Dumping Syndrome – AntBariatric

Dumping syndrome occurs as a result of the rapid passage of food into the small intestine. It can be seen after obesity surgeries as well as in the course of certain diseases.

Bariatric surgeries are almost always operations that involve intervention in the stomach and the small intestine following it. The changes that occur in the stomach-small intestine system after these operations disrupt normal physiology and set the stage for dumping syndrome.

Although it is more commonly seen after bypass surgeries, it can also occur after sleeve gastrectomy. The biggest reasons are the disruption of the physiology of the gastrointestinal system due to surgical intervention and the changes in eating habits post-surgery.

There is a structure called the pylorus at the exit of the stomach. While the food we eat undergoes preprocessing in the stomach, the pylorus intermittently contracts and relaxes to allow the processed food to pass into the small intestine in a controlled manner.

In sleeve gastrectomy surgery, the pylorus is preserved, and the stomach is transformed into a long, narrow tube. Since the pylorus is preserved, the controlled passage system continues. However, because the stomach has been shaped into a long tube, its storage function is eliminated, and the passage of food occurs more rapidly than in normal physiology. For this reason, dumping syndrome may be observed after sleeve gastrectomy, but it is less frequent due to the preservation of the pylorus.

In bypass surgeries, the pylorus is often bypassed, allowing for a direct passage between the stomach and the intestine. The passage of food into the intestine is much easier, and there is no mechanism like the pylorus to provide control. Therefore, dumping syndrome is more commonly seen after bypass surgeries.

Dumping syndrome is classified into early and late dumping based on its mechanism of occurrence, duration, and clinical findings:

Early Dumping:

Early dumping occurs half an hour after meals. It is especially seen after the consumption of foods high in carbohydrates and rich in content. With the rapid passage of food into the intestine, a significant amount of fluid enters the lumen of the small intestine due to osmotic pressure differences. You can imagine this like putting sugar on a zucchini, which causes it to release water, or salting a salad, which also makes it watery. When a dense content enters the small intestine through the same mechanism, fluid is drawn from the intestinal wall into the lumen to balance it. The fluid that enters the intestines comes from the circulatory system. As a secondary effect of the fluid being drawn into the intestines, hemodynamic and gastrointestinal symptoms occur. In addition, some hormonal changes contribute to the process.

Due to the passage of a significant amount of fluid into the intestines and the stretching of the intestinal wall, the following gastrointestinal symptoms may arise:

Abdominal pain
Bloating
Nausea
Diarrhea

Additionally, due to the drop in intravascular pressure, the following hemodynamic symptoms may occur:

Palpitations
Hypotension (drop in blood pressure)
Dizziness
Lightheadedness
Fainting
Flushing (redness of the face)

Late Dumping:

Late dumping syndrome occurs 1-3 hours after meals. The symptoms are due to a drop in blood sugar levels.

It especially occurs after the intake of foods high in carbohydrates and sugars. As carbohydrates and simple sugars are rapidly absorbed from the small intestine, blood sugar levels rise. In response to this, insulin is released from the pancreas to lower blood sugar levels. While insulin reduces blood sugar, its long half-life means that blood sugar can drop excessively. That is, although blood sugar has returned to normal, there is still insulin in circulation, which can cause blood sugar to drop below the required level. This condition results in hypoglycemia, or a significant drop in blood sugar levels. Symptoms develop due to hypoglycemia.

Symptoms may include: