Dumping syndrome refers to a group of GI and vasomotor symptoms that occurs following ingestion of a meal post gastric surgeries. Alterations of gastric anatomy by surgery including resection or bypass of the pylorus and interference with gastric innervation effects the rate of gastric emptying.The accomodation and cyclic contractility of the stomach in response to distention are abolished after partial gastrectomy allowing immediate dumping of gastric contents into the jejunum.
There are two types of dumping. Early dumping which occurs as a result of rapid emptying of sugars or CHO from the gastric pouch (post gastric bypass) into the small intestine which causes the release of hormone (gut peptides) that effects the B.P, heartrate, skin flushing & intestinal transit.
The symptoms occur 30-60min after eating and can last upto an hour. Sweating, flushing lightheadedness, tachycardia, palpitations, desire to lie down, epigastric fullness, nausea, vomiting, diarrhea, cramping and active audible bowel sounds are seen.
Late dumping which occurs 1-3 hours after a meal is related to increased insulin with subsequent reactive hypoglycemia. Symptoms include sweating shakiness, loss of concentration, hunger fainting or passing out. Severe dumping can lead to malnutrition .
The diagnosis is primarily made by obtaining a history of the presence of classic symptoms related to food intake. Dietary compliance with avoidance of refined sugars, high glycemic carbohydrates or other food associated with the syndrome would be the primary treatment. Late dumping that persists may be treated with small amount of sugar about an hour after a meal. Medications such as sandostatin or octreotide may be helpful. May need surgical management where it cannot be managed medically.