose
- interferes with carbohydrate and sugar absorption
- controls blood sugar level after a meal and helps reduce the symptoms of late dumping
octreotide (a somatostatin analogue)
- slows the initial emptying of the stomach contents into the small intestine
- limits the release of insulin and helps control symptoms of both early and late dumping syndrome

Surgery

If dietary changes and medication do not relieve the symptoms of dumping syndrome, surgery may be needed to try to change how the food moves through the gastrointestinal tract.

References

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