Definition
- 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)
- GI discomfort
Mangement
- Dietary modifications
- Second-line: ocreotide
- Third-line: surgery
Sources
Amboss: [Gastric Cancer - Amboss Article][https://next.amboss.com/us/article/-g0DB2#Zde1937c1ec3116f80e7913e779046415]