What is dumping syndrome
What is dumping syndrome?
A dumping syndrome is a complex of symptoms that occur after gastric operations (so-called Billroth operations = partial removal of the stomach) and primarily consist of various complaints in the area of the abdomen or the gastrointestinal tract.
A distinction is made between the early and late dumping syndrome, i.e. symptoms that appear either 15-30 minutes or 2-3 hours after eating.
The common cause of dumping syndrome is surgery on the stomach.
These operations are part of the stomach removed according to Billroth, a distinction being made between a so-called Billroth-I and Billroth-II operation.
In the Billroth I operation, 2/3 of the stomach is removed and the remainder of the stomach is immediately reconnected to the adjoining duodenum. The risk of dumping syndrome occurring after this operation is approx. 15%.
In the Billroth II operation, 2/3 of the stomach is also removed, but the adjoining duodenum is blindly closed, but a loop of the empty intestine is pulled up to the remaining stomach and connected to it. The risk of a subsequent dumping syndrome is lower and is around 5%.
Cause gastric bypass
Depending on the gastric bypass surgery procedure, a dumping syndrome can also occur afterwards.
If a so-called Roux-Y gastric bypass operation is performed, almost the same procedure is carried out as for a Billroth II operation:
the greatly reduced stomach is connected with a pulled up bowel loop, the duodenum that actually adjoins the stomach is blindly closed.
As a result, not only is the stomach volume reduced, but the chyme is transported directly past the duodenum into the empty intestine.
Digestive enzymes from the pancreas and gallbladder are therefore only supplied later than normal, which shortens the overall time for digestion and the absorption of food components.
As a rule, the diagnosis of dumping syndrome is based on the classic anamnesis, the so-called doctor-patient consultation.
The patients describe the classic symptoms shortly after ingestion or 2-3 hours after the meal.
In order to confirm the diagnosis of the late dumping syndrome, blood sugar measurements can be helpful:
Due to the lack of portioning by the stomach (e.g. in the absence of a gastric porter after partial gastric resection), a glucose flood in the small intestine occurs shortly after eating, with a subsequent increase in blood sugar.
As a counter-regulation, more insulin is released from the pancreas in order to absorb all the sugar as quickly as possible, but this often leads to hypoglycaemia 2-3 hours after eating.
Both high and low blood sugar levels can be measured classically.
A so-called glucose provocation test can provoke these symptoms and make the diagnosis.
The typical accompanying symptoms in early dumping syndrome are above all cramp-like abdominal pain through to diarrhea, nausea and vomiting and circulatory problems shortly after eating.
In late dumping syndrome, symptoms of classic hypoglycaemia are the main symptoms, i.e. low blood pressure, cold sweats, cravings and a feeling of weakness.
Often there are also mixed pictures of an early and a late dumping syndrome.
Do you suffer from stomach ache and want to get it under control quickly?
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Diarrhea as a symptom of a dumping syndrome is mainly found in the context of an early dumping syndrome.
The reason for this is that the stomach empties too quickly after eating, due to the lack of a gastric porter after a part of the stomach has been removed.
The food is not portioned, but too quickly in too large quantities into the newly connected loop of the small intestine, which leads to a greatly increased influx of water into the intestine from the surrounding tissue.
This not only triggers circulatory problems, but also greatly dilutes stool, which causes diarrhea.
- This article may also be of interest to you: Medication for diarrhea
What is the best diet for people with dumping syndrome?
In the case of dumping syndrome, it can help if care is taken to ensure that low-carbohydrate meals are used when eating.
If carbohydrates are consumed, they should rather be complex carbohydrates (e.g. high-fiber whole grain products; rather avoid sugary foods and drinks).
It is also important that you eat slowly and preferably in several small portions and meals throughout the day. This is the best way to enable a more portioned intake of food in the intestine and to avoid eating bread if there is no gastric porter function.
Eating food while lying down can also be helpful.
Heavily salted meals are also rather unfavorable, as they also promote the influx of water into the intestines during digestion and thus the symptoms of diarrhea.
The same applies to increased fluid intake with meals - less fluid should be consumed with meals.
Sufficient fluid intake for the day should rather be done independently of meals.
- Also read our detailed article on this topic: Post-gastric bypass nutrition
What can you do about dumping syndrome?
If a dumping syndrome occurs after gastric surgery, general measures can initially help.
Slow, conscious eating is primarily recommended, although it can also help to eat several small meals throughout the day.
However, eating large meals quickly should be avoided at all costs.
The symptoms can also be reduced if less fluid is consumed immediately when eating. However, care should be taken to ensure sufficient fluid intake throughout the day.
If these general rules of conduct do not help enough, drug therapy can be tried. So-called anticholinergics, sedatives and beta blockers are mainly used here.
In serious cases, if the intake of medication does not provide a remedy, a conversion operation into a Billroth II situation can be carried out if a Billroth I operation is present. However, this is rarely necessary.
If a dumping syndrome occurs, this is usually well controlled by the rules of conduct already described here.
Medicinal or even surgical measures are rarely necessary.
It is not uncommon for the symptoms to regress spontaneously in the course of time after gastric surgery, so that a life without dumping syndrome is possible again after a part of the stomach has been removed.
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