Dumping syndrome

Classification according to ICD-10
K91.1	Syndromes of the operated stomach
ICD-10 online (WHO version 2019)

The dumping syndrome is a so-called fall emptying of liquid and solid food from the stomach into the small intestine with its consequences. The term is derived from the English word “to dump” for “plop”, which clearly describes the clinical picture.

Etiology (causes)

Responsible for the development of a dumping syndrome is a disruption of the gastric reservoir function, which means that the stomach's contents can empty too quickly. In most cases, the dumping syndrome occurs after operations in which the gastric porter ( pylorus ) has been removed, such as. B. after a gastric bypass operation , a Billroth or a Whipple operation .

Forms and their clinic

Early dumping

Since the food does not stay in the stomach long enough, there is no pre-digestion, the chyme reaches the small intestine virtually unchanged. This hyperosmolar mass leads, on the one hand, to an unphysiological stretching of the intestinal wall, but also, due to its hyper osmolarity , to a massive influx of fluid into the small intestine. The consequences of this are vasomotor disorders, such as a drop in blood pressure up to collapse ( hyperosmolar syndrome ). Early dumping occurs immediately after eating.

Late dumping

Due to the lack of pre-digestion, water-soluble carbohydrates (i.e. sugar) reach the small intestine, are absorbed here and cause blood sugar to rise rapidly. The pancreas reacts to this with a strong release of insulin . After the sugar has been digested, insulin is left over, which leads to hypoglycemia , with the typical symptoms of dizziness, tremors, palpitations, etc. The symptoms of late dumping usually appear a few hours after eating.

Diagnosis

Usually, the anamnesis and a determination of the blood sugar level are important. In rare cases, a nuclear medicine examination (gastric emptying scintigraphy) can provide further information.

therapy

General measures

• slow eating
• frequent, small meals
• little drink to eat
• in the case of a percutaneous endoscopic gastrostomy (PEG): nutrition via a food pump for 24 hours

Medication

• Beta blockers
• Anticholinergics
• Sedatives

Surgical options

In severe, therapy-refractory cases, a conversion from Billroth II to Billroth I may help (according to Henley-Soupault).

See also

• Afferent loop syndrome
• Efferent loop syndrome

References

• Oliver Kloeters, Michael W. Müller: Crash Course in Surgery. Urban & Fischer, Munich / Jena 2004, ISBN 3-437-43230-3 .
• HK Biesalski among others: nutritional medicine. Thieme Verlag, Stuttgart et al. 1999, ISBN 3-13-100292-1 .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !