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Dumping Syndrome After Gastric Bypass Surgery

What is dumping syndrome after gastric bypass surgery?

Dumping syndrome is a problem for many people who have had gastric bypass surgery. It happens when the solid parts of a meal get “dumped” directly from your stomach into your small intestine without being digested. This can feel uncomfortable and may even lead to malnutrition if not treated.

What causes dumping syndrome after gastric bypass surgery?

Health care providers don’t really understand why dumping syndrome happens. Some think it’s because the weight-loss surgery makes the stomach so small. Of course, this is the point of the surgery. A stomach that doesn’t hold much food helps you lose weight. But some people don’t tolerate this small capacity, and problems like dumping syndrome can result.

What are the risk factors for dumping syndrome after gastric bypass surgery?

Some amount of dumping syndrome happens in at least 15% to 20% of people who have had a part of their stomach removed for some other reason. A small number of people can’t get rid of the syndrome once they have it.

Health care providers divide dumping syndrome into 2 types. Early dumping happens 10 to 30 minutes after a meal. Late dumping happens 1 to 3 hours after eating.

The symptoms of dumping syndrome are different, depending on which type you have. The majority of people with dumping syndrome have early dumping symptoms. About 25% have late dumping symptoms.

Late dumping is linked to hypoglycemia. You are more likely to have dumping syndrome if you eat a meal heavy in starches or sugars. The sugars can be either fructose or sucrose (table sugar).

What are the symptoms of dumping syndrome after gastric bypass surgery?

Early dumping syndrome causes symptoms because of the dense mass of food that gets dumped into your small intestine at an earlier stage of digestion. The intestines sense that this food mass is too concentrated. Your body reacts by shifting fluid circulating in your bloodstream to the inside of your intestine. As a result, your intestines become fuller and bloated. Diarrhea often occurs 30 to 60 minutes later. In addition, certain substances are released by your intestine that affect heart rate and often blood pressure, causing many of the symptoms of early dumping. This can lead to lightheadedness or even fainting.

These are typical early dumping symptoms:

  • Bloating
  • Sweating
  • Abdominal cramps and pain
  • Nausea
  • Facial flushing
  • Stomach growling or rumbling
  • An urge to lie down after the meal
  • Palpitations and rapid heartbeat
  • Dizziness or fainting
  • Eventual diarrhea 

Symptoms of late dumping happen because of reactive hypoglycemia (a decrease in blood sugar level). Reactive hypoglycemia is low blood sugar caused by a large surge of insulin 1 to 3 hours before.

These are symptoms of late dumping syndrome:

  • Heart palpitations
  • Sweating
  • Hunger
  • Confusion
  • Fatigue
  • Aggression
  • Tremors
  • Fainting or loss of consciousness

How is dumping syndrome after gastric bypass surgery diagnosed?

Health care providers typically diagnose dumping syndrome based on symptoms, rather than tests. A glucose tolerance test and hydrogen breath testing can also help your health care provider make a diagnosis.

How is dumping syndrome after gastric bypass surgery treated?

The main treatment for dumping syndrome is changes in your diet. These include not drinking liquids until 30 minutes after a meal and dividing your daily calories into 6 small meals. Experts also advise lying down for 30 minutes after a meal to help control the symptoms. You should also choose complex carbohydrates like whole grains, instead of simple carbohydrates like white breads and sugary sweets. Adding more protein and fat can help meet your energy needs.

Another step your health care provider may recommend is to slow gastric emptying by making your food thicker. Some people add 15 grams of guar gum or pectin to each meal. But many people don’t tolerate the supplements that well.

When dietary changes don’t help, your health care provider may give you some slow-release prescription drugs, but these work only rarely. In severe cases, when dumping syndrome causes major problems, and when diet and medicines have failed, your provider may suggest tube feeding or corrective surgery.

Can dumping syndrome after gastric bypass surgery be prevented?

Because what you eat can play such a large role in causing dumping syndrome, dietary changes after gastric bypass surgery are generally the best plan to prevent problems. These include avoiding liquids during meals and choosing complex carbohydrates over simple carbohydrates. Avoiding sugary or sweetened foods will help prevent late dumping syndrome. Some people may need to stop eating dairy products.

The most important advice for anyone with a small stomach capacity related to gastric bypass surgery is to eat small meals. If you overeat after having this procedure done, it may cause problems in the future

 

Key points

Dumping syndrome after gastric bypass surgery happens when the solid parts of a meal get “dumped” directly from your stomach into your small intestine without being digested.

  • Health care providers don’t really understand why dumping syndrome happens.
  • Health care providers divide dumping syndrome into 2 types:
    • Early dumping happens 10 to 30 minutes after a meal
    • Late dumping happens 1 to 3 hours after eating.
  • The majority of people with dumping syndrome have early dumping symptoms.
    • Bloating
    • Sweating
    • Abdominal cramps and pain
    • Nausea
  • Health care providers typically diagnose dumping syndrome based on symptoms rather than tests.
  • The main treatment for dumping syndrome is changes in the diet.
  • The most important advice for anyone with a small stomach capacity related to gastric bypass surgery is to eat small meals to prevent dumping syndrome.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Online Medical Reviewer: Berry, Judith, PhD, APRN
Online Medical Reviewer: Fetterman, Anne, RN, BSN
Last Review Date: 2/3/2014
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