Dumping Syndrome

What is dumping syndrome?

Dumping syndrome is a medical condition in which your stomach empties its contents into your small intestine more rapidly than it should. It’s also called rapid gastric emptying. When your stomach empties too quickly, your small intestine receives uncomfortably large amounts of poorly digested food. This can cause symptoms of nausea, bloating, abdominal cramps and diarrhea. It can also cause sudden blood sugar changes.

What happens in dumping syndrome?

Your stomach usually releases digestive contents into your small intestine in a gradual, controlled manner. The way your stomach moves food along through the digestive process is sometimes called your “gastric motility." Many things are involved in gastric motility: muscles, nerves and hormone signals coordinate together to tell your stomach how and when to empty. If any of these things are impaired, it can throw this coordination off.

Uncontrolled gastric emptying means that the valve at the bottom of your stomach, the pyloric valve, simply opens and dumps everything out, before your stomach has finished digesting. When your small intestine receives this mass of under-digested food, it makes adjustments to try and accommodate it. It draws in extra fluid volume and releases extra hormones. These adjustments cause the symptoms that people experience shortly after eating.

Some people experience another set of symptoms a few hours later. This happens because of blood sugar changes. If your small intestine receives a concentrated serving of sugar content, it may set off alarms in your digestive system. Your small intestine may signal your pancreas to release extra insulin to regulate your blood sugar. This can cause your blood sugar to drop sharply (reactive hypoglycemia). This drop can cause faintness, shakiness and heart palpitations.

Who gets dumping syndrome?

Dumping syndrome most commonly happens as a complication of surgery on your stomach, or on your esophagus where it connects to your stomach. An estimated 20% to 50% of people who have had stomach surgery develop some symptoms of dumping syndrome. It's most common in people who have had surgeries that remove or bypass large portions of the stomach, such as gastrectomy or gastric bypass surgery. Occasionally, it can also occur with certain gastrointestinal diseases.

Is dumping syndrome serious?

Under normal circumstances, dumping syndrome is not dangerous or life-threatening. A severe case can cause rapid weight loss and nutritional deficiencies. Persistent, unmanaged diarrhea can cause dehydration, but these complications can usually be managed or prevented with self-care. Most people have mild symptoms that ease over time. Dumping syndrome is not usually permanent.

What are the signs and symptoms of dumping syndrome?

Dumping syndrome has two phases, each with its own set of symptoms. You may experience one or both phases.

Early dumping syndrome symptoms occur within 10 to 30 minutes after you've finished eating. You may experience:

• Nausea.
• Vomiting.
• Diarrhea.
• Abdominal pain and cramping.
• A distended abdomen.
• Feeling bloated.
• Dizzy spells.
• Heart rate accelerations.

Late dumping syndrome begins to show signs about two to three hours after you’ve finished eating. You may experience:

• Weakness.
• Fatigue.
• Jitters or shakiness.
• Rapid or irregular heartbeat.
• Cold sweats.
• Face flushing.
• Brain fog.
• Hunger.

What causes dumping syndrome?

Surgical causes include:

• Gastrectomy. Surgery to remove part or all of the stomach.
• Bariatric surgery for weight loss, such as gastric bypass.
• Pyloroplasty. An operation on the pyloric valve at the bottom of your stomach.
• Esophagectomy. Surgery to remove part or all of the esophagus.
• Vagotomy. Surgery to cut the vagus nerve in the stomach to reduce stomach acid.
• Nissen fundoplication. Surgery to sew the top of the stomach around the esophagus.

Disease-related causes include:

• Diabetes mellitus.
• Cyclic vomiting syndrome.
• Autonomic dysfunction.
• Exocrine pancreatic insufficiency.
• Duodenal ulcers.
• Zollinger-Ellison syndrome.
• Functional dyspepsia.
• Cannabis hyperemesis syndrome.

How is dumping syndrome diagnosed?

If you have a history of gastric surgery, even if it was years ago, your healthcare provider may be able to diagnose dumping syndrome based on your symptoms alone. They may give you a self-assessment questionnaire called the Dumping Symptom Rating Scale that scores your symptoms to determine how severe they are. They may also want to run tests to confirm the diagnosis or to rule out other possible causes of your symptoms. This is especially important if you don’t have a history of gastric surgery.

Tests to diagnose dumping syndrome include:

• Oral glucose tolerance test. This test measures your blood sugar before and after you drink a glucose solution. It also measures your hematocrit (red blood cell count). A rise in hematocrit after you drink the glucose indicates large volumes of fluids moving from your bloodstream into your intestines. A drop in blood sugar one to three hours afterward indicates late dumping syndrome.
• Hydrogen breath test. This test measures hydrogen levels in your breath after you drink a glucose solution. A positive breath test for hydrogen shows that the glucose wasn’t well-absorbed in your small intestine. This suggests that your small intestine was too overloaded.
• Upper endoscopy. This test examines the inside of your esophagus, stomach and duodenum with an endoscope, a thin, flexible tube with a lighted camera attached. It can help find structural problems and other possible causes of your symptoms.
• Upper GI series. This imaging test allows healthcare providers to watch a fluid contrast solution travel through your esophagus, stomach and upper small intestine (duodenum). After you drink the solution, a technician takes a series of video X-rays (called fluoroscopy). The series will show how fast the solution travels.
• Gastric emptying test. This test measures how fast food moves through your stomach by adding a trace amount of radioactive material to your meal. Your healthcare provider will be able to watch your meal progress through your stomach on a special type of scanner.

How do you get rid of dumping syndrome?

Most people can successfully manage dumping syndrome with dietary changes. When severe symptoms don’t respond to diet, medication may be an option. But medications can have side effects and aren’t ideal for long-term use. Rarely, when dumping syndrome results from surgery, and when all other treatments have failed, your healthcare provider might suggest another surgery to fix the problem.

Dietary guidelines

Healthcare providers recommend following these general guidelines to reduce symptoms:

• Eat smaller meals more frequently. Aim for six small meals instead of three. Eat slowly and chew thoroughly.
• Avoid simple sugars, carbohydrates and milk products. This will prevent rapid blood sugar shifts. Complex carbs, such as whole grains, are better (see below).
• Eat more protein and healthy fats to replace carbohydrates in your diet. Fats slow down digestion and provide a steadier form of energy.
• Eat more dietary fiber to add bulk to your meal and slow down its transit time. Fiber slows down sugar absorption in your digestive system.
• Lie down on your back for 30 minutes after eating. This may slow down gastric emptying and help maintain blood pressure during digestion.
• Don’t drink fluids within 30 minutes before or after eating. Fluids encourage motility.

Medications

Certain medications can help modify the symptoms of early and late dumping syndrome, including:

• Octreotide acetate. Octreotide inhibits certain hormones in your digestive system, which slows down gastric emptying and small intestinal transit time. It also suppresses insulin. This medicine is given as an injection, either daily (short-acting form) or monthly (long-acting form).
• Acarbose. This medicine regulates blood sugar by slowing the rate at which your body absorbs carbohydrates. This has been shown to reduce hypoglycemia in late dumping syndrome.

Surgery

Surgery is rarely recommended for dumping syndrome. But if surgery was the original cause of your distress, surgery again might undo it. When nothing else has helped and dumping syndrome is severely affecting your quality of life, you might choose to undergo reconstructive surgery. This usually means:

• Reconstructing or modifying a part of your stomach that isn’t functioning well.
• Reversing or converting gastric bypass operations to a less severe alternative.

Does dumping syndrome ever go away?

It usually does, over time. Milder cases of early dumping syndrome usually resolve within three months. More severe cases and late dumping syndrome may take 12 to 18 months to subside. In the meantime, dietary changes will usually help, though it may take several weeks before you notice improvement.

What foods should I eat and not eat while living with dumping syndrome?

This diet can help modify or prevent symptoms of dumping syndrome, particularly after gastric surgery.

A note from Cleveland Clinic

Dumping syndrome is one of the most common post-gastrectomy syndromes that affect people recovering from surgery. There’s a good chance you may experience some symptoms immediately following your procedure. Fortunately, most cases are mild and go away on their own in a few weeks to months. In the meantime, you can usually manage the condition by adjusting your diet.

If you have an operation in your future, it’s a good idea to plan ahead for a dumping syndrome diet. Stock your kitchen and have some meal plans in mind. If you’ve made dietary adjustments, but they haven’t helped, contact your healthcare provider. They can prescribe medications to help get you through your recovery period.