Dumping Syndrome

What is Dumping Syndrome

Dumping syndrome is a combination of symptoms caused when food passes through your stomach too quickly. Dumping syndrome is also called rapid gastric emptying.

There are two types of dumping syndrome. Early dumping syndrome is the most common type and causes symptoms that occur soon after eating. Late dumping syndrome causes symptoms that occur a few hours after eating. Some people have both types.

The dumping syndrome, occurring in 20% of patients after vagotomy and gastrectomy, consists of tachycardia, diaphoresis, hypotension, and abdominal pain after meals in patients who have undergone ulcer operations, such as truncal vagotomy.

When you eat and drink, your stomach needs time to begin the process of digestion. Sometimes undigested food and stomach juices move too quickly into the next part of your digestive system (small intestine).

This causes symptoms of early dumping syndrome. In other cases, your pancreas releases too much insulin because of large amounts of sugar moving into your small intestine.

Insulin is a hormone that takes sugar from your bloodstream. If your blood sugar gets too low (hypoglycemia), you may develop symptoms of late dumping syndrome.

What are the causes of Dumping Syndrome?

1. Early dumping syndrome is caused by large amounts of undigested food and liquids passing into the upper part of your small intestine.
2. Late dumping syndrome is caused by large amounts of sugar from your diet moving into your small intestine.

Pathophysiology of Dumping Syndrome

Its pathophysiologic characteristic is loss of receptive relaxation of the fundus in response to a gastric load. Thus gastric pressure increases during a meal, and rapid decompression through the gastric outlet causes release of vasoactive hormones (serotonin, vasoactive intestinal peptide) and the resulting classic signs and symptoms. 

What increases the risk?

Certain types of stomach surgery can lead to dumping syndrome. You may be at risk for dumping syndrome if you have had:

• Surgery for ulcers or stomach cancer.
• Weight loss surgery (bariatric surgery).
• Surgery to treat severe heartburn (gastroesophageal reflux).

What are the symptoms?

Symptoms may start soon after eating or a few hours later. Symptoms of early dumping syndrome may begin 10–30 minutes after a meal. They include:

• Nausea.
• Fullness or bloating.
• Cramps.
• Vomiting.
• Feeling flushed.
• Sweating.
• Feeling dizzy.
• A fast or irregular heartbeat (palpitations).
• Diarrhea.
• Headache.

Symptoms of late dumping syndrome usually happen 2–3 hours after a meal. They may include:

• Dizziness.
• Weakness.
• Sweating.
• Palpitations.
• Hunger.
• Confusion.

The constellation of symptoms occurring hours after meals is described as late dumping syndrome and is due to hypoglycemia resulting from postprandial insulin peak. Symptoms improve typically with time and can be alleviated in some patients by separation of solids and liquids during meals, as well as the introduction of small and frequent meals high in protein and fat and low in carbohydrates. 

How is this diagnosed?

Your health care provider may diagnose dumping syndrome based on your symptoms and medical history. A physical exam will be done. You may need to have certain tests to confirm a diagnosis of dumping syndrome. These may include:

• Modified glucose tolerance test. This blood test measures insulin secretion after you have a certain type of sugary (glucose) drink.
• Gastric emptying test. This test involves eating a bland meal that includes a material that shows up easily on an X-ray. After eating the meal, you have X-rays to determine how long it takes the stomach to empty.
• Upper endoscopy. In this examination, a health care provider uses a flexible telescope (endoscope) passed through your mouth and throat to check the inside of your stomach.

How is this treated?

For most people, dumping syndrome can be managed with diet changes. You may need to change your diet, nutrition, and eating habits. Working with a dietitian can be helpful. Other treatments may include:

• Medicine that slows stomach emptying and reduces insulin secretion. This medicine may be given by injection.
• Medicine that slows down the digestion of sugar. This medicine is usually used to treat type 2 diabetes. Sometimes it can also relieve symptoms of late dumping syndrome.
• Surgery. For severe cases of dumping syndrome, reconstructive stomach surgery may be needed if other treatments are not working.

Conversion of a Billroth II to a Billroth I or a Billroth operation to a Roux-en-Y reconstruction can improve symptoms but is rarely necessary. Octreotide, a somatostatin analog administered on a monthly basis, has been proven to alleviate symptoms and improve quality of life, but is indicated only if symptoms are severe.

Follow these instructions at home:

• Take medicines only as directed by your health care provider.
• Work with a dietitian to change your diet and maintain good nutrition.
• Eat smaller meals more often. For example, eat six small meals a day instead of three large meals.
• Eat foods that digest slowly. Make sure your diet includes plenty of:
  • Fruits.
  • Vegetables.
  • Whole grains.
• Get lots of protein by eating foods such as eggs, poultry, and fish.
• Eat slowly and chew your food completely.
• Do notdrink while you are eating. Drink fluids before and after meals instead.
• Do noteat or drink anything with added sugar. This includes sweets and sugary drinks such as juice or soda.
• Do noteat or drink dairy products if they make your symptoms worse.
• Lie down for about 30 minutes after eating.

Contact a health care provider if:

• Your symptoms change or get worse.
• You have trouble maintaining a healthy weight.

Dumping Syndrome Diet

What is my plan?

Your health care provider or dietitian may recommend specific changes to your diet to help prevent and treat symptoms. General recommendations include:

• Eating 5–6 small meals each day.
• Limiting fluid intake during meals to 4 oz.
• Eating a balanced diet.
  • Grains: 6–8 oz per day.
  • Vegetables: 2–3 cups per day.
  • Fruits: 1–2 cups per day.
  • Meats and other protein sources: 5–6 oz per day.
  • Dairy: 2–3 cups per day.

What do I need to know about a dumping syndrome diet?

• Avoid drinking liquids for 30 minutes before meals.
• Avoid drinking liquids for at least 30 minutes after meals.
• Lie down for 15–30 minutes after meals. This will help to prevent lightheadedness and will slow down the emptying of your stomach.
• Eat smaller portions of food.
• Cut food into small pieces and chew thoroughly before you swallow.
• Try to make sure that at least half of your daily servings of grains come from whole grains. These foods are high in fiber, which helps to slow down digestion.
• Eat more complex carbohydrates, such as whole grains, vegetables, and beans.
• Avoid eating simple carbohydrates and foods that have added sugar, such as fruit juices, white bread, pastries, and sweets. Foods that are high in sugar are especially likely to bring about symptoms.
• With each meal and snack, eat one food that is high in protein.
• Avoid dairy products if they aggravate your symptoms. Try lactose-free dairy products instead.
• Avoid drinking alcohol.
• Take a fiber supplement if recommended by your health care provider.
• Increase the thickness of foods by adding plant-based thickening agents to them, such as pectin.
• Avoid eating very hot or very cold foods. They may aggravate your symptoms.

What foods can I eat?

Grains

Whole-grain bread. Brown rice. Whole-grain pasta. Corn tortillas. Multigrain crackers.

Vegetables

All fresh, frozen, and canned vegetables.

Fruits

All fresh, frozen, and canned fruits that are packed in water. Unsweetened applesauce.

Meats and Other Protein Sources

Lean meats. Chicken. Fish. Eggs. Tofu. Deli meat. Nuts and seeds. Unsweetened nut butters. Beans.

Dairy

Low-fat or fat-free milk. Low-fat plain yogurt. Light yogurt. Cheese. Lactose-free dairy products.

Beverages

Water. Sugar-free, noncarbonated soft drinks. Unsweetened tea. Unsweetened coffee. Sugar-free hot chocolate. Unsweetened soy, almond, or rice milk.

Condiments

Sugar substitutes. Sugar-free jam and sugar-free jelly. Sugar-free syrup.

Sweets and Desserts

Sugar-free gelatin. Sugar-free pudding. Sugar-free ice cream.

Fats and Oils

Butter. Vegetable oil. Salad dressings. Mayonnaise. Avocado. Cream cheese.

Other

Broth. All spices and herbs. Over-the-counter fiber supplements.

The items listed above may not be a complete list of recommended foods or beverages. Contact your dietitian for more options.

What foods are not recommended?

Grains

Cereals with added sugar. Pastries. Cakes. Sweet and white breads. Flavored instant oatmeal.

Vegetables

Breaded vegetables.

Fruits

Fruits that are dried with added sugar. Canned fruit in syrup. Fruit juice.

Meats and Other Protein Sources

Breaded meats. Meats that are cooked with glazes or sweetened sauces.

Dairy

Flavored milk. Sugar-sweetened yogurt. Milkshakes.

Beverages

Hot chocolate. Regular sugar carbonated beverages. Diet carbonated beverages. Sweetened coconut milk. Sweetened coffee drinks.

Condiments

Honey. Sugar. Syrup. Jam and jelly. Molasses. Agave nectar.

Sweets and Desserts

Cakes. Candies. Ice Cream. Donuts. Puddings. Pies. Chocolate.

Fats and Oils

Frostings. Sweetened nut butters.

Other

Candied nuts. Candied fruit.

The items listed above may not be a complete list of foods and beverages to avoid. Contact your dietitian for more information.