Find us on Google+ Gastroparesis: Dumping Syndrome

Monday, May 5, 2014

Dumping Syndrome

If you have Gastroparesis, then you have probably dealt with dumping syndrome at some point during your illness. Frequently, my friends get it when their stomachs decide to empty all at once, myself included. I thought I would write an article about it because it's not something I've already addressed and I wanted to bring awareness to the fact that it exists. I know a lot of people are scared or nervous to ask questions about pooping, so I'm going to try and do my best to explain dumping syndrome and how to get past it, especially when it's already hard for you to maintain fluids due to GP (gastroparesis).


So, what is dumping syndrome?


Image, courtesy of: http://www.nursestip.com/files/Dumping%20Syndrome.jpg


One of my friends posted a video that you can watch below, to explain what Dumping Syndrome is.

Here is Part 1 of the video: https://www.youtube.com/watch?v=-0ru-uCebF8

Here is Part 2 of the video: https://www.youtube.com/watch?v=H_EyoLCKy




According to the Mayo Clinic,

"Dumping syndrome is a group of symptoms that are most likely to develop if you've had surgery to remove all or part of your stomach, or if your stomach has been surgically bypassed to help lose weight. Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of your stomach move too rapidly into your small bowel. Common symptoms include abdominal cramps, nausea and diarrhea.

Most people with dumping syndrome experience symptoms soon after eating. In others, symptoms may occur one to three hours after eating. Some people experience both early and late symptoms.

Dumping syndrome is managed by adjusting your diet. In more-serious cases of dumping syndrome, you may need medications or surgery.



Symptoms of Dumping Syndrome:

Symptoms of dumping syndrome are most common during a meal or within 15 to 30 minutes following a meal. They include:

Gastrointestinal

Nausea
Vomiting
Abdominal cramps
Diarrhea
Feeling of fullness

Cardiovascular

Flushing
Dizziness, lightheadedness
Heart palpitations, rapid heart rate

Signs and symptoms also can develop later, usually one to three hours after eating. This is due to the dumping of large amount of sugars into the small intestine (hyperglycemia). In response, the body releases large amounts of insulin to absorb the sugars, leading to low levels of sugar in the body (hypoglycemia). Symptoms of late dumping can include:

Sweating
Hunger
Fatigue
Dizziness, lightheadedness
Confusion
Heart palpitations, rapid heart rate
Fainting

A study of more than 1,100 people who had their stomachs surgically removed found that about two-thirds experienced early symptoms and about a third experienced late symptoms of dumping syndrome. Some people experience both early and late signs and symptoms.

No matter when problems develop, however, they may be worse following a high-sugar meal, especially one that's rich in table sugar (sucrose) or fruit sugar (fructose).


Causes of Dumping Syndrome:

In dumping syndrome, food and gastric juices from your stomach move to your small intestine in an uncontrolled, abnormally fast manner. This is most often related to changes in your stomach associated with surgery, such as when the opening (pylorus) between your stomach and the small intestine (duodenum) has been removed during an operation.

The pylorus acts as a brake so that stomach emptying is gradual. When it's removed, stomach material dumps rapidly into the small intestine. The ill effects of this are thought to be caused by the release of gastrointestinal hormones in the small intestine, as well as insulin secreted to process the sugar (glucose).

Dumping syndrome can occur after any operation on the stomach as well as after removal of the esophagus (esophagectomy). Gastric bypass surgery for weight loss is the most common cause today. It develops most commonly within weeks after surgery, or as soon as you return to your normal diet. The more stomach removed or bypassed, the more likely that the condition will be severe. It sometimes becomes a chronic disorder.


Tests and Diagnosis:

Your doctor may use some of the following methods to determine if you have dumping syndrome.

Medical history and evaluation. Your doctor can often diagnose dumping syndrome by taking a careful medical history and then evaluating your signs and symptoms. If you have undergone stomach surgery, that may help lead your doctor to a diagnosis of dumping syndrome.

Blood sugar test. Because low blood sugar is sometimes associated with dumping syndrome, your doctor may order a test (oral glucose tolerance test) to measure your blood sugar level at the peak time of your symptoms to help confirm the diagnosis.

Gastric emptying test. A radioactive material is added to food to measure how quickly food moves through your stomach.


Treatments and Medications:

Most cases of dumping syndrome improve as people learn to eat better for the condition and as the digestive system adjusts. There's a good chance that changing your diet will resolve your symptoms. (See recommendations under Lifestyle and home remedies.) If it doesn't, your doctor may advise medications or surgery to address the problem.
Medications

Your doctor may prescribe certain medications to slow the passage of food out of your stomach, and relieve the signs and symptoms associated with dumping syndrome. These drugs are most appropriate for people with severe signs and symptoms, and they don't work for everyone.

The medications that doctors most frequently prescribe are:

Acarbose (Precose). This medication delays the digestion of carbohydrates. Doctors prescribe it most often for the management of type 2 diabetes, and it has also been found to be effective in people with late-onset dumping syndrome. Side effects may include sweating, headaches, sudden hunger and weakness.

Octreotide (Sandostatin). This anti-diarrheal drug can slow down the emptying of food into the intestine. You take this drug by injecting it under your skin (subcutaneously). Be sure to talk with your doctor about the proper way to self-administer the drug, including optimal choices for injection sites. Long-acting formulations of this medication are available.

Because octreotide carries the risk of side effects (diarrhea, bulky stools, gallstones, flatulence, bloating) in some people, doctors recommend it only for people who haven't responded to other treatments and who are not candidates for surgery.
Surgery

Doctors use a number of surgical procedures to treat difficult cases of dumping syndrome that are resistant to more conservative approaches. Most of these operations are reconstructive techniques, such as reconstructing the pylorus, or they're intended to reverse gastric bypass surgery.


Feeding tube

A last resort for people who are not helped by any other treatment is to insert a tube into the small intestine through which nutrients can be delivered."


Image, courtesy of: http://img.medscape.com/slide/migrated/editorial/cmecircle/2002/1989/nehra/nehra_figure_02.gif



According to WebMD,

After gastric surgery, it can be more difficult to regulate movement of food, which dumps too quickly into the small intestine. Eating certain foods makes dumping syndrome more likely. For example, refined sugars rapidly absorb water from the body, causing symptoms. Symptoms may also happen after eating dairy products and certain fats or fried foods.



Dumping Syndrome: Symptoms of the Early Phase

An early dumping phase may happen about 30 to 60 minutes after you eat. Symptoms can last about an hour and may include:

A feeling of fullness, even after eating just a small amount
Abdominal cramping or pain
Nausea or vomiting
Severe diarrhea
Sweating, flushing, or light-headedness
Rapid heartbeat




Dumping Syndrome: Causes of the Early Phase

Symptoms of an early phase happen because food is rapidly "dumping" into the small intestine. This may be due to factors such as these:

The small intestine stretches.
Water pulled out of the bloodstream moves into the small intestine.
Hormones released from the small intestine into the bloodstream affect blood pressure.



Dumping Syndrome: Symptoms of the Late Phase

A late dumping phase may happen about 1 to 3 hours after eating. Symptoms may include:

Fatigue or weakness
Flushing or sweating
Shakiness, dizziness, fainting, or passing out
Loss of concentration or mental confusion
Feelings of hunger
Rapid heartbeat




Dumping Syndrome: Causes of the Late Phase

The symptoms of this late phase may happen due to a rapid rise and fall in blood sugar levels. The cause of this rapid swing in blood sugar may be worse when eating sweets or other simple carbohydrates.




Dumping Syndrome Treatment

Many people find that taking steps like these greatly reduces symptoms of dumping syndrome.

Foods to avoid. Avoid eating sugar and other sweets such as:

Candy
Sweet drinks
Cakes
Cookies
Pastries
Sweetened breads

Also avoid dairy products and alcohol. And avoid eating solids and drinking liquids during the same meal. In fact, don't drink 30 minutes before and 30 minutes after meals.

Foods to eat. To help with symptoms, also try these tips:

Use fiber supplements, such as psyllium (Metamucil or Konsyl), methylcellulose (Citrucel), or guar gum (Benefiber). **NOTE: If you have Gastroparesis as well, please consult your doctor as high fiber content can make our condition worse.

Use sugar replacements, such as Splenda, Equal, or Sweet'N Low, instead of sugar.

Go for complex carbohydrates, such as vegetables and whole-wheat bread, instead of simple carbohydrates, such as sweet rolls and ice cream.

To prevent dehydration, drink more than 4 cups of water or other sugar-free, decaffeinated, noncarbonated beverages throughout the day





If you have any questions or comments about the article, feel free to email me. I'm currently working on an article about pregnancy and GP. I'm gathering research and will hopefully, have it out in the next two weeks. Please email me if you have an idea for an article that you'd like to see and/or questions/comments: emilysstomach[at]gmail.com.

No comments: