Dumping syndrome

Also called rapid gastric emptying, occurs when food moves too quickly from the stomach into the first section of the small intestine.

Dumping syndrome (DS) occurs when the stomach empties food into the small bowel at a faster rate than normal. 



DS is frequently related to the rapid emptying of hyperosmolar gastric content into the small intestine. 



It is usually caused by the destruction or bypass of the pyloric sphincter. 

Symptoms include cramps, diarrhea, and nausea after eating, particularly after eating high-sugar foods.

Most patients develop abdominal cramps and diarrhea within 10 to 30 minutes after eating. 



Some experience such symptoms 1 to 3 hours after eating, and yet others experience both early and late symptoms.



Clinical manifestations of DS: include GI symptoms of early satiety, crampy abdominal pain, nausea, vomiting, and explosive diarrhea; and vasomotor symptoms that include diaphoresis, flushing, dizziness, palpitations, and an intense desire to lie down.



Early DS happens within 10 to 30 minutes after eating.



Early DS is the result of rapid emptying of food into the duodenum. 



Hyperosmolality of the food causes fast fluid shifts from the plasma into the bowel, causing hypotension and a sympathetic nervous system response. 



Early dumping is self-limiting and resolves within 7 to 12 weeks.



Late DS is lnown as postprandial hyperinsulinemic hypoglycemia.



Postprandial hyperinsulinemic hypoglycemia is a rare complication of bariatric surgery, at 0.1% to 0.3% of patients.



Symptoms of postprandial hyperinsulinemic hypoglycemia (PHH)


include: dizziness, fatigue, diaphoresis, and weakness.



Postprandial hyperinsulinemic hypoglycemia symptoms usually occur 1 to 3 hours after ingestion of a carbohydrate-rich meal.



Typically,  postprandial hyperinsulinemic hypoglycemia symptoms appear months to years after surgery.



Postprandial hyperinsulinemic hypoglycemia is a result of hypoglycemia following a postprandial insulin peak. 



Most patients with PHH can be managed with the same dietary modifications, and refractory cases can be treated with medications such as nifedipine, acarbose, diazoxide, and octreotide, gastrostomy tube feeding, or revisional bariatric surgery. 


Dumping syndrome (DS) occurs when the stomach empties food into the small bowel at a faster rate than normal. 



Can occur in post–gastric bypass patients when high levels of simple carbohydrates are ingested, and in patients who have had esophageal surgery. 

Significant dumping symptoms occur in about 20% of patients after pyloroplasty or distal gastrectomy. 

DS more likely  in those younger than age 35 years or with a BMI <25 kg/m2.

The osmotic gradient draws fluid into the intestine, and this may release one or more vasoactive hormones, such as serotonin and vasoactive intestinal polypeptide. 

Can be treated through dietary and lifestyle changes.

More severe cases may require medication or surgery.

Most commonly occurs in people who have undergone gastric surgery.

Symptoms typically present within 30 minutes of eating.

Early dumping syndrome may include bloating, diarrhea, nausea, and stomach pain.

Early dumping syndrome symptoms begin 10 to 30 minutes after eating.

A second phase, the late dumping syndrome, symptoms begin 2 to 3 hours after eating.

Approximately 75 percent of people with dumping syndrome experience early dumping syndrome, and around 25 percent experience late dumping syndrome.

Some people may experience both phases of the dumping syndrome.

Symptoms vary depending on the individual and the phase of the condition.

With early dumping syndrome may experience:



feeling bloated

increased heart rate


skin flushing

stomach pain and cramping


Symptoms of late dumping

syndrome, occurs within 3 hours of meals:

can cause low blood sugar, which may lead to the following symptoms:




increased heart rate

skin flushing



With dumping syndrome food particles are not stored in the stomach for long enough and are emptied into the duodenum too quickly.

Early dumping syndrome is caused by the sudden arrival of a large amount of food in the stomach,lading to the rapid movement of fluid into the intestine, which causes discomfort, bloating, and diarrhea.

Late dumping syndrome results from the release of a large amount of insulin.

The most common cause of dumping syndrome is prior surgery.

Dumping syndrome occurs in at least 15 percent of people who have part of their stomach removed.

Surgical procedures on the stomach that increase the risk of dumping syndrome:


Gastric bypass surgery


The DS may contribute to weight loss, in part by causing the patient to modify eating habits.



The diagnosis of DS is made primarily on clinical basis.

Tests used to diagnose dumping syndrome include:

Oral glucose tolerance test

Gastric emptying test.

Treatment: changes in diet, medications, and, in some cases, surgery. 



Patients with mild DS, in many cases, improve over time with changes in eating habits and diet.



Octreotide (Sandostatin): Somatostatin and its synthetic analogue octreotide have been used with short-term success in patients with DS. 


Octreotide injection is an anti-diarrheal drug that slows the rate at which food empties into the small intestine. 

Octreotide can also prevent the release of insulin to reduce the risk of low blood sugar levels.



Acarbose (Precose) reduces the symptoms of late DS by interfering with carbohydrate absorption and thus decreasing the time delay between hyperglycemia and insulin response. 



With intractable dumping symptoms patients  may require reoperation. In patients who had a distal gastrectomy, conversion from a loop gastrojejunostomy to a Roux-en-Y reconstruction is the procedure of choice. 



Lifestyle and dietary changes can be used to ease the symptoms of dumping syndrome and are often very effective treatments and include:

foods high in fiber.

eating five to six small meals throughout the day, instead of three large meals.

stop eating once full.

chew food thoroughly to aid digestion.

do not drink liquids in the 30 minutes before or after meals.

drink 8 glasses of water throughout the day, but only between meals

lying down for 30 minutes after a meal.

limit or avoid high-sugar foods such as candy, cakes, fruit juice, and soda

limit or avoid white bread, white rice, and white pastas.

cut out alcohol.

increase protein intake by eating foods such as lean meats, fish, and tofu.

remove dairy from the diet, as dairy is high in the natural sugar lactose

add pectin, psyllium, or guar gum to meals to slow the rate at which food moves through the digestive system.

It can affect nutrient absorption, nutritional supplements may be beneficial.

Corrective surgery for dumping syndrome is often unsuccessful.

A common complication of gastric surgeries.

Other complications that may arise with dumping syndrome, and as a result of surgery, include: problems with nutrient absorption, anemia, due to a lack of vitamin B-12, folic acid, or iron or osteoporosis,weight loss due to symptoms of dumping syndrome

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