What Is Dumping Syndrome? What Causes It? Does It Improve?

Dumping syndrome occurs when the rapid passage of food into the intestines causes sudden dilation and increased blood flow in intestinal vessels, reducing blood flow to the brain.

It is characterized by vasomotor and gastrointestinal signs and symptoms caused by rapid gastric emptying or the rapid passage of nutrients into the small intestine.

Dumping syndrome is a common complication of stomach cancer surgery, noncancerous esophageal and gastric surgery, and bariatric surgery (also known as metabolic or obesity surgery).

These interventions change the stomach's anatomy and innervation (nerve stimulation), which can allow a substantial amount of undigested food to reach the small intestine too quickly.

Below, you can see how the anatomy of the stomach and small intestine may change after stomach surgery.

What Causes Dumping Syndrome? Its Pathophysiology

The stomach acts as a reservoir, begins digestion, and releases its contents in a controlled manner into the duodenum, the beginning of the small intestine. Food is partially digested by acid and proteases in the stomach.

An intact pylorus (the stomach's exit gate) prevents large pieces from passing into the duodenum. Intervening in the pyloric region reduces stomach volume and alters pyloric emptying. This results in the rapid passage of large amounts of osmotically active solids and liquids into the duodenum and small intestine.

Dumping syndrome is divided into early and late dumping according to the time elapsed after eating. Most patients have early dumping, approximately 25% have late dumping, and fewer patients experience both.

Early Dumping Syndrome

This occurs after gastric resections and Billroth II operations when the stomach empties rapidly, continuously, and uncontrollably into the small intestine. Signs and symptoms usually begin during or immediately after a meal (within 5-30 minutes). Sudden weakness, faintness, and dizziness are followed by a desire to lie down. Cold sweats, palpitations, fullness, and a churning sensation occur. Some patients have intestinal cramps resulting in nausea, vomiting, and explosive diarrhea. It may persist for 1-2 years after surgery.

What Are the Symptoms of Early Dumping?

• Diarrhea
• Nausea
• Vomiting
• Intestinal cramps
• Bloating
• Palpitations
• Fatigue
• Faintness
• Weakness
• Sweating
• Headache
• Pallor

Late Dumping Syndrome

Rapid passage of food into the small intestine leads to a high carbohydrate concentration there. This causes hyperglycemia (increased blood sugar), followed by excessive insulin release and consequent reactive hypoglycemia (low blood sugar). It occurs 1-3 hours after eating. It may begin 3-6 months after surgery and last 2-5 years.

What Are the Symptoms of Late Dumping Syndrome?

• Sweating
• Trembling
• Difficulty concentrating
• Loss of consciousness
• Hunger

What Should the Diet Be Like to Treat Dumping Syndrome?

Small amounts should be eaten frequently. In partial gastrectomy (removal of part of the stomach), gastric emptying is accelerated and the stomach reservoir is smaller, so food passes rapidly from the stomach into the small intestine.

Food should be eaten in small pieces and small, frequent meals.

Start with liquids without solid pieces. If tolerance is good, the number of meals is reduced and the amount eaten is increased; eventually, the diet is adjusted to age, physical activity, and similar factors.

Sugary foods and drinks should be restricted.

Simple carbohydrates are sugars absorbed from the intestine into the blood in 15-20 minutes without digestion and used directly as an energy source, causing sudden rises and falls in blood sugar. Complex carbohydrates are a type of carbohydrate that takes approximately 3-4 hours to digest and has a slower, longer-lasting effect on blood sugar. Reducing simple sugar intake reduces the passage of food into the small intestine. Complex carbohydrate intake should be increased and simple carbohydrate intake limited.

Foods with a low glycemic content should be selected.

Carbohydrates with a low glycemic index are digested more slowly. Because carbohydrate absorption slows, they have positive health effects (blood glucose control, reduced blood lipid levels, and so on). High-glycemic-index carbohydrates are digested and absorbed rapidly, producing a greater glycemic response characterized by high blood glucose levels and hyperinsulinemia.

• Low-glycemic-index foods: dried beans, chickpeas, lentils, bulgur, rye, bran, whole wheat, yogurt
• High-glycemic-index foods: white bread, rice, potatoes, foods with added sugar

Food should be chewed thoroughly and eaten slowly.

Chewing food into smaller pieces can prevent large, hard-to-digest pieces from flowing into the small intestine.

Fluid intake with meals should be limited, and one should eat for at least 30 minutes after a meal before taking fluids.

This method is used to ensure that the remaining stomach after partial gastrectomy is filled with food rather than liquid.

Protein should be consumed at every meal.

Proteins are the basic building blocks of the body's defense system, enzymes regulating bodily function, and some hormones. A protein-rich diet is recommended so the body can carry out its building and repair functions.

• Protein-rich foods: eggs, cheese, meat, milk, yogurt

Fiber intake should be increased.

Fiber is the name for complex carbohydrates in food that the human body cannot digest or absorb into the bloodstream. It slows carbohydrate absorption by forming a gel, delaying gastric emptying, and prolonging intestinal transit time. Starch not digested in the small intestine passes into the colon, where bacteria digest it or it is excreted in stool. Fiber-rich foods have a low glycemic index. They should be added to the diet if they do not cause discomfort.

• Foods containing fiber: dried legumes, grains, vegetables, fruit

Milk contains a large amount of lactose.

Lactose causes gas and bloating; lactose-free products can be used if it causes discomfort. Almond, soy, and coconut milks may be preferred. Yogurt and cheese contain less lactose than milk and are better tolerated.

Avoid foods that cause gas.

These include dried legumes, broccoli, cauliflower, cabbage, celery, leeks, oranges, tangerines, melon, and so on.

Lying down after a meal is preferred because it slows gastric emptying. Resting in a lying position on two pillows for about 15-30 minutes after eating is recommended.

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• Related topic: How Should Patients Eat After Gastrectomy (Stomach Cancer Surgery)?