Dumping Syndrome – Causes, Symptoms, Diagnosis, Treatment

Medical history

• Your doctor will review your medical history, including any history of stomach or esophagus surgery. The diagnosis of dumping syndrome is based on the development of symptoms in a patient with a history of stomach surgery although tests may be needed to exclude other conditions that have similar symptoms.

Oral glucose tolerance test

• You’ll be asked to fast—not eat or drink anything except water—for at least 10 hours before the test. For the test, you’ll drink a solution that contains glucose, a form of sugar. A health care professional will take blood samples and check your blood pressure and heart rate before you drink the glucose solution and then every 30 minutes for up to 3 hours.
• The health care professional will use blood samples to measure your blood glucose level, also called blood sugar and your hematocrit. A hematocrit test NIH external link measures how much of your blood is made up of red blood cells. When you have dumping syndrome, fluid moves from your bloodstream into your small intestine after a meal. With less fluid in your blood, the portion of your blood made up of red blood cells increases.

Your doctor may diagnose dumping syndrome if

• your heart rate increases by 10 beats per minute 30 minutes after you drink the glucose solution
• your blood test results show a 3 percent increase in your hematocrit 30 minutes after you drink the glucose solution
• your blood test results show low blood glucose 1 to 3 hours after you drink the glucose solution

Gastric emptying scan

• A gastric emptying scan is also called gastric emptying scintigraphy. For this test, you eat a bland meal—such as eggs or an egg substitute—that contains a small amount of radioactive material NIH external link.
• A camera outside your body scans your abdomen to show where the radioactive material is located. By tracking the radioactive material, a health care professional can measure how fast your stomach empties after the meal.
• The health care professional will scan your abdomen several times to see how fast your stomach empties for up to 4 hours after the meal. The test can help confirm a diagnosis of dumping syndrome.

Other tests

Your doctor may order additional tests, such as upper gastrointestinal (GI) endoscopy or upper GI series, to examine the structure of your esophagus, stomach, and small intestine and to check for signs of other health problems.

• Blood sugar test – Because low blood sugar is sometimes associated with dumping syndrome, your doctor may order a test (oral glucose tolerance) to measure your blood sugar level at the peak time of your symptoms to help confirm the diagnosis.
• 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.
• A gastric emptying scintigraphy test – involves eating a bland meal that contains a small amount of radioactive material. An external camera scans the abdomen to locate the radioactive material. The radiologist measures the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. The test can help confirm a diagnosis of dumping syndrome.
• 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.

Treatment of Dumping Syndrome

Non-pharmacological

• Changing your eating habits – The first step in treating dumping syndrome is changing how and what you eat. Many people with dumping syndrome have mild symptoms that improve over time with simple changes in eating and diet.
• Diet – Most cases of dumping syndrome are successfully treated with dietary adjustments. The suggested division of meals recommended is at least six times per day. Liquids should be withheld until 30 minutes after the meal. In addition, simple sugars and milk products should be avoided. Protein and fat calories should be increased to compensate for the decreased carbohydrate intake. Fiber-rich food is encouraged and has shown to promote a longer transit time in the bowel.
• Eat smaller meals – Try eating five or six small meals a day rather than three larger ones.
• Drink most of your fluids between meals – At first, don’t drink anything for 30 to 60 minutes before and after meals.
• Drink 6 to 8 cups (1.4 to 1.9 liters) of fluids a day – At first, limit fluid with meals to 1/2 cup (118 milliliters). Increase fluid with meals as you tolerate it.
• Change your diet – Eat more protein meat, poultry, creamy peanut butter, and fish and complex carbohydrates — oatmeal and other whole-grain foods high in fiber. Limit high-sugar foods, such as candy, table sugar, syrup, sodas, and juices. The natural sugar in dairy products (lactose) might worsen your symptoms. Try small amounts at first, or eliminate them if you think they’re causing problems. You might want to see a registered dietitian for more advice about what to eat.
• Increase fiber intake – Psyllium, guar gum and pectin in food or supplements can delay the absorption of carbohydrates in the small intestine.
• Check with your doctor about drinking alcohol.
• Alternative medicine – Some people use supplements such as pectin, guar gum, black psyllium and blond psyllium to thicken the digestive contents and slow its progress through the intestines. If you decide to try a supplement, discuss it with your doctor to learn about potential side effects or interactions with other medications you’re taking.

Medicines

If changing your eating habits doesn’t improve your symptoms, your doctor may prescribe medicines.

• Octreotide (Sandostatin) – may help reduce the symptoms of dumping syndrome. This medicine comes in short- and long-acting forms
• The short-acting form – is injected under your skin 2 to 4 times a day before meals. A health care professional may inject the medicine or may train you, a friend, or a relative to inject the medicine.
• The long-acting form – is injected into your buttocks muscles once every 4 weeks. Side effects may include pain where the medicine is injected, diarrhea, weight gain, gallstones, and steatorrhea.
• Octreotide – is a somatostatin analog that inhibits several GI hormones. The therapeutic effects occur with delayed gastric emptying, decreased the release of GI hormones, prolonged small intestine transit time, decreased insulin release, and splanchnic vasoconstriction. Multiple studies have shown that octreotide was alleviating symptoms of dumping syndrome both as a short and long-term therapy.
• Acarbose – is a competitive inhibitor of intestinal brush border α-glucosidase that has a higher affinity to the enzyme compared to the normal substrate. However, since it is a reversible interaction, the breakdown of oligosaccharides to monosaccharides is slowed. This delayed conversion helps prevent the adverse effects of late dumping. Studies have demonstrated a reduction in symptoms of postprandial hypoglycemia.

Doctors may prescribe acarbose (Prandase, Precose) NIH external link to help reduce the symptoms of late dumping syndrome. Side effects of acarbose may include bloating, diarrhea, and flatulence.

Surgery

Surgical interventions are reserved for patients who fail conservative measures.

• There are several options, including stomal revision, Billroth II to Billroth I anastomoses, pyloric reconstruction, jejunal interposition, and Roux-en-Y conversion.
• Stomal revision encompasses the narrowing of the gastrojejunal stoma, which delays gastric emptying. However, complications such as gastric outlet obstruction and strictures are seen. This intervention no longer has a role in Dumping syndrome.
• The Billroth II to Billroth I conversion anastomosis resumes the transit of food to the duodenum. It is a simple intervention with minimal complications. The risk of gastric outlet obstruction is avoided here as well.
• Pyloric reconstruction is useful in patients who have dumping syndrome after pyloroplasty. The pyloroplasty scar is cut, and the sphincter muscle is then approximated.
• Jejunal interposition involves the interposition of the isoperistaltic jejunal loop. One study demonstrated improvement of the early dumping syndrome, however further studies did not reproduce the same results.
• The Roux-en-Y conversion into Roux-en-Y gastrojejunostomy delays gastric emptying and the transit through the Roux limb. Even though the mechanism for improved symptoms of Dumping syndrome is not known, favorable outcomes have been demonstrated.

Which food to eat and which food not to eat