Dumping Syndrome
Introduction
Rapid gastric emptying (Dumping syndrome) is a group of signs and symptoms that develops most often in people who have had surgery to remove all or part of their stomach, or in whom much of their stomach has been surgically bypassed to help lose weight. Rapid gastric emptying, also called dumping syndrome occurs when the undigested contents of your stomach are transported or "dumped" into your small intestine too rapidly. Common symptoms include abdominal cramps and nausea.
Most people with dumping syndrome experience signs and symptoms soon after eating. In other people, they may occur later — one to three hours after eating — and they can range from mild or moderate to severe and debilitating.
Most of the time, dumping syndrome improves on its own without medical treatment, or by adjusting your diet. In more serious cases of dumping syndrome, you may need medications or surgery.
Signs and symptoms
When signs and symptoms occur during a meal or within 15 to 30 minutes following a meal, they may include:
- Nausea
- Vomiting
- Abdominal cramps,pain
- Diarrhea
- Dizziness, lightheadedness
- Bloating, belching
- Fatigue
- Heart palpitations, rapid heart rate
- Sweating
- Weakness, fatigue
- Dizziness, lightheadedness
- Shakiness
- Feelings of anxiety, nervousness
- Heart palpitations, rapid heart rate
- Fainting
- Mental confusion
Some people also experience low blood sugar (hypoglycemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Insulin influences your tissues to take up the sugar present in your bloodstream.
Causes
In rapid gastric emptying, food and juices from your stomach move to your small intestine in an unregulated, abnormally fast manner. This accelerated process is most often related to changes in your stomach associated with surgery. For example, when the opening (pylorus) between your stomach and the first portion of the small intestine (duodenum) has been damaged or removed during an operation, the syndrome may develop.
Dumping syndrome may occur in up to 15 percent of people who have had stomach surgery. It develops most commonly one to six months after surgery, and the greater the amount of stomach removed or bypassed, the more likely that the condition will be severe. It sometimes becomes a chronic disorder.
Gastrointestinal hormones also are believed to play a role in this rapid dumping process.
Treatment
Most cases of rapid gastric emptying improve without any treatment, typically in several months to about a year after signs and symptoms begin. However, if they don't improve on their own — or if you want relief from symptoms soon after they appear — your doctor may advise one or more treatment options to slow the emptying of your stomach's contents. The choices for managing dumping syndrome include dietary changes, medications and surgery.
Dietary changes
Adjusting your diet may relieve your symptoms. Here are some strategies that your doctor may recommend:
- Eat smaller meals. Try consuming about six small meals a day rather than three larger ones.
- Avoid fluids with meals. Drink liquids only between meals.
- Change the makeup of your diet. Consume more low-carbohydrate foods. In particular, concentrate on a diet low in simple carbohydrates such as sugar (found in sweets like candy, cookies and cakes). Read labels on packaged food before buying, with the goal of not only avoiding foods with sugar in their ingredients list, but also looking for (and staying away from) alternative names for sugar, such as glucose, sucrose, fructose, dextrose, honey and corn syrup. Artificial sweeteners are acceptable alternatives. Consume more protein in your diet, and adopt a higher fiber diet.
- Increase pectin intake. Pectin is found in many fruits such as peaches, apples and plums, as well as in some fiber supplements. It can delay the absorption of carbohydrates in the small intestine.
- Stay away from acidic foods. Tomatoes and citrus fruits are harder for some people to digest.
- Use low-fat cooking methods. Prepare meat and other foods by broiling, baking or grilling.
- Consume adequate vitamins, iron and calcium. These can sometimes become depleted in the aftermath of stomach surgery. Discuss this nutritional issue with a registered dietitian.
- Lie down after eating. This may slow down the movement of food into your intestines.
Medications
Your doctor may prescribe certain medications to slow the passage of food out of your stomach, and relieve the signs and symptoms associated with rapid gastric emptying. These drugs are most appropriate for people with severe signs and symptoms, and they don't work for everyone.
The medications that doctors most frequently prescribe are:
- Acarbose. This medication delays the digestion of carbohydrates. Doctors prescribe it most often for the management of type 2 diabetes, and it has also been found to be effective in people with late-onset dumping syndrome. Side effects may include sweating, headaches, pallor, sudden hunger and weakness.
- Octreotide (Sandostatin). This anti-diarrheal drug can slow down the emptying of food into the intestine. You take this drug by injecting it under your skin (subcutaneously). Be sure to talk with your doctor about the proper way to self-administer the drug, including optimal choices for injection sites. Long-acting formulations of this medication are available. Because octreotide carries the risk of side effects (diarrhea, bulky stools, gallstones, flatulence, bloating) in some people, doctors recommend it only for people who haven't responded to other treatments.
Doctors use a number of surgical procedures to treat severe cases resistant to more conservative approaches. Most of these operations are reconstructive techniques, such as reconstructing the pylorus, or they're intended to reverse gastric bypass surgery.
Prevention
You can't prevent rapid gastric emptying. However, measures such as dietary adjustments may prevent recurrences of your symptoms and minimize their severity.
Informations obtained from National Institute of Health.