What is dumping syndrome?
Dumping syndrome is a medical condition in which your stomach empties its contents into the first part of your small intestine (the duodenum) faster than normal. Dumping syndrome is also known as rapid gastric emptying.
People with dumping syndrome experience symptoms like nausea and abdominal cramping. These symptoms happen because your small intestine cannot absorb nutrients from food that has not been digested properly in the stomach. You are more likely to have dumping syndrome if you have had certain types of gastric surgery, like gastric bypass surgery.
Doctors classify dumping syndrome into two specific types: early dumping syndrome and late dumping syndrome. Each type occurs at different times after you eat and causes different symptoms.
Symptoms and Causes
What causes dumping syndrome?
Early and late dumping syndromes have different causes.
- Early dumping syndrome: Large amounts of food from your stomach move faster than normal into your duodenum (small intestine). After this food movement, fluid from the stomach rushes into your small intestine. This fluid is a mixture of stomach acid and partially digested foods and beverages.
- Late dumping syndrome: Symptoms occur when large amounts of glucose (sugar) from foods and beverages move quickly into the small intestine. The arrival of sugar causes your blood glucose (blood sugar) level to rise faster than normal. In response, your pancreas releases the hormone insulin. Insulin causes your blood glucose level to fall too fast. The result can be hypoglycemia (low blood sugar) and other symptoms like weakness.
Who is most at risk for getting dumping syndrome?
You are more likely to experience early or late dumping syndrome if you have had certain types of gastric surgeries. It is most common in people who have had surgeries that remove or bypass large portions of the stomach. These procedures include gastric bypass surgery and gastrectomy.
You may also experience dumping syndrome if you have certain medical conditions. One example is functional dyspepsia, which causes the upper portion of your digestive tract, including your esophagus and stomach, to constantly move food forward. Also, certain types of nerve damage, like that caused by certain esophageal surgeries, affect how your stomach retains and passes food to the small intestine.
What are the symptoms of dumping syndrome?
The symptoms of dumping syndrome depend on the type of dumping syndrome you have.
Early dumping syndrome usually occurs within 30 minutes of finishing a meal. If you live with early dumping syndrome, your symptoms may include:
The symptoms of late dumping syndrome typically occur 2 to 3 hours after a meal. Your symptoms may include:
- Low blood sugar (hypoglycemia)
- Cold sweats
- Rapid or irregular heartbeat
Diagnosis and Tests
How is dumping syndrome diagnosed?
Your doctor may diagnose dumping syndrome based on your specific symptoms and history of gastric surgery.
Your doctor may recommend more diagnostic tests to confirm your diagnosis and rule out other medical problems. These tests may include:
- Glucose tolerance test: Your doctor takes a blood sample after you have avoided eating for at least 8 hours. After the initial blood sample, you drink a solution containing glucose (sugar). More blood samples are taken immediately after you drink the solution, and again every 30 minutes for up to 3 hours. This test measures how your body uses insulin to control blood glucose levels.
- Gastric emptying test: This test measures how your stomach empties its contents 1 to 4 hours after eating. Before the test, you eat a meal containing a trace amount of radioactive material. Using a special scanner, your doctor can watch food’s movement through your gastrointestinal (GI) tract. You will have this test at a hospital or radiology center.
- Upper GI endoscopy: Your doctor uses an endoscope (a thin, flexible tube with a light source) to look into your esophagus, stomach, and duodenum. This test helps your doctor identify other medical problems that could cause your symptoms. These other problems could include ulcers or inflammation of your stomach lining.
- Upper GI series: During this procedure, you sit or stand in front of an X-ray machine. Your doctor provides you with a barium solution to drink. As you drink, your doctor observes how your body processes this liquid on the X-ray. Barium solution helps make certain complications, like intestinal blockages, more visible on X-rays.
Management and Treatment
How is dumping syndrome treated?
Dietary changes may help reduce the severity of your symptoms or prevent them from occurring. These changes include:
- Increasing your intake of protein and fiber
- Eating 5 to 6 small meals each day
- Adding thickening agents to make food less watery
For some people, doctors prescribe medications, such as octreotide acetate (Sandostatin®). This medication is given as an injection. You might take it daily (short-acting form) or as a long-acting injection that you receive once a month. Octreotide acetate slows the rate at which your stomach empties. It also stops your pancreas from releasing insulin in response to food.
Another medication, acarbose (Precose®), may help prevent late dumping syndrome. It does this by slowing the rate at which your body absorbs carbohydrates.
If dumping syndrome is caused by your history of gastric surgery, or if your symptoms do not respond to other treatments, your doctor may recommend additional surgery. The type of surgery depends on what surgeries you have had before.
What complications are associated with dumping syndrome?
Most people living with dumping syndrome experience only mild symptoms. If you have more severe symptoms, it can be difficult to maintain your weight. Weight loss can occur when nutrients pass out of your GI tract faster than they can be absorbed. If dietary and medication changes are not enough to manage your dumping syndrome, your doctor may recommend surgery. However, surgery to correct dumping syndrome has a low success rate. Doctors recommend surgery only as a last resort.
Can dumping syndrome be prevented?
Currently, there is no way to prevent dumping syndrome after gastric surgery. Not all people who have gastric surgery will develop dumping syndrome.
Dietary changes may prevent or reduce dumping syndrome symptoms. These changes include:
- Increasing the amount of protein and fiber in your diet
- Eating 5 to 6 small meals each day
- Avoiding drinking fluids until after meals
- Avoiding simple sugars, like table sugar, in foods and beverages
- Increasing the thickness of foods or beverages
Outlook / Prognosis
What is the prognosis (outlook) for people with dumping syndrome?
For most people, early or late dumping syndrome improves with time and dietary changes. If your symptoms do not improve after changing your diet, your doctor may recommend medication or surgery to help.
What should I expect after treatment for dumping syndrome?
For many people, dumping syndrome improves over time. Improvement is especially likely with dietary changes like those listed above.
The medications used to treat dumping syndrome, including octreotide acetate, may cause side effects. These include:
- Low blood glucose (hypoglycemia)
- Fatty, foul-smelling feces (stool)
- Pain at the injection site
When should I call my doctor?
If you have a history of gastric surgery, and you experience the symptoms of dumping syndrome, contact your doctor. He or she can evaluate and diagnose you based on your unique medical history, symptoms, and additional testing.