Dumping syndrome is common after gastric surgery. It is a group of symptoms that may result from having part of your stomach removed or from other surgery involving the stomach. The symptoms range from mild to severe and often subside with time. Although you may find dumping syndrome alarming at first, it is not life threatening. You can control it by making changes in what and how you eat. By controlling dumping syndrome, you will also be avoiding the foods that tend to make you gain weight. The symptoms of this syndrome or disorder are of two phases: i. Early and Late phase. An early dumping phase may happen about 30 to 60 minutes after you eat. Symptoms can last about an hour and may include: • A feeling of fullness, even after eating just a small amount • Abdominal cramping or pain • Nausea or vomiting • Severe diarrhea • Sweating, flushing, or light-headedness • Rapid heartbeat Dumping Syndrome: Symptoms of the Late Phase A late dumping phase may happen about 1 to 3 hours after eating. Symptoms may include: • Fatigue or weakness • Flushing or sweating • Shakiness, dizziness, fainting, or passing out • Loss of concentration or mental confusion • Feelings of hunger • Rapid heartbeat,
Reductions in the need for elective gastric surgery have led to a decline in the frequency of postgastrectomy syndromes. A 10-fold reduction has occurred in elective operations for peptic ulcer disease in the last 20-30 years. Although this trend preceded the advent of histamine-2 receptor antagonists, these drugs and proton pump inhibitors have accelerated the decline. Helicobacter pylori treatment and eradication in patients with peptic ulcer disease have further decreased the need for surgery. Although the need for elective surgery for peptic ulcer disease has declined, the need for emergency surgery has remained the same over the last 20 years. Emergency surgery tends to be more mutilating to the stomach. This increases the incidence of more severe symptoms. Some 80% of the deaths that occur within a month of bariatric surgery arise from anastomotic leaks, pulmonary emboli, and respiratory failure. Other authors report that long-acting octreotide is as effective long term as subcutaneous octreotide, with superior symptom control as assessed by the Gastrointestinal Specific Quality of Life Index, better maintenance of body weight, and higher quality of life. Pancreatic nesidioblastosis or pancreatic islet cell hyperplasia has been speculated to contribute to the sometimes disabling neurologic immune restoration inflammatory syndrome (NIRIS). Resection of this hyperplasia and therefore removing the exaggerated insulin response has been proposed.
Dumping syndrome is largely avoidable by avoiding certain foods that are likely to cause it; therefore having a balanced diet is important. Treatment includes changes in eating habits and medication. People who have gastric dumping syndrome need to eat several small meals a day that are low in carbohydrates, avoiding simple sugars, and should drink liquids between meals, not with them. Fiber delays gastric emptying and reduces insulin peaks. People with severe cases take medicine (such as octreotide and cholestyramine) or proton pump inhibitors (such as pantoprazole and omeprazole) to slow their digestion. Doctors may also recommend surgery. Surgical intervention may include conversion of a Billroth I to a Roux-en Y gastrojejunostomy. Medical care is taken by using two drugs: Acarbose and Somatostatin. The use of acarbose, an alpha-glycoside hydrolase inhibitor, interferes with carbohydrate absorption and thus may decrease the time delay between hyperglycemia and insulin response. This may lead to coinciding of the peak of glucose and insulin levels and thus prevent hypoglycemic symptoms in patients with late dumping. Imhof et al showed that acarbose produced a 5-fold decrease in postprandial glucagon-like peptide 1 levels which, in turn, may lead to a decrease in insulin release. Acarbose use may be limited by the occurrence of diarrhea secondary to fermentation of unabsorbed carbohydrates as manifested by increased breath hydrogen excretion and symptoms such as flatulence. Somatostatin and its synthetic analogue octreotide (Sandostatin) have been used with short-term success in patients with dumping syndrome, but the long-term efficacy of octreotide is much less favorable. They exert a strong inhibitory effect on the release of insulin and several gut-derived hormones.