Dumping syndrome
Overview
Dumping
syndrome is a condition in which food, especially food high in sugar, moves
from your stomach into your small bowel too quickly after you eat. Sometimes
called rapid gastric emptying, dumping syndrome most often occurs as a result
of surgery on your stomach or esophagus.
Most
people with dumping syndrome develop signs and symptoms, such as abdominal
cramps and diarrhea, 10 to 30 minutes after eating. Other people have symptoms
1 to 3 hours after eating. And still others have both early and late symptoms.
Generally, you can help prevent dumping syndrome by changing
your diet after surgery. Changes might include eating smaller meals and
limiting high-sugar foods. In more-serious cases of dumping syndrome, you may
need medications or surgery.
Symptoms
Signs
and symptoms of dumping syndrome generally occur within minutes after eating,
especially after a meal rich in table sugar (sucrose) or fruit sugar
(fructose). They include:
·
Feeling bloated or too full after eating
·
Nausea
·
Vomiting
·
Abdominal cramps
·
Diarrhea
·
Flushing
·
Dizziness, lightheadedness
·
Rapid heart rate
Late
dumping syndrome starts 1 to 3 hours after you eat a high-sugar meal. It takes
time for signs and symptoms to develop because after you eat your body releases
large amounts of insulin to absorb the sugars entering your small intestine.
The result is low blood sugar.
Signs
and symptoms of late dumping syndrome can include:
·
Sweating
·
Flushing
·
Dizziness, lightheadedness
·
Weakness
·
Rapid heart rate
Some people have both early and late signs and symptoms. And
dumping syndrome can develop years after surgery.
When to see a doctor
Contact your health care provider 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 an
eating plan.
Causes
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,
including any stomach surgery or major esophageal surgery, such as removal of
the esophagus (esophagectomy). But in rare cases, dumping syndrome can develop
without a history of surgery or other obvious causes.
Risk factors
Surgery that alters your stomach can increase your risk of
dumping syndrome. These surgeries are most commonly performed to treat obesity,
but are also part of treatment for stomach cancer, esophageal cancer and other
conditions. These surgeries include:
·
Bariatric surgery —
especially gastric bypass surgery (Roux-en-Y operation) or sleeve gastrectomy —
which is performed to treat morbid obesity.
·
Gastrectomy, in which a portion
or all of your stomach is removed.
·
Esophagectomy, in
which all or part of the tube between the mouth and the stomach is removed.
·
Fundoplication, a
procedure used to treat gastroesophageal reflux disease (GERD) and hiatal
hernia
·
Vagotomy, a type of surgery
to treat stomach ulcers.
·
Pyloroplasty, which
is done to widen the valve to the stomach (pylorus), allowing food to pass
through.
Diagnosis
Your health care provider may
use some of the following methods to determine if you have dumping syndrome.
·
Medical history and evaluation. Your
doctor can often diagnose dumping syndrome by taking a medical history,
particularly if you've had stomach surgery, and evaluating your signs and symptoms.
·
Blood sugar test. Because
low blood sugar is sometimes associated with dumping syndrome, your doctor may
order a test (oral glucose tolerance) to measure your blood sugar level at the
peak time of your symptoms to help confirm the diagnosis.
·
Gastric emptying test. A
radioactive material is added to food to measure how quickly food moves through
your stomach.
Treatment
Early dumping syndrome is likely
to resolve on its own within three months. In the meantime, there's a good
chance that dietary changes will ease your symptoms. If not, your health care
provider may recommend medications or surgery.
Medications
If
changes to your diet don't improve symptoms, your health care provider may
prescribe octreotide (Sandostatin). This anti-diarrheal drug, administered by
injection under your skin, can slow the emptying of food into the intestine.
Possible side effects include nausea, diarrhea and fatty stools (steatorrhea).
Talk with your doctor about the
proper way to self-administer the drug.
Surgery
If conservative approaches don't
help, surgery may be recommended. Depending on your situation, surgical
procedures to treat dumping syndrome may include reconstructing the pylorus or
surgery to reverse gastric bypass surgery.
Self
care
Here are some dietary strategies
that can help you maintain good nutrition and minimize your symptoms.
·
Eat smaller meals. Try
eating 5 or 6 small meals a day rather than three larger ones.
·
Lie down after meals. Try
lying down for 30 minutes after you eat.
·
Drink most of your fluids between meals. At
first, don't drink anything for 30 to 60 minutes before and after meals.
·
Drink 6 to 8 cups (1.4 to 1.9 liters) of
fluids a day. At first, limit fluid with meals to 1/2 cup (118
milliliters). Increase fluid with meals as you tolerate it.
·
Change your diet. Eat
more protein, including meat, poultry, creamy peanut butter and fish, and
complex carbohydrates such as oatmeal and other whole-grain foods high in
fiber. Limit high-sugar foods, such as candy, table sugar, syrup, sodas and
juices.
The natural sugar in dairy
products (lactose) might worsen your symptoms. Try small amounts at first, or
eliminate them if you think they're causing problems. You might want to see a
registered dietitian for more advice about what to eat.
·
Increase fiber intake. Guar
gum and pectin in food or supplements can delay the absorption of carbohydrates
in the small intestine.
·
Check with your doctor about drinking
alcohol.
Alternative
medicine
Some people use supplements such
as pectin and guar gum to thicken the digestive contents and slow its progress
through the intestines. If you decide to try a supplement, discuss it with your
doctor to learn about potential side effects or interactions with other
medications you're taking.
Preparing
for your appointment
If you
have signs and symptoms of dumping syndrome, you're likely to first see your
family health care provider. You may then be referred to a doctor who
specializes in treating digestive system disorders (gastroenterologist).
Here's some information to help
you get ready for your appointment.
What you can do
·
Be aware of pre-appointment restrictions. When
you make the appointment, ask if there's anything you need to do beforehand,
such as restrict your diet.
·
Write down your symptoms, including
any that may seem unrelated to the reason for which you scheduled the
appointment.
·
Write down key personal information, including
major stresses or recent life changes.
·
List all medications, vitamins
or other supplements you take, including dosage.
·
Take a family member or friend along to
help you remember everything.
·
Bring your medical records about past
treatment, especially stomach surgery.
·
Write down questions to ask your
health care provider.
Questions to
ask your doctor
For
dumping syndrome, some basic questions to ask your health care provider
include:
·
What is likely causing my symptoms?
·
What are other possible causes?
·
What tests do I need?
·
What is the best course of action?
·
Should I see a dietitian?
·
I have other health conditions. How can I best manage them
together?
·
Should I see a specialist?
·
Are there brochures or other printed material that I can take?
What websites do you recommend?
Don't hesitate to ask other
questions during your appointment.
What to expect
from your doctor
Your health care provider is
likely to ask you questions, including:
·
Have you had stomach surgery, and if so, what kind?
·
When did your symptoms begin?
·
Have your symptoms been continuous or occasional?
·
How long after eating do your symptoms begin?
·
Do certain foods make your symptoms worse?
·
How severe are your symptoms?
·
What, if anything, seems to improve your symptoms?
·
What, if anything, appears to worsen your symptoms?
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