Gastric dumping syndrome
......................................................................................................................................................................................................................................................................................................................................................................................................
Dumping syndrome is a group of symptoms that occurs following ingestion of a meal when who have undergone gastric bypass surgery. It is typically induced when the patient eats certain foods, such as sweets or carbohydrate sources. Dumping syndrome exists in either a late or an early form, with the early form occurring more frequently.
What is early dumping?
Early dumping usually occurs with in 20 to 30 minutes after ingestion of meal and accompanied by both GI and cardiovascular symptoms. The GI symptoms include nausea and vomiting, a sense of epigastric fullness, cramping abdominal pain, and often diarrhea. The cardiovascular symptoms include palpitation, tachycardia, diaphoresis, fainting, dizziness, flushing, and occasionally blurred vision. Usually GI symptoms are most common.
Although the exact sequence of events responsible fro this syndrome remains to be fully defined, it is generally agreed that it occurs because of the rapid passage of food of high osmolality from the stomach into the small intestine. The resultant hypertonic food bolus passes into the small intestine lumen to achieve isotonicity. After this shift extracelluar fluid, luminal distention occurs and induces the autonomic responses.
The symptoms associated with early dumping syndrome appear to be secondary to the release of several humoral agents, such as serotonin, bradykinin-like substance, neurotensin and enteroglucagon.
What is late dumping?
The syndrome of late dumping appears 2 to 3 hours after a meal and is far less common than early dumping syndrome. When carbohydrate rapidly delivers to small intestine, they are quickly absorbed, resulting in hyperglycemia, which triggers the release of large amounts of insulin to control the rising blood glucose. This results in an actual overshooting such that a profound hypoglycemia occurs in response to the insulin. The activates the adrenal gland to release catecholamines, which result in diaphoresis, tremulousness, light-headedness, tachycardia, and confusion. The symptoms complex is indistinguishable from insulin shock.
How dumping syndrome is diagnosed?
Usually, the symptoms of dumping are sufficiently obvious that the diagnosis can be on this basis alone; however if there is doubt, gastric emptying scans can be obtained that demonstrate rapid gastric emptying. Alternatively a provocation test can be done in the form of a 200 ml, meal of 50% glucose solution and water. Patients with this syndrome have their symptoms elicited after ingestion of this glucose solution.
Is there a treatment for dumping syndrome?
There is no any specific treatment for this syndrome, most however, experiences spontaneous relief and require no specific therapy. In those situations in which symptoms are prolonged, dietary measures are usually sufficient. These include avoiding foods containing sugar, frequent feeding on small meals rich in protein and fat. Recently the long acting somatostatin analogue octreotide acetate has been shown be highly effective in preventing the development of GI and cardiovascular symptoms.
In the fewer patients who fail to response to the conservative measures mentioned above, operative intervention may become necessary.
References:
- Sabiston textbook of surgery 18th edition
- Bailey and love, surgery 25th edition
- The Washington manual of surgery, 5th edition.
- emedicine.medscape.com
Loading ...
