Condition where ingested foods pass through the stomach very rapidly and enter the small intestine largely undigested.
- Also known as postgastric surgery syndrome (occurs in 10% patients following gastrectomy or vagotomy and drainage)
Etiology
Surgical injury to vagus nerve
- Partial gastrectomy for peptic ulcer disease
- Bariatric surgeries
Pathophysiology
- Early emptying of liquids
- Delayed emptying of solids
Presentation
| Early dumping | Late dumping (Secondary hypoglycaemia) | |
| Incidence | 5-10% | 5% |
| Relation to meals | Immediate | Second hour after meal |
| Duration | 30-40 minutes | |
| Relieved by | Laying down | Food |
| Aggravated by | More food | Exercise |
| Precipitating factors | Food, especially carbohydrate-rich & wet | |
| Major symptoms | Epigastric fullness Sweating Light-headedness Tachycardia Colic Diarrhoea | Tremor Faintness Prostration |
Diagnosis
Glucose provocation test:
50g glucose solution taken orally
- Positive signs:
- Rise in resting heart rate
- Hypoglycemia after 1-2 hours
- Typical symptoms
Management
Syndrome tends to improve over time.
Conservative management:
- Small, dry meals: Avoid liquids for 30 minutes after meal
- Avoid fluids with high carbohydrate content
- Drugs: Acarbose, Octreotide
Surgical management:
Revisional surgery
- Antrectomy + Roux-en-Y reconstruction