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Updated: Dec 11 2021

Dumping Syndrome

  • Snapshot
    • A 48-year-old woman presents to the clinic for complaints for flushing and diarrhea for the past 2 weeks. She reports that these symptoms often occur 15 minutes after a meal and usually resolves within hours. She endorses nausea and palpitations during these episodes but denies weight changes, fever, abdominal pain, or diarrhea. Her past medical history is significant for a gastric bypass surgery 3 months ago for weight reduction.
  • Introduction
    • Clinical definition
      • postgastrectomy syndrome caused by the destruction or bypass of the pyloric sphincter
  • Epidemiology
    • Demographics
      • clinically significant dumping syndrome occur in ~20% of patients after pyloroplasty or distal gastrectomy
    • Risk factors
      • gastrectomy
    • Pathogenesis
      • rapid emptying of hyperosmolar chime into the small bowel due to the destruction or bypass of the pyloric sphincter
      • osmotic gradient draws fluid into the intestine and lead to the release of one or more vasoactive hormones (e.g., serotonin)
  • Presentation
    • Symptoms
      • usually occurs about 15-30 minutes after a meal
      • nausea
      • vomiting
      • cramps
      • diarrhea
      • diaphoresis
      • palpitations
      • flushing
      • abdominal pain
      • light-headedness
    • Physical exam
      • hypotension
      • confusion secondary to hypoglycemia
  • imaging
    • Upper gastrointestinal series
      • used to support the diagnosis
    • Scintigraphic gastric emptying
      • would demonstrate rapid gastric empyting
  • Studies
    • Diagnostic testing
      • diagnostic approach
        • diagnosis is based on clinical symptoms in the setting of gastric surgery
      • studies
        • monitored glucose challenge
  • Differential
    • Cyclic vomiting syndrome
      • distinguishing factors
        • clinical presentation of intense vomiting episodes separated by symptom-free periods
        • history of cannabinoid use
    • Gastroparesis
      • distinguishing factors
        • scintigraphic gastric emptying study would demonstrate delayed gastric emptying
  • Treatment
    • First-line
      • dietary modification
        • frequent small meals that are high in fiber and protein and low in carbohydrates
        • separation of liquid from solid during meals
        • avoid foods that aggravate the problem
    • Second-line
      • octreotide (rarely required)
      • reoperation
        • indicated in patients with intractable symptoms who fails dietary and medical therapy
  • Complications
    • Electrolyte imbalance
    • Malnutrition
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