Dumping syndrome

Dumping syndrome is a group of symptoms most likely to develop most if you’ve had surgery to remove all or part of your stomach, or if your stomach has been surgically bypassed to help lose weight. Also called rapid gastric emptying, 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 symptoms soon after eating. In others, they may occur one to three hours after eating, and can range from mild to severe.

Most often, you’ll find that dumping syndrome improves on its own without medical treatment or after adjusting your diet. In more-serious cases of dumping syndrome, you may need medications or surgery.

Causes

In dumping syndrome, 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 at least mildly in one-quarter to one-half of people who have had gastric bypass surgery. However, fewer than 5 percent have severe symptoms. It develops most commonly within weeks after surgery, or as soon as you return to your normal diet. The more 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.

Several types of stomach surgery increase your risk of dumping syndrome. These include:

  • Gastrectomy, in which a portion or all of your stomach is removed. It typically includes removing the pylorus.
  • Gastroenterostomy or gastrojejunostomy, in which your stomach is surgically connected directly to your small intestine about two feet beyond the pylorus, thus bypassing the pylorus. Doctors sometimes perform this operation in people with cancer of the stomach.
  • Vagotomy, in which the nerves to your stomach are cut in order to lower the levels of acid manufactured by your stomach.
  • Fundoplication, which is an operation sometimes performed on people with gastroesophageal reflux disease. It involves wrapping the upper portion of your stomach around the lower esophagus to apply pressure that reduces the reflux of gastric contents into the esophagus. However, on rare occasions, certain nerves to the stomach can unintentionally be damaged during surgery and lead to dumping syndrome.
  • Gastric bypass surgery (Roux-en-Y operation), which is often performed in people who are morbidly obese. It surgically creates a stomach pouch that’s smaller than the entire stomach, meaning you’re no longer able to eat as much as you once did, resulting in weight loss.

Certain underlying conditions also may make you more susceptible to dumping syndrome. These conditions include:

In addition, using the medication metoclopramide (Reglan) can increase your risk. This drug is sometimes prescribed to ease nausea, vomiting and heartburn.

Symptoms

When symptoms of dumping syndrome occur during a meal or within 15 to 30 minutes following a meal, they may include:

  • Nausea
  • Vomiting
  • Abdominal pain, cramps
  • Diarrhea
  • Dizziness, lightheadedness
  • Bloating, belching
  • Fatigue
  • Heart palpitations, rapid heart rate

When signs and symptoms develop later, they may include:

  • Sweating
  • Weakness, fatigue
  • Dizziness, lightheadedness
  • Shakiness
  • Feelings of anxiety, nervousness
  • Heart palpitations, rapid heart rate
  • Fainting
  • Mental confusion
  • Diarrhea

Some people experience both early and late signs and symptoms. Conditions such as dizziness and heart palpitations can occur either early or late — or both. No matter when problems develop, however, they may be worse in the aftermath of a high-sugar meal, especially one that’s rich in sucrose (table sugar) or fructose (fruit sugar).

Some people also experience low blood sugar (hypoglycemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Hypoglycemia is more often related to late signs and symptoms. Insulin influences your tissues to take up the sugar present in your bloodstream.

Contact your doctor if you develop signs and symptoms that might be due to dumping syndrome, even if you haven’t had surgery. If you’ve already been diagnosed with this syndrome, keep your doctor informed on how well your treatment is working. Whenever symptoms worsen, talk to your doctor.

Because poor dietary choices can worsen signs and symptoms, your doctor may refer you to a registered dietitian to help you create the most appropriate eating plan. The guidance provided by a registered dietitian may be particularly important if you have lost large amounts of weight due to this syndrome.

Diagnosis

Your doctor can often diagnose dumping syndrome by taking a careful medical history and then evaluating your signs and symptoms. If you have undergone stomach surgery, that may help lead your doctor to a diagnosis of dumping syndrome.

Because low blood sugar is sometimes associated with dumping syndrome, your doctor may order a test to measure your blood sugar level at the peak time of your symptoms to help confirm the diagnosis.

Treatment

Most cases of dumping syndrome improve with nutritional measures alone. However, if changing your diet doesn’t relieve your symptoms, your doctor may advise medications or surgery to slow the emptying of your stomach’s contents.

Dietary changes
Here are some dietary treatment 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.

Even with dietary changes, you may continue to experience severe symptoms associated with dumping syndrome.

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 dumping syndrome. 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 (Precose). 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.

Surgery
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.

In people with severe cases of dumping syndrome, marked weight loss and malnutrition may occur. Sometimes people who lose a lot of weight may also develop a fear of eating, related to the discomfort associated with the rapid dumping of undigested food. They may also avoid outdoor physical activity in order to stay close to a toilet. Some have difficulty keeping a job because of their chronic symptoms.