Dumping Syndrome

Dumping syndrome occurs when the contents of the stomach empty too quickly into the small intestine.

The partially digested food draws excess fluid into the small intestine causing nausea, cramping, diarrhea, sweating, faintness, and palpitations. Dumping usually occurs after the consumption of too much simple or refined sugar in people who have had surgery to modify or remove all or part of the stomach.

 

People who have had surgery to remove or bypass a significant part of the stomach are more likely to develop dumping syndrome.

Some types of gastric surgery, such as bariatric surgery, reduce the size of the stomach. As a result, dietary nutrients pass quickly into the small intestine.

Other conditions that impair how the stomach stores and empties itself of food, such as nerve damage caused by esophageal surgery, can also cause dumping syndrome.

Dumping syndrome is caused by problems with the storage of food particles in the stomach and emptying of particles into the small intestine.

Early dumping syndrome results from rapid movement of fluid into the intestine following a sudden addition of a large amount of food from the stomach. Late dumping syndrome results from rapid movement of sugar into the intestine, which raises the body's blood glucose level and causes the pancreas to increase its release of the hormone insulin.

The increased release of insulin causes a rapid drop in blood glucose levels, a condition known as hypoglycemia, or low blood sugar.

The symptoms of early and late dumping syndrome are different and vary from person to person.

Early dumping syndrome symptoms may include
  • nausea
  • vomiting
  • abdominal pain and cramping
  • diarrhea
  • feeling uncomfortably full or bloated after a meal
  • sweating
  • weakness
  • dizziness
  • flushing, or blushing of the face or skin
  • rapid or irregular heartbeat
The symptoms of late dumping syndrome may include
  • hypoglycemia
  • sweating
  • weakness
  • rapid or irregular heartbeat
  • flushing
  • dizziness

About 75 percent of people with dumping syndrome report symptoms of early dumping syndrome and about 25 percent report symptoms of late dumping syndrome. Some people have symptoms of both types of dumping syndrome.

 

A health care provider will diagnose dumping syndrome primarily on the basis of symptoms.

The following tests may confirm dumping syndrome and exclude other conditions with similar symptoms:
  • A modified oral glucose tolerance test checks how well insulin works with tissues to absorb glucose.
  • A gastric emptying scintigraphy test involves eating a bland meal—such as eggs or an egg substitute—that contains a small amount of radioactive material. The radiologist measures the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. The test can help confirm a diagnosis of dumping syndrome.
The health care provider may also examine the structure of the esophagus, stomach, and upper small intestine with the following tests:
  • An upper GI endoscopy involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract.The test may show ulcers, swelling of the stomach lining, or cancer.
  • An upper GI series examines the small intestine. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of a blockage or other complications of gastric surgery show up more clearly on x rays.

A person may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes white or light-colored stools.

Treatment for dumping syndrome includes changes in eating, diet, and nutrition; medication; and, in some cases, surgery. Many people with dumping syndrome have mild symptoms that improve over time with simple dietary changes

The first step to minimizing symptoms of dumping syndrome involves changes in eating, diet, and nutrition, and may include
  • eating five or six small meals a day instead of three larger meals
  • delaying liquid intake until at least 30 minutes after a meal
  • increasing intake of protein, fiber, and complex carbohydrates—found in starchy foods such as oatmeal and rice
  • avoiding simple sugars such as table sugar, which can be found in candy, syrup, sodas, and juice beverages
  • increasing the thickness of food by adding pectin or guar gum—plant extracts used as thickening agents

Some people find that lying down for 30 minutes after meals also helps reduce symptoms.

Medication

A health care provider may prescribe octreotide acetate (Sandostatin) to treat dumping syndrome symptoms. The medication works by slowing gastric emptying and inhibiting the release of insulin and other GI hormones. 

Surgery

A person may need surgery if dumping syndrome is caused by previous gastric surgery or if the condition is not responsive to other treatments. For most people, the type of surgery depends on the type of gastric surgery performed previously. However, surgery to correct dumping syndrome often has unsuccessful results.