Generality
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 subjected to gastric bypass. In other words, it is a surgical complication.
To diagnose the dumping syndrome, a physical examination and evaluation of the clinical history are often sufficient.
The treatment consists of an adaptation of the diet to what is the new structure of the patient's digestive system.
Fundamental, to limit the symptomatology, is not to take foods containing sugars.
Brief anatomical reference to the stomach
Resides between the esophagus and small intestine (or small intestine): to separate it from the first, is a valve called cardias ; while, to separate it from the second, it is a valve known as the pyloric sphincter . Cardias and pyloric sphincters regulate the passage of food (called more properly bolus) between the compartments that separate, therefore: esophagus-stomach and stomach-small intestine.
What is dumping syndrome?
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 too rapid passage of food inside the small intestine.
Causes
In general, the dumping syndrome occurs when an individual totally lacks the stomach or is only partially present.
In fact, in such conditions, the ingested food reaches the intestine without passing through a compartment of the digestive system of fundamental importance.
All this explains what was stated in the previous definition of dumping syndrome, concerning the too rapid passage of the bolus in the intestine.
AFTER WHAT INTERVENTIONS AT THE STOMACH CAN UNDERSTAND?
Dumping syndrome is a possible complication of surgical operations involving:
- The partial or total removal of the stomach . This procedure is called gastrectomy and is the main treatment for treating 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 COMPLICANCE OF INTERVENTIONS AT THE ESOPHAGUS
Although it occurs more rarely, an individual may suffer from dumping syndrome even after the esophagus is removed. Known as esophagectomy, this intervention is necessary in case of esophageal cancer or any other serious illness affecting the latter.
RISK FACTORS
On the basis of what was stated above, all persons with a serious stomach disease (who need gastrectomy), highly obese individuals (for whom the only therapeutic solution is gastric bypass) and those suffering from severe esophageal disease (esophageal cancer, Barrett's esophagus, etc.).
Symptoms and Complications
The symptoms and signs that characterize the dumping syndrome generally appear after each meal rich in sugars (saccharose and fructose in particular).
There are two different symptoms: one called " early ", which occurs less than an hour after a meal, and one called " tardiva ", which appears only 1-3 hours after a meal.
Patients with dumping syndrome can complain about both symptoms or only one (in these cases, usually the present one is "early").
"EARLY" SYMPTOMS
The early symptoms and signs of dumping syndrome are:
- Nausea
- He retched
- Cramps and / or abdominal pains
- Diarrhea
- Feeling of emptiness in the head or dizziness
- Hot flushes and sweating
- Increased heart rate
There are at least three reasons for this symptomatology:
- The strong distention 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 changes, set in motion by the small intestine, which lower blood pressure.
"LATE" SYMPTOMS
Late clinical manifestations of dumping syndrome are:
- Sweating
- Increased appetite
- Sense of fatigue
- Weakness
- Sense of emptiness in the head, 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 inside the small intestine.
Insulin hypersecretion leads to the establishment of a medical condition called hypoglycemia .
Note: produced by a group of pancreatic cells, insulin is the hormone of a protein nature that facilitates the passage of glucose from the blood to the cells.
WHEN TO REFER TO THE DOCTOR?
People at risk of dumping syndrome should go to the doctor or go to the nearest hospital, when, despite the therapeutic measures practiced, they still show the symptoms and signs reported above.
This, in fact, means that the therapy is unsuitable for the case in question and requires its variation.
Diagnosis
To diagnose the dumping syndrome, a physical examination and evaluation of the clinical history are often sufficient. The first is a medical analysis of the symptoms and signs present; the second, instead, consists of an investigation aimed at probing the patient's entire medical past (from the surgical operations he underwent to the pathologies he suffered from).
If the doctor has doubts or wants to complete the diagnosis with further information, he could also prescribe blood tests and a special test, known as gastrointestinal scintigraphy .
Blood tests can determine whether the patient, especially after meals containing sugars, suffers from reactive hypoglycemia.
Gastrointestinal scintigraphy, on the other hand, makes it possible to measure how long the ingested food takes to reach the small intestine; if there is still part of the stomach, it allows the measurement of the speed with which 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 aforementioned substance, a special detection instrument, called gamma-camera, is required.
Treatment
The treatment of dumping syndrome focuses on the planning of a diet that limits to a minimum the possibility of the appearance of symptoms and signs previously mentioned.
Physicians use pharmacological therapies or surgery only in particularly serious cases. For serious cases we 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 trigger the typical symptoms of dumping syndrome, it is necessary to avoid taking these foods.
Therefore, patients must eliminate from their diet:
- Candies
- Sugary drinks
- Cakes
- Cookies
- Pastry products
- Sweet bread
In addition, doctors also consider it important:
- Limit the consumption of milk and derivatives.
- Avoid alcohol.
- Avoid consuming solid foods at the same time (or almost) with liquid foods. Generally, it is a good idea to take drinks out of meals or at least half an hour before / half an hour after meals.
FOOD THAT THE PATIENT CAN EAT
Patients with dumping syndrome are allowed to take some artificial sweeteners, such as sucralose (splenda), and complex carbohydrates, such as those contained in cereals and foods made from whole wheat flour.
Moreover, in the new diet they represent a fundamental point:
- Consumption of at least 4 glasses of water a day, to prevent dehydration.
- Consumption of foods rich in vitamins, iron and calcium. The stomach is the preferred compartment for the absorption of these nutritional elements. Because in people with dumping the stomach lacks or is modified, vitamins and various minerals are likely to be lost.
This also explains why doctors also prescribe vitamin supplements or those containing the most important minerals. Of particular importance is the integration of vitamin B12.
- The use of fiber supplements based on psyllium, guar gum and pectin. These products slow the absorption of carbohydrates in the small intestine, reducing the likelihood of a hypoglycemic state (therefore, the late symptoms and signs).
It is a good idea to take fiber supplements only as prescribed by your doctor, as these preparers are not completely free from side effects.
HOW TO FEED
When planning a diet for a patient with a dumped 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 around 6 small meals a day, instead of the normal 3 (breakfast, lunch and dinner). This makes the work the digestive system has to work to digest ingested foods less demanding.
- Cut the foods you eat carefully and chew them well. This facilitates the digestive process.
- Combine protein or fatty foods with fruit or starchy foods.
- Don't overeat and always stop before feeling full.
- Drink at least 30 minutes before meals or 30 minutes later; never during.
- Never lie down immediately after a meal, to avoid feeling empty in the head and to facilitate digestion. Care must be taken for at least the first hour.
PHARMACOLOGICAL TREATMENT
The drugs administered in the event of severe dumping include octreotide, cholestyramine and some proton pump inhibitors (pantoprazole and omeprazole).
The first two medicines act against diarrhea, while the third serve to slow down the digestive process, so as to reduce a certain symptomatology.
Please note that the prescription of the aforementioned drugs is the exclusive responsibility of the attending physician, after an appropriate evaluation.
Octreotide is a peptide with a structure similar 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 the event of severe dumping, the possible surgical procedures are:
- The procedures for the reconstruction of a part of the stomach (for example the pylorus). These methods are applicable only when the gastrectomy has been partial and when, according to the doctor, there is a good chance of success.
- Reversal operation of gastric bypass. During this type of operation, 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 is usually positive.
