Dumping Syndrome: Symptoms, Causes, and Treatment

Dumping syndrome happens when food moves too quickly from the stomach into the small intestine, often as a result of surgery involving the stomach or the lower part of the esophagus. Most people have symptoms that ease over time, and the syndrome is not usually permanent. Lifestyle and dietary adjustments help manage symptoms effectively. In severe cases, healthcare providers may prescribe medication or perform surgery.

What is Dumping Syndrome?

When you have dumping syndrome, your stomach empties contents into the small intestine very rapidly, faster than it should. This causes the small intestine to receive large amounts of poorly digested food. This is very uncomfortable, and the patient experiences bloating, nausea, abdominal cramps, and even diarrhoea. Dumping syndrome impacts the blood sugar level, which fluctuates suddenly because of this.

In a normal human being, the stomach releases digested food into the small intestine slowly and in a controlled manner. “Gastric motility” denotes the way the stomach moves food through the digestive process. Normal gastric motility relies on the coordination of muscles, nerves, and hormonal signals. These signals tell your stomach when and how to empty food into the small intestine. When this coordination is affected, the pyloric valve at the bottom of the stomach simply opens and dumps undigested food into the small intestine. This uncontrolled gastric emptying results in the small intestine having to cope with a whole lot of undigested food. To do this, it draws in extra fluid volume and releases extra hormones. All this activity results in the symptoms that people with dumping syndrome experience shortly after eating.

In some people, the symptoms appear a few hours after they have eaten. This happens because when the small intestine receives concentrated sugar content, it signals to your pancreas which release extra insulin to regulate the blood sugar. As a result, your blood sugar drops sharply resulting in hypoglycaemia. The patient may experience, faintness, shakiness, and palpitations of the heart.

Symptoms

There are two types of dumping syndrome. One is early dumping syndrome, in which the patient experiences symptoms between 10 to 30 minutes after eating something. The symptoms are:

Feeling bloated or full after eating

• Nausea
• Abdominal cramps
• Diarrhoea
• Flushing
• Dizziness and light-headedness
• Rapid heart rate and acceleration

The other type of dumping syndrome is called late dumping syndrome. These symptoms appear about 2 or 3 hours after eating:

• Sweating
• Flushing
• Weakness and fatigue
• Dizziness and light-headedness
• Heart acceleration or rapid heartbeat
• Jitters and shakiness
• Cold sweats
• Brain fog
• Hunger

Causes

Dumping syndrome can have various causes, with certain surgeries being a major factor. Surgically, it may result from any of the following procedures:

• Gastrectomy, where some part or all of the stomach is removed
• Bariatric surgery is done for weight loss
• Pyloroplasty is a surgery on the pyloric valve at the bottom of your stomach.
• Esophagectomy, in which a part of the oesophagus is removed
• Vagotomy, or a surgery where the vagus nerve is cut to reduce stomach acid
• Nissen fundoplication is a surgery that sews the top of the stomach around the oesophagus

Dumping syndrome can also result from various other medical conditions, such as:

• Diabetes mellitus
• Cyclic vomiting syndrome
• Autonomic dysfunction
• Exocrine pancreatic insufficiency
• Duodenal ulcers
• Zollinger-Ellison syndrome
• Functional dyspepsia
• Cannabis hyperemesis syndrome

Diagnosis and Treatment

Various tests can diagnose dumping syndrome, which are listed as follows.

• Oral glucose tolerance test: You will consume a glucose solution, and your blood sugar levels will be tested both prior to and following the intake. The test also measures your hematocrit (red blood cell count). If the test shows a higher hematocrit after you drink the solution, it means that large volumes of fluid are moving to your intestines from your bloodstream. If your blood sugar drops 1 to 3 hours after this, it indicates late dumping syndrome.
• Hydrogen breath test: You are made to drink a glucose solution, and the hydrogen levels in your blood are measured. If your small intestine is overloaded, the test results are positive, which indicates that the glucose is not well absorbed in your small intestine.
• Upper endoscopy: A thin, flexible tube with an attached lighted camera is used to examine the oesophagus, stomach, and duodenum. Endoscopy can reveal any structural problems and other causes of dumping syndrome.
• Upper GI series: In this test, your healthcare providers will take a series of video X-rays called fluoroscopy, which can show how fast the solution travels from your oesophagus and stomach to your upper intestine.
• Gastric emptying test: This test shows how fast food moves through your stomach to your small intestine. To do this, a small (trace) amount of radioactive material is added to your meal. By tracking the radioactive material, a scanner can easily reveal how the food moves.

Treatment of dumping syndrome is usually through dietary changes. If these changes do not produce results, then you may need medication. Medicines may include:

• Octreotide acetate: The medicine inhibits certain hormones that slow down the gastric emptying and transit time to the small intestine. It also suppresses insulin. It is an injection given in two forms: daily or monthly, once, depending on whether it is a short or long-acting form.
• Acarbose: This medicine regulates your blood sugar and slows down the rate at which your body absorbs carbohydrates. 

Doctors do not recommend medications in the long term since they have side effects. Very rarely, another surgery may be suggested to fix dumping syndrome. These reconstruction surgeries may be:

• Modifying or reconstructing a part of your stomach that is not working properly.
• If you have had a gastric bypass operation, it may have to be reversed or converted to a less severe form

What to Expect During Recovery

Generally, dietary guidelines are given to those with dumping syndrome:

• Smaller meals are recommended; you must eat slowly and chew thoroughly.
• Avoid carbohydrates, sugar, and milk products. Instead, eat complex carbohydrates such as whole grains. Eat unsweetened whole-grain cereal, oatmeal, bread, rice, and pasta.
• Eat more protein and healthy fats to get a steady form of energy. You can have eggs, meat, poultry, fish, and nut butter. Butter, mayonnaise, avocados, and salad dressings can also be included.
• When your meal is very bulky, the transit time and sugar in your digestive system slow down.
• Lying down on your back for 30 minutes after eating helps slow down gastric emptying and maintain blood pressure during digestion.
• Avoid drinking fluids 30 minutes before or after eating, as they can speed up gastric motility.

Dumping syndrome is a common problem that affects people recovering from surgery. You can manage the condition by adjusting your diet. Mild cases resolve within three months, and severe cases take up to 18 months to resolve. Even after you make dietary changes, it may take several weeks before you notice any improvement.

Frequently Asked Questions