Dumping Syndrome
Dumping syndrome occurs as a result of the rapid passage of food into the small intestine. It can occur as a result of certain diseases and after obesity surgeries.
Bariatric surgeries are surgeries that almost always cause changes in the stomach and small intestine. These changes that occur in the gastrointestinal tract after these surgeries disrupt normal physiology and pave the way for dumping syndrome.
Although it is more common after bypass surgeries, it can also be caused after a sleeve gastrectomy. Physiological deterioration of the gastrointestinal tract due to surgical intervention and changes in eating habits after surgery are among the main causes.
There is a structure called the sphincter (gastric pylori) at the exit of the stomach. The pylori shrinks and relaxes intermittently, regulating the controlled passage of nutrients into the small intestine. All the foods we eat do not pass immediately to the small intestine, they are stored in the stomach. When the stomach is full, we are full. While the foods we eat are pre-processed in the stomach, contraction and pyloric relaxation regulate the controlled passage of processed foods into the small intestine.
In sleeve gastrectomy surgery, the pylorus is preserved and the stomach turns into a long thin tube. Since the pylorus is protected, the controlled food passage system continues. However; as the stomach becomes a long thin tube, the storage function disappears and the passage of nutrients is faster than in normal physiology. For this reason, dumping syndrome can be noticed after sleeve gastrectomy surgery, but is less common because the pyloric effect is preserved.
In bypass surgeries, most of the time, the pylorus is bypassed and new pathways are created that allow food to pass directly from the stomach to the intestines. The passage of nutrients in the intestine is much easier and there is no control mechanism such as pylori. For this reason, dumping syndrome is more common after bypass surgeries.
Dumping syndrome based on mechanism, duration and clinical condition is divided into early and late dumping:
Early dumping:
Early dumping appears half an hour after eating. Especially seen after consuming foods rich in carbohydrates and in quantity. With the rapid passage of nutrients into the intestine, a large amount of fluid passage is created in the lumen of the small intestine due to the change in osmotic pressure. You can imagine this as watering the zucchini when we add sugar, or watering the salad when we add salt. By the same mechanism, when large amounts of food pass into the small intestine, fluid is drawn from the intestinal wall into the lumen to balance it. The fluid that passes into the intestine is taken from the bloodstream. Hemodynamic and gastrointestinal symptoms appear as a result of withdrawal of fluid in the intestine. In addition, there are some hormonal changes that affect this process.
Due to the large amount of fluid that passes into the intestine and retraction of the intestinal wall appear some gastrointestinal symptoms such as;
•Stomach ache,
• Bloating,
• Mixed,
• Diarrhea
Due to the decrease in intravascular pressure, hemodynamic symptoms appear such as;
• Tachycardia
• Hypotension (low blood pressure)
• Dizziness
• Feeling faint
• Faint
• Flashing
Late dumping:
Late dumping syndrome appears from 1-3 hours after eating. Symptoms are associated with low blood sugar.
Occurs especially after eating foods rich in carbohydrates and sugar. As a result of the rapid absorption of simple carbohydrates and sugars from the small intestine, blood sugar rises. In response, insulin is secreted by the pancreas to lower blood sugar levels. Insulin lowers blood sugar, but due to its long half-life, blood sugar drops more than it should. In other words, although blood sugar returns to normal, there is still insulin in circulation and blood sugar drops more than it should. This results in hypoglycemia, meaning a lowering of the blood sugar level.
Symptoms are;
• Weaknesses
• Darkening of the eyes
• Fainting
• Sweating
• Tachycardia
• Feeling hungry
• Blurring of consciousness
They appear due to hypoglycemia.
Dumping syndrome often occurs as a result of malnutrition. Therefore, it can be prevented by adjusting the diet.
To avoid dumping syndrome;
• Foods and drinks rich in carbohydrates / sugar should be limited.
• Low glycemic index foods should be preferred.
• Liquids should be separated from solid foods
• Fiber intake should be increased
• Foods should be chewed well and eaten slowly.
• Frequent and small meals should be consumed.
