Dumping Syndrome
The content of the article:
- Causes and risk factors
- Forms of the disease
-
Symptoms
- Signs of mild dumping syndrome
- Signs of moderate dumping syndrome
- Signs of severe dumping syndrome
- Sympathetic-adrenal type
- Vago-insular type
- Diagnostics
- Dumping Syndrome Treatment
- Possible complications and consequences
- Forecast
- Prevention
Dumping syndrome (from the English dumping - "dumping", "dumping") is a pathological condition characterized by the accelerated evacuation of not properly processed stomach contents into the small intestine.
It develops in 10-50% of cases after surgery for the removal of part of the stomach or after gastrectomy. The data are very contradictory: various sources provide information on the incidence of dumping syndrome after gastric resection in 3.5–80% of cases.
The disease was first described by K. Meeks in 1922 under the name "dumping stomach"; the term "dumping syndrome" was coined by Gilbert and Dunbar 25 years later.
In dumping syndrome, stomach contents that are not properly processed are dumped into the small intestine
Causes and risk factors
The main cause of dumping syndrome is gastric resection [removal of a part of it with subsequent restoration of the integrity of the digestive tract by directly connecting the remaining part (stump) with the small intestine]. The severity and likelihood of the development of the pathological condition depend on the modification of the surgical intervention.
Most often, pathology is formed during the operation by the Billroth-II method. It involves deaf suturing of the stumps of the stomach and duodenum, followed by the formation of a bypass path (anastomosis) between the stomach and the jejunum. Dumping syndrome after gastric resection by this method develops in 1/3 of patients (according to other sources - in 1/2).
Most often, dumping syndrome develops after gastric resection
In second place in terms of the risk of developing a pathological condition is Billroth-I surgery, when the stumps of the stomach and duodenum are connected in an “end to end” manner.
The syndrome is least common in patients who have undergone vagotomy with gastric-draining operations.
Risk factors for developing a dumping reaction:
- eating hot, liquid, dairy and carbohydrate foods;
- psycho-emotional overstrain;
- binge eating;
- intense physical activity;
- the presence of certain somatic diseases (diabetes mellitus, pathologies of the small or large intestine).
In rare cases, dumping reactions can occur in healthy people who have not undergone surgery.
The pathogenesis of the pathological condition is not fully understood. Due to the removal of the pyloric part of the stomach, its reservoir function (accumulation of food mass) suffers. Undigested food is rapidly evacuated into the small intestine, where a high concentration of osmotically active substances is created, which results in the transport of fluid from the bloodstream to the intestinal lumen - transient dyspeptic disorders and hypovolemia develop. Hypovolemia, in turn, provokes the activation of the sympatho-adrenal system and a powerful release of catecholamines into the systemic circulation.
Forms of the disease
Depending on the severity of the dumping syndrome, there are:
- easy;
- medium;
- heavy.
Clinical variants of pathology:
- sympatho-adrenal type;
- vago-insular type;
- mixed version.
By the time of development, the syndrome can be:
- early (within 5–20 minutes after eating);
- late (up to 3 hours after eating).
Symptoms
Signs of dumping syndrome vary depending on the severity and clinical variant. The disease can make its debut both a few days after surgery and a few years later. The average duration of an attack is 20-30 minutes, in severe cases - up to 1-2 hours.
Dumping Syndrome Symptoms
Signs of mild dumping syndrome
After consuming dairy or carbohydrate-rich foods, the following symptoms appear:
- non-intense dizziness;
- increased heart rate;
- weakness.
The dumping reaction in this case is poorly expressed and has a fleeting character. The patient's ability to work practically does not suffer, the quality of life does not decrease. The manifestations of mild dumping syndrome are successfully neutralized by correcting the diet.
Signs of moderate dumping syndrome
It can be provoked by the intake of any food, occurs regularly, several times a week (usually 3-4 times). Its manifestations:
- a sudden sharp deterioration in health;
- sweating;
- increased heart rate by 20-30 beats (in some cases - reduction);
- nausea;
- diarrhea;
- flatulence, abdominal discomfort;
- preservation of weakness, increased fatigue in the interictal period;
- emotional lability, irritability.
When the body moves to a horizontal position, the symptoms subside.
Abdominal pain can signal dumping syndrome
Characterized by a decrease in body weight, impaired metabolic processes (protein, mineral metabolism, hypovitaminosis). The performance is reduced, the dumping reaction can develop even if dietary recommendations are followed.
Signs of severe dumping syndrome
Symptoms appear after every meal and last up to several hours:
- sharp tachycardia (more than 30 beats per minute) or bradycardia;
- pouring sweat;
- abrupt increase in blood pressure by 20-30 mm Hg. Art., sometimes - hypotension;
- collaptoid states (last up to 10-15 minutes);
- weight loss up to 10 kg or more.
Patients are forced to eat while lying down and spend most of the time in bed due to unsatisfactory health. The ability to work in this case is lost, the quality of life suffers sharply.
A dumping attack can proceed as a sympatho-adrenal crisis, a vago-insular crisis, or a mixed type.
Sympathetic-adrenal type
This type is manifested as follows:
- pallor of the skin;
- speech and motor excitement;
- trembling limbs, chills;
- dry mouth;
- headache;
- severe weakness;
- increased heart rate (HR);
- arterial hypertension;
- bloating, flatulence.
Vago-insular type
Signs of the named type:
- hyperemia of the skin;
- increased salivation;
- sweating;
- decrease in heart rate;
- lowering blood pressure;
- vomiting, diarrhea;
- feeling short of breath.
Diagnostics
The main diagnostic criterion for dumping syndrome is the relationship of characteristic clinical manifestations with previous gastrectomy or gastrectomy.
To confirm the diagnosis, an X-ray examination with a contrast agent and a provocative dumping test are performed.
Dumping Syndrome Treatment
Therapy of pathology presents serious difficulties and is not always effective. Only mild and moderate forms are amenable to conservative treatment. Appointed:
- hydrochloric acid preparations;
- hormones;
- enzyme preparations;
- antispasmodics;
- anesthetics;
- sedatives;
- antihistamines;
- vitamin and mineral complexes;
- intravenous plasma substitutes, protein preparations.
One of the main directions in the treatment of a pathological condition is adherence to a special diet.
With dumping syndrome, food should be fractional with the exception of simple carbohydrates.
Dumping Syndrome Diet:
- fractional meals in small portions (6-7 times a day);
- elimination of simple carbohydrates;
- restriction of complex carbohydrates;
- high protein content (130-140 g);
- high calorie content (2800-3200 kcal);
- thermal and mechanical sparing (eating warm food, boiled or steamed).
In case of ineffectiveness of conservative treatment of dumping syndrome, severe course or a combination of pathology with the syndrome of the adductor loop, surgery is indicated.
Possible complications and consequences
Complications of dumping syndrome can be:
- metabolic disorders, electrolyte disturbances;
- exhaustion;
- loss of ability to work and social activity, a sharp decline in the quality of life.
Forecast
As a rule, the dumping reaction is moderate and spontaneously stopped or transformed into a mild form over time. A severe course of pathology is rare.
With timely diagnosis and complex treatment, the prognosis is favorable.
Prevention
It is not possible to prevent or predict the development of a dumping reaction. Preventive measures are aimed at reducing the frequency and severity of attacks and are as follows:
- adherence to a diet specific to dumping syndrome;
- avoidance of excessive physical and psycho-emotional stress;
- refusal to overeat;
- timely access to a specialist if symptoms of the disease occur.
Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
