Dumping syndrome

Last revised by Rohit Sharma on 8 Feb 2024

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)

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.

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:

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

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.

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.

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