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 ETIOLOGY 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