Dumping syndrome is an accelerated emptying of the stomach. In this case, the affected person suffers from various complaints.
What is dumping syndrome?
Dumping syndrome refers to the precipitous emptying of food from the stomach into the small intestine. The term “to dump” comes from English and translates as “to plop.” The symptoms are often the result of stomach surgery. For example, five to ten percent of all those affected have previously had to undergo stomach surgery. People who also suffer from obesity are particularly affected. The symptoms appear 30 minutes to three hours after a meal. Different parts of the body can be affected by the symptoms. Doctors distinguish between two forms of dumping syndrome: early dumping and late dumping. In the case of early dumping, those affected suffer from symptoms as early as 30 minutes after eating a meal. In late dumping, which is the rarer form, on the other hand, symptoms occur one to three hours later.
Causes
Dumping syndrome is usually caused by prior surgery on the stomach. For example, early dumping syndrome can result from partial removal of the stomach, in which the pylorus (stomach gate), located at the exit of the stomach, is operated out. This results in an uncontrolled fall, so to speak, of undiluted food mush into the small intestine or empty intestine (jejunum), which causes the small intestine to stretch. Especially sweet foods such as sugar or milk cause problems due to their strong osmotic pressure. Thus, they cause a considerable concentration gradient between the intestinal blood vessels and the contents of the intestine. To compensate, copious amounts of fluid are released from the vessels into the bowel. However, this poses the risk of a significant drop in blood pressure. In addition, various substances are released from the intestinal wall. These include the hormone neurotensin, which is responsible for the contraction of the intestine. In late dumping syndrome, the absence of pyloric function results in rapid absorption of glucose. This process results in an elevated blood glucose level (hyperglycemia). The high blood glucose in turn results in increased insulin secretion, which causes a counter-reaction to hypoglycemia (low blood glucose). In both forms, predigestion of food is absent, resulting in almost unchanged release of the food mush into the small intestine.
Symptoms, complaints, and signs
Typical of early dumping is the rapid onset of symptoms after about half an hour. In this process, affected individuals usually suffer from abdominal pain, flatulence, bloating, diarrhea, nausea, vomiting and a growling stomach. Furthermore, fatigue, headache, pallor, sweating, rapid heartbeat and fainting may occur. The symptoms of late dumping do not show up until one to three hours after a meal. These are ravenous hunger, feelings of weakness, trembling, sweating and difficulty concentrating. Even clouding of consciousness is possible.
Diagnosis and course
If dumping syndrome is suspected, a physician must be consulted. This first deals with the medical history of the patient and inquires with him about previous stomach operations and previous diseases. In most cases, the typical symptoms of dumping syndrome are enough to establish the disease. To confirm the diagnosis, a so-called provocation test can be performed. In this test, the patient ingests 50 grams of glucose. The physician then measures the effects on the body’s functions. Indications of a dumping syndrome include a drop in the hemocrit value by more than three percent, an increase in the heart rate by more than ten beats per minute, and increased excretion of hydrogen in the breath. In addition, blood glucose levels drop sharply after hyperglycemia. Typical hyperglycemia symptoms are considered indicative of late dumping syndrome. Another diagnostic option is gastroscopy using an endoscope. This excludes other possible causes for the symptoms. In rare cases, a nuclear medicine examination is also performed. The dumping syndrome poses great problems for those affected. However, it usually disappears on its own after 6 to 12 months. A consistent diet is considered important for a favorable course.
Complications
Due to dumping syndrome, complications mainly occur in the abdomen and stomach area. In most cases, the affected suffer as bloating and severe abdominal pain. In addition to the pain, there is often diarrhea and nausea. The nausea is not infrequently accompanied by vomiting. The patient’s everyday life is severely restricted by the dumping syndrome. Due to accelerated digestion, there is often headache and fatigue. In some cases, the symptoms can be so severe that the affected person loses consciousness. After the abrupt emptying, there is often a growling stomach and cravings. As a rule, dumping syndrome can be treated quite well by changing the diet. However, this involves restricting the patient’s food intake to certain foods. Treatment can also be supported with the help of medication. Only in severe cases, surgical intervention is necessary for a positive course of the disease. In this case, dumping syndrome does not lead to a reduced life expectancy, nor does it lead to further complications when treated. Usually, dumping syndrome does not recur after treatment.
When should you see a doctor?
Regardless of whether it is early or late dumping syndrome, the discomfort after meals is usually severe enough that a trip to the doctor is strongly advised. However, since these complaints (nausea, abdominal cramps, palpitations, etc.) after meals may not only be signs of dumping syndrome, clarification by a doctor is necessary. For example, it must be checked at which form of food intake – in terms of quantity and composition – the problems occur, so that the affected person can act accordingly in everyday life. Since the consequences of dumping syndrome can lead to circulatory failure, those affected should consult a doctor early if they regularly feel unwell after eating. Otherwise, there is a risk of falls and other serious health risks. At the doctor’s office – the family doctor can be chosen as the first point of contact – an investigation into the cause must take place. The medical history of the person concerned provides information here: for example, people who have undergone an operation on the stomach in particular should see a doctor quickly in the event of subsequent complaints. The stomach must also be examined to clarify the possible presence of tissue damage, growths, etc,
Therefore, the exact cause of dumping syndrome should be located because the condition is treatable in many cases.
Treatment and therapy
Treatment of dumping syndrome is not always easy. For example, patients must adhere to specific dietary rules to achieve improvement in symptoms. These include limiting daily carbohydrate intake. Instead of simple carbohydrates such as white flour, honey and sugar, the consumption of complex carbohydrates such as potatoes, vegetables or whole grain products is recommended. It is also important to reduce milk consumption. Instead of a few large meals, several smaller meals should be eaten throughout the day. The patient should not drink anything during the meal and shortly afterwards. If the change in diet does not show the desired success, drug therapy is possible. In this case, the patient receives octreotide or acarbose. In the event that these drugs also fail to bring about an improvement, surgical intervention may be advisable. For example, a Billroth II resection of the stomach, which causes dumping syndrome, is sometimes followed by surgical correction. During a Billroth II resection, the lower portion of the stomach is operated out along with the stomach portal. The surgeon connects the remaining gastric stump directly to the jejunum. He also blindly closes the duodenum. Billroth II resection correction involves direct connection of the gastric stump and duodenum.
Outlook and prognosis
Since dumping syndrome is associated with serious and very unpleasant symptoms, medical treatment must always be provided in this case. It does not come to a self-healing, whereby it can come without treatment also to a reduced life expectancy with the patient. Most patients suffer from abdominal pain, flatulence or diarrhea without treatment. Vomiting and nausea may also occur, with many patients suffering from pallor or palpitations.The symptoms usually appear a few hours after the ingestion of food and significantly reduce the quality of life. If left untreated, the syndrome can cause lasting damage to the body, destroying the intestines or stomach. This damage is usually irreversible and cannot be treated. Dumping syndrome is treated by changing the diet and taking medications. However, in severe cases, the condition can be resolved by surgical intervention. In this case, there are no particular complications and the syndrome is completely cured. After successful treatment, life expectancy usually remains unchanged.
Prevention
To prevent dumping syndrome after gastric surgery, changing the diet from simple carbohydrates to complex carbohydrates is recommended. Nutritional counseling may also be helpful.
Follow-up care
In most cases of dumping syndrome, the affected person does not have any special options for aftercare. In this case, the affected person is first dependent on an early diagnosis in order to prevent further complaints and complications, since dumping syndrome also cannot heal on its own. The earlier the dumping syndrome is detected, the better the further course of the disease usually is. As a rule, this disease is treated by adjusting the diet. In this process, a doctor can also advise the patient so that no complications arise. Especially vegetables and potatoes can have a positive effect on the further course of the syndrome. However, in many cases it is also necessary to take medication to alleviate the symptoms. Those affected should follow the doctor’s instructions and observe the correct dosage of medication. Furthermore, it is not uncommon for surgical interventions to be necessary in order to correct the malformations. After such an operation, the affected person should in any case rest and not exert his body unnecessarily. Whether the dumping syndrome leads to a reduced life expectancy of the affected person, can not be predicted in general.
This is what you can do yourself
Sufferers of dumping syndrome have a few options to lower the risks for abrupt leakage of food mush from the stomach. In addition, the consequences can be prevented. The decisive factor is a small portioned diet that is taken in slowly. This reduces the strain on the stomach’s sphincter muscles and there is a better chance that the food will be digested. In addition, drinking while eating should be avoided as far as possible in order to keep the pressure in the stomach low. Drinking should also be avoided in the half hour after eating. In addition, liquids in the food pulp promote the excessive resorption of sugar in the small intestine. This also helps to curb the intensity of hypoglycemia during late dumping. Any hypoglycemia that occurs can be compensated for with a small amount of sugar that is absorbed directly. Foods that have a high osmotic pressure (i.e., are water-sucking) should be avoided or ingested only in small quantities. This is because they in particular draw water out of the body in the small intestine and are partly responsible for a drop in blood pressure. In general, it is recommended to eat potatoes, vegetables and whole grain products. Milk and sugar should only be consumed in small quantities. If the affected person feels the drop in blood pressure, it is advisable that he sits on the floor to prevent a fall due to fainting.