Dumping Syndrome - Causes, Symptoms, Diagnosis and Treatment.

Introduction:

A common group of symptoms after surgery in which a part of the stomach is either removed or bypassed. Initially, the symptoms may seem alarming but gradually subside. They can appear within 30 minutes after a meal or after one or two hours. It can be controlled by altering the diet. Foods that can cause a gain in weight (sugar, fat) are avoided while managing dumping syndrome. Sugar is known to move more quickly from the stomach to the intestine in this condition.

What Causes Dumping Syndrome?

Food and gastric secretions from the stomach go uncontrollably and unusually quickly to the small intestine when someone has dumping syndrome. Most frequently, this has to do with modifications made to the stomach as a result of surgery, such as any stomach operations or significant esophageal procedures like esophagus removal (esophagectomy). However, dumping syndrome can also occur in rare instances in which there is no prior surgical history or other clear reason.

What Are the Risk Factors of Dumping Syndrome?

Dumping syndrome risk increases with stomach-related surgeries. Although stomach and esophageal cancers, among other illnesses, are also treated with these operations, obesity is the condition for which they are most frequently performed. Among these operations are:

• Bariatric surgery, particularly sleeve gastrectomy or gastric bypass surgery, is used to treat morbid obesity.

• Gastrectomy is a surgical procedure in which a piece or the whole of the stomach is removed.

• Esophagectomy is a procedure in which the tube connecting the stomach and mouth is removed entirely or in part.

• Fundoplication is a treatment for gastroesophageal reflux disease (GERD) and hiatal hernia.

• A vagotomy is a kind of stomach ulcer surgery.

• Pyloroplasty is a procedure that opens the stomach's (pylorus) valve to let food pass through.

What Is the Phenomenon Causing Dumping Syndrome?

Once the meal is consumed, the rapid emptying of food from the stomach can cause three conditions:

• Hyperosmolar Jejunal Chyme: Rapid transit of chyme (food from the stomach) into the duodenum can cause an exchange of fluid from the vasculature to the intestinal lumen, causing increased volume in the small intestine.

• Rapid Glucose Absorption: Due to improper digestion of sugar, inappropriate insulin secretion can cause delayed hypoglycemia.

• Inappropriate hormone release due to altered digestion.

Depending upon the time of food dumping after each meal, the syndrome is divided into the following phases:

• Early Phase: It takes almost 30 to 60 minutes after food consumption.

• Late Phase: It may happen about one to three hours after food intake.

Causes of Early Phase: Food is rapidly dumped into the small intestine during this phase. The following are the reasons:

• Stretching of the small intestine.

• Water that is pulled out of the bloodstream moves into the small intestine.

• Effects on blood pressure due to hormones released by the small intestine.

Causes of Late Phase: The main cause behind late-phase dumping is rapid alterations in blood sugar levels. Both rises and falls in sugar levels are attributed to dumping. Consumption of sweets or carbohydrates worsens the situation.

What Are the Symptoms of Dumping Syndrome?

Early Phase:

• Abdominal cramping or pain.

• Severe diarrhea.

• A feeling of a full stomach after a small amount of food intake.

• Rapid heartburn leads to sweating.

• Flushing or lightheadedness.

• Nausea.

• Vomiting.

Late Phase:

• Feeling of hunger

• Dizziness: A sense of spinning of head and losing balance.

• Fainting: A temporary unconsciousness for a short duration of time.

• Flushing or sweating.

• Mental confusion and loss of concentration.

• Weakness and shakiness.

• Brain fog.

• Irregular heartbeats.

How to Diagnose Dumping Syndrome?

Even if the surgery was performed years ago, the physician might be able to identify dumping syndrome just by looking at the signs. They may also do testing to confirm the diagnosis or rule out other potential explanations for the symptoms.

Among the tests used to identify dumping syndrome are

• Oral Glucose Tolerance Assessment: This test measures blood sugar before and after consuming a glucose solution. The red blood cell count is also determined by it. After consuming the glucose, a rise in hematocrit signifies a significant amount of fluids leaving the bloodstream and entering the intestines. One to three hours later, a decrease in blood sugar levels suggests late dumping syndrome.

• Breath Test for Hydrogen: After consuming a glucose solution, the hydrogen levels in the breath are measured. A positive hydrogen breath test indicates poor small intestine absorption of glucose.

• Upper Endoscopy: Using an endoscope—a tiny, flexible tube with a lighted camera attached—this test looks inside the stomach, duodenum, and esophagus. It can assist in identifying structural issues and additional potential reasons for the symptoms.

• Gastric Emptying Test: A radioactive material is added to food, which helps trace the duration of food in the stomach and its dumping time.

What Are the Treatments for Dumping Syndrome?

The most important factor in controlling and curing dumping syndrome is regulating diet and

eating habits.

Some of the at-home remedies for dumping syndrome are -

Foods to Avoid Eating:

• Sugar and sweets such as cookies, cakes, candies, and sweetened bread should be avoided.

• Control consumption of dairy products and alcoholic beverages.

• Avoid drinking liquids like water or others during the meal. Wait to drink half an hour before and after the meals.

Foods to Eat:

• Replacement of sugar with supplements.

• Consumption of fiber supplements.

• Consumption of complex carbohydrates such as vegetables and whole wheat bread instead of simple carbohydrates such as sweets and ice-creams.

• Drink lots of water and other sugar-free and non-carbonated fluids to prevent dehydration.

• Consumption of protein-rich foods like eggs, meat, fish, and pulses.

Other Factors to Regulate Diet:

• Split the meals into small (5–6) meals instead of big ones.

• Eat small portions at a time.

• Chewing the food well before swallowing - can be done by cutting it into small pieces.

• Plan the diet to combine proteins or fat with fruits or starches.

• Avoid eating when the feeling of fullness appears.

• Reclining after food intake may prevent lightheadedness.

• Avoid consuming liquids for 30 minutes before or following a meal. Fluids promote motility.

Drugs:

Some drugs, such as the following, can help reduce the signs and symptoms of early and late dumping syndrome:

• Octreotide Acetate: The digestive system's hormones are inhibited by octreotide, which slows down the small intestine's transit time and stomach emptying. Moreover, it inhibits insulin. This medication is administered intravenously once a day (short-acting) or once a month (long-acting).

• Acarbose: This medication lowers blood sugar by reducing the pace at which the body absorbs carbohydrates. It has been demonstrated that doing this lessens late dumping syndrome hypoglycemia.

Surgery:

Rarely is surgery advised in cases of dumping syndrome. However, if surgery initially brought on the problem, having it done again could undo it. Reconstructive surgery may be the best choice if all other treatments have failed to improve the quality of life and dumping syndrome is a major concern. Surgical treatments to treat dumping syndrome may involve pylorus reconstruction or gastric bypass reversal, depending on your particular circumstances.

How to Monitor Dumping Syndrome?

Once the diagnosis is confirmed, a referred diet should be followed- a dietitian can be consulted. Bodyweight monitoring is important while following the diet plan, as it helps to realize the effectiveness of the diet on digestion. The weight loss should be relatively slow, as it may be due to an issue with the diet plan. Proper consultation with doctors and dietitians is essential.

Conclusion:

Dumping syndrome can be severe but gradually subsides with time and proper diet and care. The most important factor affecting the condition is the food choice after surgeries. It is essential to address the symptoms with the doctors to avoid further complications, as the most imp