- Occurs within 20-30mins after meal
- More common than late dumping
- More GI and less cardiovascular effects.
- Symptoms related to serotonin and bradykinin release
- GI
- Nausea/vomiting, epigastric discomfort, crampy pains + explosive diarrhoea
- Cardio
- Tachycardia, palpitations, diaphoresis, fainting, dizziness, flushing, blurred vision
- Pathophysiology
- Rapid transit of high osmotic load into small bowel
- Draws fluid in → Visceral distension → Release of vasomotor mediators
- Vasomotor (serotonin & bradykinin) release causes
- 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