Dumping Syndrome

Symptoms: abdo cramps, dizziness, heart palpitations, nausea, fainting and/or diarrhoea

• Tends to occur after partial gastrectomy and pyloroplasty although it can occur to a lesser extent after other major upper GI surgery

• Early Dumping Syndrome:

• Occurs within 20-30mins after meal

• More common than late dumping

• More GI and less vasomotor effects.

• Symptoms related to serotonin and bradykinin release

  • GI
    • Nausea/vomiting, epigastric discomfort, crampy pains + explosive diarrhoea
  • Vasomotor
    • Tachycardia, palpitations, diaphoresis, fainting, dizziness, flushing, blurred vision

• Pathophysiology

  • Rapid transit of high osmotic load into small bowel
  • Draws fluid in →  Rapid fluid shifts from the plasma into the bowel occur, resulting in hypotension and a sympathetic nervous system response
  • Bowel distension leads to release of vasoactive molecules (serotonin & bradykinin) release which causes vasomotor symptoms
    • Weakness, dizziness, faint, pallor, sweat

• Most common after Billroth II (especially if >2/3 resected)

• Investigations

  • Contrast study to demonstrate rapid emptying or provocation test by ingesting 200ml of 50% glucose & water

• Management

  • Dietary change
  • Avoid sugary foods, small frequent meals, separate liquids from solids, high protein/fat meals
  • Diet consisting of high-fiber, complex carbohydrate, and protein-rich foods.
  • Octreotide can help – inhibits hormonal response & delays gastric emptying
  • Surgery – consider interposition of 10-20cm jejunum

• Late Dumping Syndrome:

• Occurs 2-3 hours post-meal

  • Related to high carbohydrate load into small bowel
  • Get rapid glucose absorption and profound insulin release that overshoots glucose
  • Rebound hypoglycaemia
  • Triggers Adrenal Gland to secrete Catecholamines

• Diaphoresis/tremors/tachycardia

  • Just like hypoglycaemic shock symptoms

• Management

  • Small frequent meals & less carbs

• Surgical option of jejunal interposition