Gastric dumping syndrome overview
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Differentiating Gastric dumping syndrome from other Diseases |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Umar Ahmad, M.D.[2]
Overview
Gastric dumping syndrome is a group of symptoms that occur when food or liquid enters the small intestine too rapidly. These symptoms include cramps, nausea, diarrhea, and dizziness. Dumping syndrome sometimes occurs in people who have had a portion of their stomach removed.
Historical Perspective
The history of gastric dumping syndrome goes back over a hundred years. Over the years, various methods have been developed to detect it. It was initially described after bariatric surgery but later was found to be present in non-surgical causes as well.
Classification
Dumping syndrome can be divided into early dumping and late dumping syndrome based upon the timeline of onset of symptoms and clinical features.
Pathophysiology
The exact pathogenesis of dumping syndrome is not completely understood. Symptoms of early and late dumping syndrome appear to be caused by distinct pathological mechanisms. The pathogenesis can be divided into accelerated gastric emptying and reduced gastric volume.
Causes
Gastric dumping syndrome can be caused mainly by surgeries, diseases, and certain post-surgical diets.
Differentiating Gastric dumping syndrome overview from Other Diseases
Dumping syndrome may often be confused with other similar diseases that cause upper abdominal pain, nausea, and fatigue.
Epidemiology and Demographics
Incidence and prevalence varies depending on the procedure or disease leading to dumping syndrome.
Risk Factors
The most common risk factor in the development of dumping syndrome is bariatric surgery. Dumping syndrome is not limited to surgery but occurs due to other conditions as well. The severity of dumping syndrome is proportional to the rate of gastric emptying following different surgical procedures:
Screening
There is insufficient evidence to recommend routine screening for dumping syndrome. Screening is done after exposure to the risk factors for dumping syndrome. The Sigstad score is a table of symptoms used to differentiate dumpers from non-dumpers (healthy). Other methods have been used but were never formally validated.
Natural History, Complications, and Prognosis
If left untreated dumping syndrome causes problems with digestion and absorption. This may in turn lead to symptoms such as nausea, vomiting, distention, abdominal pain and diarrhea.
Diagnosis
Diagnostic Criteria
The two most sensitive and specific tests used in confirming the clinical suspicion and in diagnosing Dumping syndrome are the oral glucose tolerance test and the Hydrogen breath test.
History and Symptoms
The history of dumping syndrome has to do with surgeries or diseases that alter the motility or capacity of the stomach. The most common history of dumping syndrome is a bariatric surgery history. The most common symptoms of dumping syndrome are diarrhea, shock, fainting, syncope, unconsciousness, desire to lay down or sit down, breathlessness, dyspnea, weakness, exhaustion, sleepiness, drowsiness, apathy, falling asleep, palpitation, restlessness, and dizziness.
Physical Examination
Common physical examination findings of dumping syndrome include tachycardia, flushing, abdominal pain, abdominal distention, borborygmus, tremor and weight loss in most severe cases.
Laboratory Findings
There are no diagnostic laboratory findings that help in diagnosing dumping syndromebut there are associated laboratory finding that may present if severe.
Imaging Findings
Other imaging options are useful in determining the anatomy and how well a patient will respond to therapy.
Other Diagnostic Studies
There are no other diagnostic studies associated with Dumping syndrome.
Treatment
Medical Therapy
The main therapy for the management of dumping syndrome includes diet and pharmacological intervention.
Surgery
Surgery is not the first-line treatment option for patients with dumping syndrome. Surgery is usually reserved for patients as a last resort.
Prevention
Effective measures for the primary prevention of dumping syndrome include preventing or avoiding surgery and preventing risk factor exposure. No vaccines are available for dumping syndrome. Secondary prevention is similar to primary prevention. Investigational therapies of dumping syndrome include continuous enteral feeding, drugs, electrical pacing of the stomach and surgical re-intervention.