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Dumping syndrome

Dumping syndrome is a group of symptoms that are most likely to develop 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 move too rapidly into your small bowel. Common symptoms include abdominal cramps, nausea and diarrhea.

Most people with dumping syndrome experience symptoms soon after eating. In others, symptoms may occur one to three hours after eating. Some people experience both early and late symptoms.

Dumping syndrome is managed by adjusting your diet. In more-serious cases of dumping syndrome, you may need medications or surgery.

Symptoms Causes Risk factors Complications

Symptoms of dumping syndrome are most common during a meal or within 15 to 30 minutes following a meal. They include:

Gastrointestinal

  • Nausea
  • Vomiting
  • Abdominal cramps
  • Diarrhea
  • Feeling of fullness

Cardiovascular

  • Flushing
  • Dizziness, lightheadedness
  • Heart palpitations, rapid heart rate

Signs and symptoms also can develop later, usually one to three hours after eating. This is due to the dumping of large amount of sugars into the small intestine (hyperglycemia). In response, the body releases large amounts of insulin to absorb the sugars, leading to low levels of sugar in the body (hypoglycemia). Symptoms of late dumping can include:

  • Sweating
  • Hunger
  • Fatigue
  • Dizziness, lightheadedness
  • Confusion
  • Heart palpitations, rapid heart rate
  • Fainting

A study of more than 1,100 people who had their stomachs surgically removed found that about two-thirds experienced early symptoms and about a third experienced late symptoms of dumping syndrome. Some people experience both early and late signs and symptoms.

No matter when problems develop, however, they may be worse following a high-sugar meal, especially one that's rich in table sugar (sucrose) or fruit sugar (fructose).

When to see a doctor

Contact your doctor if any of the following apply to you.

  • You develop signs and symptoms that might be due to dumping syndrome, even if you haven't had surgery.
  • Your symptoms are not controlled by dietary changes.
  • You are losing large amounts of weight due to dumping syndrome. Your doctor may refer you to a registered dietitian to help you create the most appropriate eating plan.

In dumping syndrome, food and gastric juices from your stomach move to your small intestine in an uncontrolled, abnormally fast manner. This is most often related to changes in your stomach associated with surgery, such as when the opening (pylorus) between your stomach and the small intestine (duodenum) has been removed during an operation.

The pylorus acts as a brake so that stomach emptying is gradual. When it's removed, stomach material dumps rapidly into the small intestine. The ill effects of this are thought to be caused by the release of gastrointestinal hormones in the small intestine, as well as insulin secreted to process the sugar (glucose).

Dumping syndrome can occur after any operation on the stomach as well as after removal of the esophagus (esophagectomy). Gastric bypass surgery for weight loss is the most common cause today. 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.

Several types of 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. Stomach contents then enter the small intestine directly, bypassing the pylorus. Doctors sometimes perform this operation in people with cancer of the stomach.
  • Vagotomy, in which the fibers of the vagus nerve to your stomach are cut in order to lower the levels of acid produced by your stomach. The vagus nerve is important in coordinating emptying of stomach contents into the small intestine.
  • 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 are unintentionally damaged during surgery, leading to dumping syndrome.
  • Gastric bypass surgery (Roux-en-Y operation), which is performed to treat morbid obesity. It surgically creates a stomach pouch smaller than the entire stomach, meaning you're no longer able to eat as much as you once did. It connects the small intestine to this pouch in the form of a gastrojejunostomy.
  • Esophagectomy, where all or part of the tube between the mouth and the stomach is removed.

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

  • Diabetes
  • Cyclic vomiting syndrome (CVS)
  • Zollinger-Ellison syndrome, which causes severe peptic ulcers
  • Metoclopramide (Reglan, Metozolv), sometimes prescribed to ease nausea, vomiting and heartburn

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.

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