Dumping syndrome

Dumping syndrome is an uncoordinated flow of food into the small intestine due to the loss of the reservoir function of the stomach.

A distinction is made between early dumping syndrome, which occurs immediately or 10-15 minutes after eating, and late dumping syndrome, which develops 2-3 hours after eating.

Early dumping syndrome

The pathogenesis of early dumping syndrome involves the rapid entry of insufficiently processed chyme into the jejunum. This creates extremely high osmotic pressure in the initial portion of the jejunum, causing fluid to flow from the bloodstream into the small intestinal lumen and hypovolemia. Hypovolemia, in turn, causes stimulation of the sympathoadrenal system and the release of catecholamines into the bloodstream. In some cases, significant stimulation of the parasympathetic nervous system is possible, accompanied by the release of acetylcholine, serotonin, and kinins into the bloodstream. These disturbances are what lead to the clinical presentation of early dumping syndrome.

The main clinical manifestations of early dumping syndrome:

• the appearance soon after eating of sudden general weakness, nausea, severe dizziness, and palpitations;
• sweating;
• pallor or, conversely, redness of the skin;
• tachycardia (less often - bradycardia);
• decrease in blood pressure (this is observed most often, but an increase is also possible).

These symptoms usually appear after eating large amounts of food, especially those containing sweets.

Late dumping syndrome

The pathogenesis of late dumping syndrome involves excessive dumping of food, especially carbohydrate-rich foods, into the small intestine, followed by absorption of carbohydrates into the bloodstream, the development of hyperglycemia, and the release of excess insulin into the bloodstream, followed by hypoglycemia. Increased vagal tone and impaired endocrine function of the duodenum play a significant role in the excess insulin release.

Main clinical manifestations:

• a pronounced feeling of hunger;
• sweating;
• dizziness, sometimes fainting;
• trembling of the arms and legs, especially the fingers;
• double vision;
• redness of the facial skin;
• heartbeat;
• rumbling in the stomach;
• urge to defecate or frequent bowel movements;
• decrease in blood glucose levels;
• after the attack ends, there is severe fatigue and lethargy.

There are three degrees of severity of dumping syndrome:

• mild degree is characterized by episodic and short-term attacks of weakness after eating sweet and dairy foods; the general condition of the patient is satisfactory;
• Moderate severity - the symptoms described develop naturally after each consumption of sweet and dairy foods and persist for a long time; the general condition of patients may suffer, but there is no significant limitation of work capacity or weight loss;
• severe degree - manifested by very pronounced symptoms, significant deterioration of general condition, sharp decrease in performance, weight loss, disruption of protein, fat, carbohydrate, mineral, and vitamin metabolism.

As the period after surgery increases, the symptoms of dumping syndrome decrease.