Dumping Syndrome, Animation

(USMLE topics, gastroenterology) Pathology, types, symptoms and management of dumping syndrome.

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Voice by Ashley Fleming

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Dumping syndrome is a very common complication following gastric and esophageal surgeries.
Also known as rapid gastric emptying, dumping syndrome is a condition in which undigested food moves too quickly from the stomach to the small intestine. In other words, food gets “dumped” into the intestine before being properly digested. This happens because the valve that separates the stomach and the small intestine, called the pyloric sphincter, was either removed or damaged in the surgery.
There are 2 forms of the disease, based on when symptoms occur: early or late.
• Early dumping happens between 10 to 30 minutes after a meal. Symptoms arise as the rapid dumping of the undigested, concentrated food mass triggers the body to move fluid from the bloodstream into the intestine, in an attempt to dilute the food. The resulting distended intestine produces bloated feeling, abdominal cramps, nausea, vomiting and diarrhea. This shift of fluid, when excessive, may also significantly reduce blood volume, causing rapid heart rates, dizziness, lightheadedness or even fainting.
• Late dumping symptoms occur within 1 to 3 hours after eating. At this point, the rapid increase in sugar absorption triggers the pancreas to produce more insulin, in an attempt to prevent too high levels of blood glucose. However, it may overreact and produce too much insulin, causing instead too low blood glucose levels, or hypoglycemia, which may manifest as weakness, sweating, confusion, and tremors.
Increase in gastrointestinal hormones is also observed and thought to contribute to both early and late symptoms.
Symptoms are often more severe after meals that are high in simple carbohydrates, such as table sugar.
Most cases of dumping syndrome can be successfully managed with diet changes. These include:
Eating smaller meals throughout the day
Avoiding foods with high simple-sugar content
Choosing foods that are rich in proteins, fibers and complex carbohydrates
Delaying liquid intake until at least 30 minutes after a meal
Adding thickening agents to increase food consistency
If these fail, medications that slow down gastric emptying or inhibit insulin release may be prescribed. Tube feeding that bypasses the upper digestive tract, or corrective surgery such as reconstruction of the pyloric sphincter, maybe performed as a last resort.