Dumping syndrome: rapid gastric emptying as a result of defective gastric reservoir function, impaired pyrloci emptying mechanism or anomalous postsurgery gastric motor function
Early Dumping
Dysfunctional or bypassed pyloric sphincter → rapid emptying of undiluted hyperosmolar chyme into the small intestine → fluid shift to the intestinal lumen → small bowel distention → vagal stimulation → ↑ increased intestinal motility
Clinical Features
Occurs within 15-30 minutes after meal ingestion
Include nausea, vomiting diarrhoea and cramps
Vasomotor symptoms such as sweating, flushing and palpitations
Management
Dietary modifications: small meals that include combination of complex carbohydrates and foods rich in protein and fat
30-60 min of rest in the supine position after meals
Beta blockers may be helpful to ease tachycardia arising from hypovolemia
Late Dumping
Dysfunctional pyloric sphincter → rapid emptying of glucose-containing chyme into the small intestine → quick reabsorption of hlucose → hyperglycaemia → ↑ insulin → hypoglycaemia and release of catecholamines
Clinical Features
Occurs hours after meal ingestion
Include signs of hypogylcaemia (e.g. hunger, tremor and lightheadedness)