Gastric dumping syndrome

Dumping syndrome is a condition where ingested foods pass through the stomach very rapidly and enter the small intestine largely undigested. It happens when the small intestine expands too quickly due to the presence of hyperosmolar (having increased osmolarity) contents from the stomach. This causes symptoms due to the fluid shift into the gut lumen with plasma volume contraction and acute intestinal distention.^[1] "Early" dumping begins concurrently within 15 to 30 minutes from ingestion of a meal.^[1] Symptoms of early dumping include nausea, vomiting, bloating, cramping, diarrhea, dizziness, and fatigue. "Late" dumping happens one to three hours after eating. Symptoms of late dumping include weakness, sweating, and dizziness. Many people have both types. The syndrome is most often associated with gastric bypass (Roux-en-Y) surgery.

Rapid loading of the small intestine with hypertonic stomach contents can lead to rapid entry of water into the intestinal lumen. Osmotic diarrhea, distension of the small bowel (leading to crampy abdominal pain), and hypovolemia can result.

In addition, people with this syndrome often suffer from low blood sugar, or hypoglycemia, because the rapid "dumping" of food triggers the pancreas to release excessive amounts of insulin into the bloodstream. This type of hypoglycemia is referred to as "alimentary hypoglycemia."

Diagnosis

Physicians diagnose dumping syndrome primarily on the basis of symptoms in patients who have had gastric surgery. Tests may be needed to exclude other conditions that have similar symptoms. Two ways of determining if a patient has dumping syndrome include barium fluoroscopy and radionuclide scintigraphy. In the first procedure, a contrast of barium-labeled medium is ingested and x-ray images are taken; early dumping can be easily recognized by premature emptying of the contrast medium from the stomach.

The second method, scintigraphy (or radionuclide scanning), involves a similar procedure in which a labeled medium containing ^99mTc (or other radionuclide) colloid or chelate is ingested. The ^99mTc isotope decays in the stomach, and the gamma photons emitted are detected by a gamma camera; the radioactivity of the area of interest (the stomach) can then be plotted against time on a graph. Patients with dumping syndrome generally exhibit steep drops in their activity plots, corresponding to abnormally rapid emptying of gastric contents into the duodenum.

Treatment

Dumping syndrome is largely manageable by avoiding certain foods that are likely to cause it; therefore having a balanced diet is important. Treatment includes changes in eating habits and medication. People who have gastric dumping syndrome need to eat several small meals a day that are low in carbohydrates, avoid simple sugars, and should drink liquids between meals, not with them. People who are very sensitive to choking on their foods can choose to drink small amounts of liquid with meals to prevent choking, although this can vary in different patients, as some people love taking a sip after every bite of their meal to make the food pass down more fluently. Those who choose to drink large amounts of water after every meal are best advised in not to drink after and before meals, unless if they feel very thirsty. However, in most cases, only small meals low in carbohydrates and simple sugars will suffice to manage this condition, as it is actually the sugar that is responsible for the dumping and not the water itself. Fiber delays gastric emptying and reduces insulin peaks and therefore also helps to reduce dumping syndrome. People with severe cases may take medicine (such as octreotide and cholestyramine) or proton pump inhibitors (such as pantoprazole and omeprazole) to slow their digestion, and Fortisips to provide complete nutrition in supplement form. Doctors may also recommend surgery. Surgical intervention may include conversion of a Billroth I to a Roux-en Y gastrojejunostomy.

References

• "Dumping Syndrome".