Generality
There dumping syndrome, or rapid emptying syndrome, is a condition that can occur in patients undergoing removal of the stomach or esophagus and in obese individuals undergoing gastric bypass. In other words, it is a surgical complication.
To diagnose the dumping syndrome very often, simple physical examination and evaluation of clinical history are sufficient.
The treatment consists in an adaptation of the diet to what is the new structure of the patient's digestive system.
To limit the symptoms, it is essential not to take foods containing sugars.
Brief anatomical reference on the stomach
It resides between the esophagus and the small intestine (or small intestine): to separate it from the first, it is a valve called the cardia; while, to separate it from the second, it is a valve known as the pyloric sphincter. Cardias and pyloric sphincter regulate the passage of food (more properly called bolus) between the compartments that separate, therefore: esophagus-stomach and stomach-small intestine.
What is dumping syndrome?
There dumping syndrome, also known as rapid emptying syndrome or dumping syndrome, is a possible complication of surgery on the stomach or esophagus; it is characterized by the passage of food into the small intestine too quickly.
Causes
Typically, the dumping syndrome it occurs when an individual is totally lacking in the stomach or the stomach is only partially present.
In fact, in such conditions, the ingested food reaches the intestine without crossing a compartment of the digestive system of fundamental importance.
All this explains what was stated in the previous definition of dumping syndrome, relative to the too fast passage of the bolus in the intestine.
AFTER WHICH STOMACH INTERVENTIONS CAN "ARISE?
There dumping syndrome is a possible complication of surgical interventions that involve:
- Partial or total removal of the stomach. This procedure is called gastrectomy and is the main treatment for stomach cancer.
- The anatomical modification of the stomach, aimed at reducing body weight in obese people. Today, among the surgical practices for the treatment of obesity, the one that most commonly causes dumping syndrome is gastric bypass, also known as Roux-en-Y.
IT IS A POSSIBLE COMPLICATION OF THE INTERVENTIONS TO THE ESOPHAGUS
Although it happens more rarely, an individual can suffer from dumping syndrome even after removal of the esophagus. Known as esophagectomy, this operation is necessary in the case of cancer of the esophagus or any other serious disease affecting the latter.
RISK FACTORS
On the basis of what has been stated above, "indeed, I am at risk of dumping syndrome all people with severe stomach disease (who need gastrectomy), severely obese individuals (for whom gastric bypass surgery is the only therapeutic solution) and those who suffer from severe esophageal disease ( esophageal tumor, Barrett's esophagus etc.).
Symptoms and Complications
Symptoms and signs that characterize the dumping syndrome they generally appear after every meal rich in sugars (sucrose and fructose in particular).
There are two different symptoms: one defined as "early", which occurs less than one "hour after the meal, and one called" late ", which appears only 1-3 hours after the meal.
Patients with dumping syndrome they can complain of both symptoms or only one (in these cases, usually the one present is the "early" one).
"EARLY" SYMPTOMS
Symptoms and early signs of the dumping syndrome I'm:
- Nausea
- He retched
- Cramps and / or abdominal pain
- Diarrhea
- Feeling of light-headedness or dizziness
- Flushing and sweating
- Increased heart rate
The reasons behind this symptomatology are at least three:
- The strong distension of the small intestine.
- The passage of fluids (water) from the blood to the intestine, due to the high presence of sugars (osmotic diarrhea).
- A series of hormonal variations, set in motion by the small intestine, which lower blood pressure.
"LATE" SYMPTOMS
The late clinical manifestations of the dumping syndrome I'm:
- Sweating
- Increased appetite
- Sense of fatigue
- Weakness
- Feeling of lightheadedness, dizziness and / or fainting
- Mental confusion and poor concentration
- Increased heart rate
This symptomatic picture is explained by the large release of insulin, induced by the "high presence of sugars in the" small intestine.
A "hypersecretion of insulin leads to" the onset of a medical condition called hypoglycemia.
Please note: produced by a group of pancreatic cells, insulin is the protein-based hormone that facilitates the passage of glucose from the blood to the cells.
WHEN TO SEE THE DOCTOR?
People at risk of dumping syndrome they must contact the doctor or go to the nearest hospital when, despite the therapeutic measures applied, they still show the symptoms and signs reported a little while ago.
This, in fact, means that the therapy is unsuitable for the case in question and requires its variation.
Diagnosis
To diagnose the dumping syndrome Very often, the physical examination and evaluation of the clinical history are sufficient. The first consists in the medical analysis of the symptoms and signs present; the second, on the other hand, consists of an "investigation aimed at probing the entire medical past of the patient (from the surgical interventions he underwent to the pathologies he suffered).
If your doctor is unsure or wants to complete the diagnosis with more information, they may also order blood tests and a special test, known as a gastrointestinal scan.
Blood tests make it possible to establish whether the patient, especially after meals containing sugars, suffers from reactive hypoglycemia.
Gastrointestinal scintigraphy, on the other hand, allows to measure how long the ingested food takes to reach the small intestine; if there was still part of the stomach, it allows the measurement of the speed with which the food passes through what remains of the gastric compartment .
Gastrointestinal scintigraphy is a rather invasive test, as it involves the use of a radioactive substance, administered to the patient through a food or drink.
For the observation of the aforesaid substance, a specific instrument of detection is needed, called gamma-camera.
Treatment
The treatment of dumping syndrome focuses on planning a diet that limits the possibility of the onset of the symptoms and signs mentioned above to a minimum.
Doctors only resort to pharmacological therapies or surgery in particularly severe cases. Severe cases mean when the modification of the diet has not produced the desired results.
FOODS TO AVOID
Since it is the ingestion of foods containing sugars that triggers the typical symptoms of dumping syndrome, you must avoid taking the aforementioned foods.
Hence, patients must eliminate from their diet:
- Candies
- Sweetened drinks
- Cakes
- Cookies
- Pastry products
- Sweet bread
In addition, doctors also consider it important:
- Limit the consumption of milk and dairy products.
- Avoid alcohol.
- Avoid consuming solid foods at the same time (or nearly so) with liquid foods. Generally, it is a good idea to take drinks between meals or at least half an hour before / half an hour after meals.
FOODS THE PATIENT CAN EAT
To patients with dumping syndrome certain artificial sweeteners are allowed, such as sucralose (splenda), and complex carbohydrates, such as those contained in cereals and wholemeal flour-based foods.
Furthermore, in the new diet they represent a fundamental point:
- Consumption of at least 4 glasses of water a day, as a prevention of dehydration.
- Consumption of foods rich in vitamins, iron and calcium. The stomach is the compartment of choice for the absorption of these nutritional elements. Since in people with dumping syndrome the stomach is missing or modified, vitamins and various minerals are in danger of being lost.
This also explains why doctors also prescribe vitamin supplements or supplements containing the most important minerals. The integration of vitamin B12 is of particular importance. - The use of fiber supplements based on psyllium, guar gum and pectin. These products slow down the absorption of carbohydrates in the small intestine, reducing the likelihood of hypoglycemia (hence the symptoms and late signs).
It is good to take fiber supplements only on the prescription of the attending physician, as these preparations are not completely free from side effects.
HOW TO EAT
When planning a diet for a patient with dumping syndrome, doctors report not only the foods allowed and not allowed, but also the "how to eat".
In this regard, the most important recommendations are:
- Consume about 6 small meals a day, instead of the usual 3 (breakfast, lunch and dinner). This makes the work that the digestive system has to do to digest the food ingested less demanding.
- Carefully cut out the foods you will eat and chew them well. This facilitates the digestive process.
- Combine protein or fat-containing foods with fruit or starchy foods.
- Do not binge and always stop before the feeling of fullness.
- Drink at least 30 minutes before meals or 30 minutes after; never during.
- Never lie down immediately after a meal, to avoid the feeling of emptiness in the head and to facilitate digestion. This must be taken care of for at least the first hour.
PHARMACOLOGICAL TREATMENT
Among the drugs administered in case of dumping syndrome severe, include octreotide, cholestyramine and some proton pump inhibitors (pantoprazole and omeprazole).
The first two medicines act against diarrhea, while the third ones serve to slow down the digestive process, so as to reduce a certain symptomatology.
We remind you that the prescription of the aforementioned drugs is the sole responsibility of the attending physician, after an "appropriate evaluation.
Octreotide is a peptide with a similar structure to somatostatin, a hormone produced by the hypothalamus, pancreas and gastrointestinal tract.
In addition to limiting diarrhea, it is also able to inhibit insulin synthesis with some success. This is useful in all those cases of dumping syndrome characterized by late symptoms.
Generally, the route of administration of octreotide is subcutaneous.
SURGERY
In case of dumping syndrome severe, possible surgery are:
- The procedures for the reconstruction of a part of the stomach (for example the pylorus). These methods are applicable only when the gastrectomy was partial and when, according to the doctor, there is a good chance of success.
- The gastric bypass reversal operation. During this type of surgery, the surgeon restores the normal anatomy of the digestive system.
Prognosis
The adaptation of the diet to what is the new structure of the digestive system is effective in most patients. This means that the prognosis of dumping syndrome it is usually positive.
