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Internal Medicine

Dumping syndrome

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 dumpingLate dumping (Secondary hypoglycaemia)
Incidence5-10%5%
Relation to mealsImmediateSecond hour after meal
Duration30-40 minutes
Relieved byLaying downFood
Aggravated byMore foodExercise
Precipitating factorsFood, especially carbohydrate-rich & wet
Major symptomsEpigastric 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

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