Dumping Syndrome

Dumping syndrome is a relatively rare disorder in which the stomach's contents are delivered too quickly to the small intestine. Symptoms include abdominal pain, bloating, abdominal cramping, diarrhea, and dizziness. In addition, people with this syndrome often suffer from low blood sugar, or hypoglycemia, because the rapid "dumping" of food triggers the pancreas to release excessive amounts of insulin into the bloodstream. Just a little info for some of the newbies.....Good to know with the Holidays here.... LisaMarie

These r 2 articles I saved on dumping, for me I know less than 50% RNYers dump, although it sounds horrid, not umping that fear is worse for me, I also know that one can desensitive new plumbing to sugar i see it all the time online and in my support group so I keep away! dUMPING TENDS TO DECRASE OVER TIME AS WELL.... Original Article:http://www.mayoclinic.com/health/dumping-syndrome/DS00715/DSECTION=1 Dumping syndrome Overview Dumping syndrome is a group of signs and symptoms that develops most often in people who have had surgery to remove all or part of their stomach, or in whom much of their stomach has been surgically bypassed to help lose weight. Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of your stomach are transported or "dumped" into your small intestine too rapidly. Common symptoms include abdominal cramps and nausea. Most people with dumping syndrome experience signs and symptoms soon after eating. In other people, they may occur later -- one to three hours after eating -- and they can range from mild or moderate to severe and debilitating. Most of the time, dumping syndrome improves on its own without medical treatment, or by adjusting your diet. In more serious cases of dumping syndrome, you may need medications or surgery. Signs and symptoms When signs and symptoms occur during a meal or within 15 to 30 minutes following a meal, they may include: § Nausea § Vomiting § Abdominal pain, cramps § Diarrhea § Dizziness, lightheadedness § Bloating, belching § Fatigue § Heart palpitations, rapid heart rate When signs and symptoms develop later, they may include: § Sweating § Weakness, fatigue § Dizziness, lightheadedness § Shakiness § Feelings of anxiety, nervousness § Heart palpitations, rapid heart rate § Fainting § Mental confusion Some people experience both early and late signs and symptoms. Conditions such as dizziness and heart palpitations can occur either early or late -- or both. No matter when problems develop, however, they may be worse in the aftermath of a high-carbohydrate meal, especially one that's rich in sugars such as sucrose (table sugar) or fructose (fruit sugar). Some people also experience low blood sugar (hypoglycemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Insulin influences your tissues to take up the sugar present in your bloodstream. Causes In dumping syndrome, food and juices from your stomach move to your small intestine in an unregulated, abnormally fast manner. This accelerated process is most often related to changes in your stomach associated with surgery. For example, when the opening (pylorus) between your stomach and the first portion of the small intestine (duodenum) has been damaged or removed during an operation, the syndrome may develop. Dumping syndrome may occur in up to 15 percent of people who have had stomach surgery. It develops most commonly one to six months after surgery, and the greater the amount of stomach removed or bypassed, the more likely that the condition will be severe. It sometimes becomes a chronic disorder. Gastrointestinal hormones also are believed to play a role in this rapid dumping process. Risk factors Several types of stomach surgery increase your risk of dumping syndrome. These include: § Gastrectomy, in which a portion or all of your stomach is removed. It typically involves removing the pylorus. § Gastroenterostomy or gastrojejunostomy, in which your stomach is surgically connected directly to your small intestine about two feet beyond the pylorus, thus bypassing the pylorus. Doctors sometime perform this operation in people with cancer of the stomach. § Vagotomy, in which the nerves to your stomach are cut in order to lower the levels of acid manufactured by your stomach. § Fundoplication, which is an operation sometimes performed on people with gastroesophageal reflux disease. It involves wrapping the upper portion of your stomach around the lower esophagus to apply pressure that reduces the reflux of gastric contents into the esophagus. However, on rare occasions, certain nerves to the stomach can unintentionally be damaged during surgery and lead to dumping syndrome. § Gastric bypass surgery (Roux-en-Y operation), which is often performed in people who are morbidly obese. It surgically creates a smaller stomach pouch that's smaller than the entire stomach, meaning you're no longer able to eat as much as you once did, resulting in weight loss. Certain underlying conditions also may make you more susceptible to dumping syndrome. These conditions include: § Diabetes § Gastroesophageal reflux disease (GERD), in which the contents of your stomach move back into your esophagus § Zollinger-Ellison syndrome, which causes severe peptic ulcers In addition, using the medication metoclopramide (Reglan) can increase your risk. This drug is sometimes prescribed to ease nausea, vomiting and heartburn. When to seek medical advice Contact your doctor if you develop signs and symptoms that might be due to dumping syndrome even if you have not had surgery. If you've already been diagnosed with this syndrome, keep your doctor informed on how well your treatment is working. Whenever symptoms worsen, talk to your doctor. Because poor dietary choices can worsen signs and symptoms, your doctor may refer you to a registered dietitian to help you create the most appropriate eating plan. The guidance provided by a registered dietitian may be particularly important if you have lost large amounts of weight due to the syndrome. Screening and diagnosis Your doctor can diagnose dumping syndrome by taking a careful medical history and then evaluating your signs and symptoms. If you have undergone stomach surgery, that may help lead your doctor to a diagnosis of dumping syndrome. Because low blood sugar is sometimes associated with dumping syndrome, your doctor may order a test to measure your blood sugar level at the peak time of your symptoms to help confirm the diagnosis. Complications In people with severe cases of dumping syndrome, marked weight loss and malnutrition may occur. Sometimes people who lose a lot of weight may also develop a fear of eating, related to the discomfort associated with the rapid dumping of undigested food. They may also avoid outdoor physical activity in order to stay close to a toilet. Some have difficulty keeping a job because of their chronic symptoms. Treatment Most cases of dumping syndrome improve without any treatment, typically in several months to about a year after signs and symptoms begin. However, if they don't improve on their own -- or if you want relief from symptoms soon after they appear -- your doctor may advise one or more treatment options to slow the emptying of your stomach's contents. The choices for managing dumping syndrome include dietary changes, medications and surgery. Dietary changes Adjusting your diet may relieve your symptoms. Here are some strategies that your doctor may recommend: § Eat smaller meals. Try consuming about six small meals a day rather than three larger ones. § Avoid fluids with meals. Drink liquids only between meals. § Change the makeup of your diet. Consume more low-carbohydrate foods. In particular, concentrate on a diet low in simple carbohydrates such as sugar (found in sweets like candy, cookies and cakes). Read labels on packaged food before buying, with the goal of not only avoiding foods with sugar in their ingredients list, but also looking for (and staying away from) alternative names for sugar, such as glucose, sucrose, fructose, dextrose, honey and corn syrup. Artificial sweeteners are acceptable alternatives. Consume more protein in your diet, and adopt a higher fiber diet. § Increase pectin intake. Pectin is found in many fruits such as peaches, apples and plums, as well as in some fiber supplements. It can delay the absorption of carbohydrates in the small intestine. § Stay away from acidic foods. Tomatoes and citrus fruits are harder for some people to digest. § Use low-fat cooking methods. Prepare meat and other foods by broiling, baking or grilling. § Consume adequate vitamins, iron and calcium. These can sometimes become depleted in the aftermath of stomach surgery. Discuss this nutritional issue with a registered dietitian. § Lie down after eating. This may slow down the movement of food into your intestines. Even with dietary changes, you may continue to experience severe symptoms associated with dumping syndrome. Medications Your doctor may prescribe certain medications to slow the passage of food out of your stomach, and relieve the signs and symptoms associated with dumping syndrome. These drugs are most appropriate for people with severe signs and symptoms, and they don't work for everyone. The medications that doctors most frequently prescribe are: § Acarbose. This medication delays the digestion of carbohydrates. Doctors prescribe it most often for the management of type 2 diabetes, and it has also been found to be effective in people with late-onset dumping syndrome. Side effects may include sweating, headaches, pallor, sudden hunger and weakness. § Octreotide (Sandostatin). This anti-diarrheal drug can slow down the emptying of food into the intestine. You take this drug by injecting it under your skin (subcutaneously). Be sure to talk with your doctor about the proper way to self-administer the drug, including optimal choices for injection sites. Long-acting formulations of this medication are available. Because octreotide carries the risk of side effects (diarrhea, bulky stools, gallstones, flatulence, bloating) in some people, doctors recommend it only for people who haven't responded to other treatments. Surgery Doctors use a number of surgical procedures to treat severe cases resistant to more conservative approaches. Most of these operations are reconstructive techniques, such as reconstructing the pylorus, or they're intended to reverse gastric bypass surgery. Prevention You can't prevent dumping syndrome. However, measures such as dietary adjustments may prevent recurrences of your symptoms and minimize their severity. By Mayo Clinic Staff Apr 5, 2006 http://www.mayoclinic.com/print/dumping-syndrome/DS00715/DSECTION=all&METHOD=print ********************** www.sabariatric.com DUMPING SYNDROME DEFINED, EXPLAINED, AND AVOIDABLE! The weight loss that is achieved through the RNY appears to be primarily dependent upon the removal of the pyloric valve, leaving the individual without a regulator of food movement into the small intestine. This results in the well-known phenomena called "dumping syndrome" which can cause an individual to feel sick or even faint. Rapid gastric emptying, or dumping syndrome, happens when the lower end of the small intestine (jejunum) fills too quickly with undigested food from the stomach. "Early" dumping begins during or right after a meal. Symptoms of early dumping include nausea, vomiting, bloating, diarrhea, and shortness of breath. "Late" dumping happens 1 to 3 hours after eating. Symptoms of late dumping include weakness, sweating, and dizziness. Many people have both types. Stomach surgery is the main cause of dumping syndrome because surgery may damage the system that controls digestion. Treatment includes changes in eating habits and medication. People who have dumping syndrome need to eat several small meals a day that are low in carbohydrates and should drink liquids between meals, not with them. It is imperative to the Roux En Y or other procedural gastric bypass patient that they follow their diet plan to reduce the risk factor of Dumping Syndrome. Many people equate the term solely to be spasmodic fits of diarrhea, when that is merely one of the symptoms of a more intensified unpleasant experience. Dumping syndrome is usually divided into "early" and "late" phases - the two phases have separate physiologic causes and shall be described separately. In practical fact, a patient usually experiences a combination of these events and there is no clear-cut division between them. Early dumping is caused by the high osmolarity of simple carbohydrates in the bowel. The various types of sugar all have small molecules, so that a gram of (for example) sucrose has MANY more molecules than a gram of protein, creating a higher concentration (number of molecules per cc) from simple sugars than from other foods. This matters because, inside the body, fluid shifts will generally go toward the higher concentration of molecules. So, if a patient consumes a bite of milk chocolate (lots of sugar), when it gets to the Roux limb it will quickly "suck" a significant amount of fluid into the bowel. This rapid filling of the small bowel causes it to be stretched (which causes cramping pain). This also causes the activation of hormonal and nerve responses that cause the heart to race (palpitations) and cause the individual to become clammy and sweaty. Vomiting or diarrhea may follow as the intestine tries to quickly rid itself of this "irritant."Late dumping has to do with the blood sugar level. The small bowel is very effective in absorbing sugar, so that the rapid absorption of a relatively small amount of sugar can cause the glucose level in the blood to "spike" upward. The pancreas responds to this glucose challenge by "cranking up" its output of insulin. Unfortunately, the sugar that started the whole cycle was such a small amount that it does not sustain the increase in blood glucose, which tends to fall back down at about the time the insulin surge really gets going. These factors combine to produce hypoglycemia (low blood sugar), which causes the individual to feel weak, sleepy, and profoundly fatigued. Late dumping is the mechanism by which sugar intake can create low blood sugar, and it is also a way for gastric bypass patients to get into a vicious cycle of eating. If the patient takes in sugar or a food that is closely related to sugar (simple carbohydrates like rice, pasta, potatoes) they will experience some degree of hypoglycemia in the hour or two after eating. The hypoglycemia stimulates appetite, and it's easy to see where that is going...The reason that sugar does not cause dumping in non-operated people is that the stomach, pancreas, and liver work together to prepare nutrients (or sugar) before they reach the small intestine for absorption. The stomach serves as a reservoir that releases food downstream only at a controlled rate, avoiding sudden large influxes of sugar that can occur after a Roux En Y. The released food is also mixed with stomach acid, bile, and pancreatic juice to control the chemical makeup of the stuff that goes downstream and avoid all the effects outlined above. Obviously, surgeons consider dumping syndrome to be a beneficial effect of gastric bypass - it seems to be important to provide quick and reliable negative feedback for intake of the "wrong" foods. In practice, most patients do NOT experience full-blown dumping more than once or twice. Most simply say that they have "lost their taste" for sweets. Of course, this is always a great topic to ask patients about directly, so you may want to ask about it at our support group in person, or in a support group online. It is an unpleasant side effect of this surgical procedure, experiencing it means one simple thing; you are not following your prescribed diet, and unless you do, dumping syndrome is going to become a major part of your life. Do yourself, and your body a favor and follow doctors orders, to the letter. ********************* Take Care, Jamie 100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY 320(preop)/163 (lowest)/174 (current) 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com http://www.obesityhelp.com/member/jamiecatlady5/ "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"