Diseases

Dumping Syndrome | Causes,Diagnosis & Treament

What is Dumping Syndrome?

Dumping syndrome occurs when food items, such as sugar, moves quickly from the stomach to the duodenum which is the first part of the small intestine in the upper gastrointestinal (GI) tract. Also known as Rapid Gastric Emptying, the syndrome has two main forms categorized on the basis of symptoms:

  1. Early Dumping Syndrome which starts after 10 to 30 minutes after ingesting
  2. Later Dumping Syndrome as the name suggest occurs after a later time period, usually after 3 hours of eating.

Understanding the Digestive Process

The GI tract is a chain of hollow organs connected by a long tube from the mouth to the anus. The body digests meals using the motion of muscular tissues in the GI tract, coupled with the release of hormones and enzymes which aid in the entire process. The oesophagus is responsible for transporting food and beverages from the mouth to the stomach. The stomach sends the food from the stomach to the intestine where essential minerals and vitamins are absorbed.  The juices secreted by the liver and pancreas travel to the small intestine through tiny tubes called duct. The lower Gastrointestinal tract consisting of large intestine and anus are the two parts where the digestive process finally terminates. The large intestine has the function of absorbing water and any unabsorbed nutrients from the small intestine. The unwanted food items are then converted to faeces or stool. Stool passes from the colon to the rectum. The rectum is responsible for storing stool before bowel movement initiates.

Causes

Dumping syndrome is a result of troubles with the storing of digestive particles inside the belly causing difficulty emptying these particles into the duodenum. The initial stage of dumping syndrome leads to the transportation of fluid into the gut accompanied by an addition of a huge amount of meals from the stomach. The later stage is a  fast movement of sugar into the gut, enhancing blood glucose level in the blood which propels the pancreas to secrete more insulin The elevated launch of insulin leads to hypoglycemia which is characterized by low blood sugar level.

Who is at risk?

If you had a surgical procedure to remove a full-size a part of the stomach then you are more likely to be diagnosed with dumping syndrome. Bariatric surgery significantly lessens the size of the stomach as a consequence of which, nutrients move quickly into the small gut. Any other complication, like nerve damage due to oesophagal surgery that disrupts how the stomach empties its food contents will likely cause Dumping Syndrome

Symptoms

The symptoms of both the early and late dumping syndrome vary considerably. Even with the type of syndrome, the signs may be different from person to person.

Signs that characterize Early Dumping Syndrome:

  • Feeling nausea and vomiting
  • Cramps and intense abdominal pain
  • Bloating
  • Sweating
  • Feeling dizzy

Signs that characterize Late Dumping Syndrome:

  • Hypoglycemia (An endocrinologist should be consulted on an urgent basis)
  • Excessive sweating
  • Flushing
  • Irregular Heartbeat and palpation

 

Type Proportion of Total affected population
Early Stage 75%
Late Stage 25%

 

Only a small chunk of the population will be diagnosed with both the types at the same time.

Diagnosing

Like with the case of all other diseases, it is best to characterize the condition ordinarily on the basis of perceived symptoms. The modern advancement in the field of medical science has seen the discovery of the scoring device which essentially ascribes points to all the recognized symptoms. If you have a score exceeding 7, then you are diagnosed with dumping syndrome.

In addition, there are other clinical tests that can help in a clearer diagnosis:

  • An oral glucose tolerance test: It is a way of checking the accuracy of the body tissues in absorbing glucose. In the first stage, the person is recommended to fast (avoid food) and drink nothing besides water. Tests are conducted to check for the initial glucose concentration in the body. In addition, the number of red blood cells and pulse rate are also noted. When these measurements are done, they are followed by the person drinking a glucose solution. The blood sugar level is then reported after 30 minutes interval for the next 3 hours. People with dumping syndrome will confirm a low blood sugar level between the second and third hour time , red blood cells increasing by 3% at 30 minutes and pulse rate intensifying after 30 minutes of drinking the solution.
  • Gastric emptying scintigraphy: The test involves the consumption of food items that contain radioactive material like eggs. The radiologist then tests the abdomen for locating the radioactive materials. The gastric emptying is noted after every hour for the next 4 hours. This clinical test will confirm the presence of dumping syndrome.

It is also important to note the structure for esophagus, stomach and upper small intestine when checking for dumping syndrome:

Upper GI endoscopy:  A small tube like structure is inserted into the upper GI tract, with a small camera attached along. It is carried out to examine the linings of the stomach to check for ulcers, swelling or cancer

Upper GI series: A series of tests carried out for a thorough examination of the small intestine. A person is exposed to an X ray machine and is instructed to drink barium to notice for any gastric blockage that may be present.

These tests may have some side effects and the person, as a result of the radiations, may feel nauseous or fatigues. It is also important to follow the diet as might be directed by the medical professional.

Treatment

If mild symptoms are noted, then no rigorous  procedure of treatment might be required. In other cases, it becomes imperative to either alter dietary requirements, take medications  and in rare cases a surgery might be prescribed.

Dietary Changes

The following table summarizes the amendments in the diet that should be followed to lessen the complications caused by dumping syndrome:

1.      Having 5/6 smaller meals in a day rather than three hearty breakfast, lunch or dinner meals
2.     Having no liquid until 30 minutes of food ingestion
3.     Including a significant portion of fiber and complex carbohydrates (starchy food, oatmeal, rice)
4.     Limiting the intake of junk foods particularly the ones that contain a high amount of simple sugars
5.      Natural food thickening agents to be used

Use of Synthetic Medication

Octreotide Acetate (Sandostatin) is commonly prescribed for minimizing the symptoms of dumping syndrome. This synthetic medication inhibits the production of insulin and other gastrointestinal hormones. Octreotide is either available in short or long acting formulas. The former is inserted intravenously twice in a day. While the latter is injected in the buttocks region once after every four weeks. The side effects of this form of treatment may include the production of gallstones, fatty stools and intense pain in the injected region.

Surgery

Surgical method is only advised when the above 2 treatment processes have proved to ineffective or the complications have resulted from past gastric surgery. Although, taken as a last resort the surgeries often yield no positive outcome.

 

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