What is a dumping syndrome?
A dumping syndrome is a complex of symptoms that occur after stomach operations (so-called Billroth operations = partial removal of the stomach) and primarily consist of various complaints in the area of the abdomen or gastrointestinal tract. A distinction is made between early and late dumping syndrome, i.e. symptoms that occur either 15-30 minutes or 2-3 hours after food intake.
Causes
The cause of a dumping syndrome is generally an operation on the stomach. These operations involve partial removal of the stomach according to Billroth, whereby a distinction is made between a so-called Billroth-I and Billroth-II operation. In Billroth I surgery, 2/3 of the stomach is removed and the remaining stomach is immediately reconnected to the adjacent duodenum.
The risk of dumping syndrome after this operation is about 15%. In the Billroth II operation, 2/3 of the stomach is also removed, but the adjacent duodenum is blindly closed, but an empty bowel loop is pulled up to the remaining stomach and connected to it. The risk of a dumping syndrome afterwards is lower here and is about 5%.
Depending on the method of the gastric bypass operation, dumping syndrome can also occur afterwards. If a so-called Roux-Y gastric bypass operation is performed, almost the same procedure is performed as in a Billroth II operation: the greatly reduced stomach is connected to a pulled up loop of the empty bowel, and the duodenum that actually follows the stomach is blindly closed. As a result, not only is the stomach volume reduced, but the chyme is transported directly past the duodenum into the empty bowel. Digestive enzymes from the pancreas and gallbladder are thus supplied later than normal, which reduces the overall time required for digestion and absorption of food components.
Diagnosis
As a rule, the diagnosis of a dumping syndrome is made by the classic anamnesis, the so-called doctor-patient conversation. The patients describe the classic symptoms shortly after eating or 2-3 hours after the meal. In order to confirm the diagnosis of late dumping syndrome in particular, blood glucose measurements can be helpful: Due to the lack of portioning by the stomach (e.g. when there is no stomach gate after partial gastric resection), glucose flood in the small intestine occurs shortly after food intake with a subsequent increase in blood sugar.
As a counter-regulation, more insulin is secreted from the pancreas in order to absorb all the sugar as quickly as possible, but this often results in hypoglycaemia 2-3 hours after eating. Both high and low blood sugar levels can be measured classically. These symptoms can be provoked and a diagnosis made by a so-called glucose provocation test.
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