DUMPING SYNDROME

General Information

DEFINITION--A group of symptoms that are a complication of surgical removal of all or part of the stomach. Most patients experience the problem to a minor degree for 1 to 6 months after surgery. It becomes a serious problem in 1% or 2% of patients. The symptoms are of 2 types--early dumping syndrome and late dumping syndrome. Symptoms of the first begin a few minutes to 45 minutes after every meal. Symptoms of the second begin 2 to 3 hours after eating. Most persons experience late dumping syndrome--one person does not have both forms.

BODY PARTS INVOLVED--Gastrointestinal system; cardiovascular system.

SEX OR AGE MOST AFFECTED--Both sexes of adults following surgery on the stomach.

SIGNS & SYMPTOMS

Early dumping syndrome:

• Weakness and fainting.
• Sweating.
• Irregular or rapid heartbeat.
• Decreased blood pressure.
• Flushing of skin.
• Dizziness.
• Shortness of breath.
• Vomiting.
• Explosive diarrhea and abdominal cramps.

Late dumping syndrome:

• Sweating, anxiety and tremors.
• Exhaustion and faintness.
• Decreased blood pressure.
• Headache.

CAUSES

> Early dumping syndrome: Rapid entry of food and fluids directly into the small intestine, producing decreased blood pressure and increased blood flow to the intestines.

> Late dumping syndrome: Low blood sugar caused by excess insulin produced in response to sudden dumping of food and fluids into the intestine.

RISK INCREASES WITH--The larger the amount of stomach removed, the more severe the dumping syndrome.

HOW TO PREVENT--Some degree cannot be prevented, but recurrence and severity can be minimized with dietary changes (see Diet).

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory studies of blood sugar levels.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.

POSSIBLE COMPLICATIONS

• Malnutrition and weight loss.
• Anxiety.

PROBABLE OUTCOME--Spontaneous recovery for most patients. Early dumping syndrome usually lasts 3 to 4 months. Late dumping syndrome usually lasts 1 year, but it may persist for many years.

How To Treat

GENERAL MEASURES--

• Early syndrome: Lie down for 45 minutes until symptoms pass.
• Late syndrome: Eat small amounts of sugar candy or drink sweetened orange juice.

MEDICATION--Your doctor may prescribe:

• Anticholinergics to block the dumping-syndrome reflex.
• Pectin to reduce the severity of diarrhea.
• Vitamin and mineral supplements to compensate for poor absorption.

ACTIVITY--

• Between symptoms: no restrictions.
• With symptoms: rest until they pass.

DIET--

• Early dumping syndrome: Diet control is the most important treatment. Eat a diet low in sugar and other simple carbohydrates. Increase fat and protein consumption. Eat 6 small, evenly spaced meals a day. Take meals dry--without water or beverages--and drink fluids only between meals.
• Late dumping syndrome: Avoid refined sugar.

Call Your Doctor If

• You have symptoms of dumping syndrome not relieved by measures outlined above.
• You vomit blood, have black, tarry stools or other signs of gastrointestinal bleeding.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.