What is Dumping Syndrome?
Obesity is a significant problem in today’s Western world. As a result, many people opt for weight loss surgery. One complication that can occur after this type of surgery is Dumping syndrome. This condition is caused by changes in how the digestive system functions, leading to unwanted side effects. These result from the too-quick movement of a highly-concentrated digestive fluid from the stomach into the small intestine.
What Causes Dumping Syndrome?
Dumping syndrome’s intensity often corresponds with how extensive the stomach surgery was. This issue can result from various types of surgeries such as gastrojejunostomy, antrectomy, pylorectomy, pyloroplasty, esophagectomy, vagotomy, Roux-en-Y bypass, and Nissen fundoplication.
On the other hand, non-surgical reasons for dumping syndrome include conditions like diabetes, viral illnesses, and other unexplained or unknown causes.
Risk Factors and Frequency for Dumping Syndrome
In those who have had surgery on their stomach, around 20% to 50% experience the symptoms of Dumping syndrome, which involves the rapid emptying of food into the small intestine. However, only about 1% to 5% of people will face severe symptoms. Early Dumping syndrome, which occurs soon after eating, is observed to happen more frequently than late Dumping syndrome, which happens a few hours after meal.
- 20% to 50% of people who’ve had stomach surgery experience symptoms of Dumping syndrome.
- About 1% to 5% will deal with severe symptoms.
- Early Dumping syndrome is usually more common than late Dumping syndrome.
Signs and Symptoms of Dumping Syndrome
Dumping syndrome is a condition that can affect people who have undergone stomach surgery. There are two types: early and late dumping. Early dumping shows up within 10 to 30 minutes after eating, while late dumping happens about 1 to 3 hours after consuming a meal rich in carbohydrates.
Patients may experience symptoms affecting their digestive system or certain body functions. Digestive system symptoms can consist of feeling nauseous, vomiting, diarrhea, or excessive burping. Other body-related symptoms could involve shock, fainting or near-fainting, heart palpitations, dizziness, a desire to lie down, or breaking out in a cold sweat.
- Early dumping: symptoms show within 10-30 minutes after eating
- Late dumping: symptoms occur 1-3 hours after a high-carb meal
- Digestive system symptoms: nausea, vomiting, diarrhea, belching
- Other body-related symptoms: shock, fainting, heart palpitations, dizziness, desire to lie down, cold sweats
Testing for Dumping Syndrome
Sigstad came up with a way to identify Dumping syndrome, a condition linked to several signs like feeling sick, throwing up, and shock-like symptoms. If a person scores higher than seven, it may mean they have Dumping syndrome.
A self-reported questionnaire known as the Dumping Symptom Rating Scale is another method to spot patients with severe signs of this syndrome.
There’s a specific test involving consuming glucose that can cause the symptoms of Dumping syndrome to show up. If a patient, who’s fasted for 10 hours, has their heart rate increase by ten or more beats per minute in the hour after consuming 50 grams of glucose, it indicates they’re very likely to have early dumping syndrome. This test has been shown to be 100% sensitive, meaning it correctly identified all those with the syndrome in studies. Also, it’s 94% specific, which means it accurately ruled out those who didn’t have the syndrome.
To learn more about a patient’s body, doctors might use other techniques such as endoscopy, a barium upper GI study, or a gastric emptying scan.
Treatment Options for Dumping Syndrome
In most instances, the treatment for dumping syndrome center around adjustments to one’s diet. It is typically advised for patients to consume their meals in smaller portions about six times daily, avoiding liquids for 30 minutes after eating. Certain foods and drinks like simple sugars and dairy products should be cut out from the diet while others like protein, fats, and fiber-rich food should be incorporated more as they promote a slower digestion process.
If symptoms persist after these dietary changes, medication may be necessary. This may include drugs like tolbutamide and propranolol. Another medication, octreotide, has been proven beneficial as it slows down gastric emptying, decreases certain gastrointestinal hormones and insulin production while also extending digestion time in the small intestine. Acarbose is another medication that could be considered as it slows down the conversion of certain sugars in the body which helps to alleviate the symptoms of late dumping syndrome.
When all else fails and dumping syndrome continues to present its symptoms, surgical intervention may become necessary. This could involve stomal revision, which narrows the opening between the stomach and small intestine but this does carry the risk of complications such as obstruction and constriction. There’s also the concept of changing the surgical connection between the stomach and small intestine from a Billroth II to Billroth I method. This may sound complicated, but it simply ensures food passes as it should through the digestive system with minimal complications.
Pyloric reconstruction could be another option for patients who still encounter dumping syndrome after initial surgery. This procedure involves cutting the scar from a previous stomach surgery and reinstating the stomach’s natural closing muscle. Jejunal interposition is another procedure which places a naturally contracting segment of the small intestine in a new position, however, this procedure’s effectiveness is still up for debate.
The last surgical alternative involves converting one type of connection in the stomach, known as Roux-en-Y, into another version to slow down the rate at which food leaves the stomach and transits through the intestine. The exact way this improves symptoms is not yet fully understood, but overall, it has shown positive outcomes in patients.
What else can Dumping Syndrome be?
Dumping syndrome is a condition that typically includes symptoms like stomach pain, feeling sick or vomiting, losing weight, diarrhea, feeling full quickly after eating, feeling very hot, and feeling tired. Since these symptoms can also be signs of many other stomach and hormone-related conditions, it’s really important to have a thorough check-up to figure out the actual cause.
What to expect with Dumping Syndrome
Dumping syndrome, for the most part, is effectively managed with changes to the patient’s diet. If these dietary changes don’t work, doctors might suggest medical or surgical treatment. However, it’s important to note that the success of these alternative approaches isn’t fully proven yet.