Dumping syndrome

Dumping syndrome is a common complication following gastric, bariatric or esophageal surgeries.

There are two types of dumping syndrome:

• early dumping syndrome

• postprandial hyperinsulinemic hypoglycemia (late dumping syndrome)

Epidemiology

Dumping syndrome occurs in approximately 12-40% of patients following Roux-en-Y gastric bypass, and up to 50% of patients following esophagectomy ^1,2. Most cases of dumping syndrome are the early dumping syndrome type ^1,2.

Clinical presentation

Early dumping syndrome ²:

• symptom onset 30-60 minutes after eating, typically after a carbohydrate-rich meal

• gastrointestinal symptoms: epigastric distension, nausea, vomiting, explosive diarrhea, cramping abdominal pain

• vasomotor symptoms: flushing, dizziness, tachycardia and palpitations, hypotension

Postprandial hyperinsulinemic hypoglycemia (late dumping syndrome) ^2,3:

• symptom onset 1-3 hours after eating, typically after a carbohydrate-rich meal

• hypoglycemic symptoms with Whipple triad

Pathology

Dumping syndrome can occur as a complication of a number of gastric, bariatric, or esophageal surgical procedures, such as Roux-en-Y gastric bypass, esophagectomy, vagotomy with pyloroplasty, sleeve gastrectomy, or Nissen fundoplication ².

The pathogenesis of dumping syndrome differs between the two types:

• early dumping syndrome: fluid shift into small bowel lumen due to hyperosmolality of (often carbohydrate-rich) foods ²

• postprandial hyperinsulinemic hypoglycemia (late dumping syndrome): exaggerated incretin response ^2,3

Radiographic features

In early dumping syndrome, a broad stoma and a brief transit time might be seen on barium radiographic studies ⁴. However, gastric emptying studies and dumping provocation test are deemed most useful investigations ⁴.

History and etymology

Hertz first studied the association between postprandial symptoms and gastroenterostomy in 1913 ⁵. Wyllys et al. coined the term "dumping" in 1922 after radiographically noting rapid gastric emptying in patients with vasomotor and gastrointestinal symptoms ⁶.