Dumping syndrome

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

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Dumping syndrome is a pathologically accelerated gastric emptying. It causes a multitude of complaints that either become noticeable within the first hour (early dumping) or one to three hours after a meal (late dumping). The dumping syndrome occurs particularly often after gastric surgery. Here you can read everything you need to know about dumping syndrome: causes, symptoms, diagnosis and treatment.

Dumping syndrome: description

The term dumping syndrome describes a pathologically accelerated gastric emptying (fall emptying). It can trigger a wide variety of complaints - both in the digestive tract (such as nausea, vomiting) and in other parts of the body (racing heart, weakness, tremors). Depending on how quickly such symptoms appear after a meal, doctors differentiate between two forms of dumping syndrome, early and late dumping syndrome, with mixed forms sometimes being observed:

Early dumping syndrome (early dumping)

In early dumping syndrome, symptoms appear within the first hour after a meal. Typical symptoms include:

Bloating
nausea
Vomit
Flatulence
stomach pain
diarrhea
Stomach growling
Racing heart
Fatigue
Fainting
sweat
headache
paleness

Late dumping syndrome (late dumping)

In the rarer late dumping syndrome, symptoms such as:

sweat
Tremble
weakness
Difficulty concentrating
Cravings
Clouding of consciousness

Dumping Syndrome: Frequency

Dumping syndrome is seen in five to ten percent of all patients after gastric surgery. For certain interventions, the frequency is much higher. Up to 75 percent of all patients who have undergone gastric bypass surgery due to severe obesity (morbid obesity: BMI> 40 kg / m2) develop a dumping syndrome.

Dumping Syndrome: Causes and Possible Diseases

Dumping syndrome is primarily the result of gastric surgery.

Early dumping syndrome

Due to the partial removal of the stomach with removal of the gastric porter (pylorus) at the gastric outlet, undiluted chyme gets too quickly from the stomach into the small intestine - it "rushes" into the small intestine in an uncontrolled manner, more precisely: into the evacuating loop of the empty intestine (jejunum). This leads to a sudden stretching of the small intestine.

So-called dishes with high osmotic pressure, such as desserts, sugar and milk, are particularly problematic. They cause a strong concentration gradient between the intestinal contents and the blood vessels in the intestinal wall. To compensate for this, a lot of fluid is released from the vessels into the interior of the intestine. The result is a reduction in the plasma volume in the vessels, which can significantly lower blood pressure.

In addition, various substances such as the hormone neurotensin are suddenly released from the intestinal wall. Among other things, this stimulates bowel contraction.

Overall, this gives rise to the various symptoms that are observed in early dumping syndrome.

Late dumping syndrome

In late dumping syndrome, the symptoms of low blood sugar (hypoglycemia) are in the foreground: The rapid emptying of the stomach leads to a high concentration of carbohydrates and sugar (glucose) in the intestine. These are quickly absorbed into the bloodstream, which causes the blood sugar level to rise sharply (excess sugar = hyperglycaemia).

The result is the release of an excessive amount of the blood sugar lowering hormone insulin. This ensures that the body's cells absorb the abundance of blood sugar quickly. Since insulin circulates in the blood for a long time, this can ultimately lead to a too low blood sugar level (low blood sugar = hypoglycaemia). This results in the various symptoms of late dumping syndrome such as weakness and cravings.

Dumping syndrome: when do you need to see a doctor?

If you feel nauseous after a meal on a regular basis, or if you suffer from symptoms such as feeling weak, headache or racing heart, this is always a reason to see a doctor. If you have also had a stomach operation, it can also be due to a dumping syndrome.

Dumping Syndrome: What Does the Doctor Do?

Your doctor will first talk to you in detail about your symptoms, any previous illnesses and operations (anamnesis). The description of the symptoms usually gives a strong suspicion of dumping syndrome.

To confirm the diagnosis, a provocation test based on the oral intake of 50 grams of glucose can be performed. It measures how this affects various body functions. A dumping syndrome is therefore present if:

the heart rate increases by more than ten beats per minute after taking glucose,
the hematocrit value (percentage of blood cells in the total blood volume) drops by more than three percent,
the excretion of hydrogen in the air increases (indication of early dumping syndrome) or
after the initial hypoglycaemia (hyperglycaemia) the blood sugar level drops sharply (hypoglycaemia) or the typical hypoglycaemia symptoms occur (indication of late dumping syndrome).

A gastroscopy (gastroscopy) can also help if dumping syndrome is suspected by excluding other possible causes for the symptoms. Sometimes a special X-ray examination of the stomach and small intestine is also done (gastrointestinal passage, MDP).

This is how the doctor treats dumping syndrome

In the case of dumping syndrome, certain dietary rules must be followed. Patients should:

limit the daily carbohydrate intake and prefer complex carbohydrates such as whole grain products, potatoes, vegetables to simple carbohydrates (sugar, honey, white flour products);
reduce consumption of milk and dairy products;
eat several small meals a day instead of a few large ones;
do not drink anything during a meal or for the first half an hour afterwards;

In the case of late dumping syndrome, the symptoms of which are mainly based on the sudden hypoglycaemia, food intake (especially sugar) can help in acute cases.

If the change in diet does not have a lasting effect on dumping syndrome patients, the doctor can consider the additional use of drugs (such as acarbose, octreotide).

If the above-mentioned conservative measures are unsuccessful, a surgical intervention may be necessary, for example in severe cases of dumping syndrome after a so-called Billroth II resection of the stomach: In the Billroth II resection, the lower two thirds of the Stomach including the gastric porter removed. The remaining stomach stump is connected directly to the jejunum, while the first section of the small intestine (duodenum or duodenum) is blindly closed.

In patients who suffer from a severe and unsuccessfully treatable dumping syndrome after this operation, a subsequent correction can be made - conversion of the Billroth II stomach into a Billroth I stomach by connecting the stomach stump directly to the duodenum.