Dumping Syndrome Clinical Presentation

  • Author: Alan BR Thomson, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 26, 2010
 

History

The clinical presentation of dumping syndrome can be divided into GI symptoms and vasomotor symptoms. GI symptoms include early satiety, crampy abdominal pain, nausea, vomiting, and explosive diarrhea. Vasomotor symptoms include diaphoresis, flushing, dizziness, palpitations, and an intense desire to lie down.

The expression of these symptoms varies in different individuals. Most patients with early dumping have both GI and vasomotor symptoms, while patients with late dumping have mostly vasomotor symptoms. Patients with severe dumping often limit their food intake to avoid symptoms. This leads to weight loss and, over time, malnutrition.

  • Early dumping systemic symptoms
    • Desire to lie down
    • Palpitations
    • Fatigue
    • Faintness
    • Syncope
    • Diaphoresis
    • Headache
    • Flushing
  • Early dumping abdominal symptoms
    • Epigastric fullness
    • Diarrhea
    • Nausea
    • Abdominal cramps
    • Borborygmi
  • Late dumping
    • Perspiration
    • Shakiness
    • Difficulty to concentrate
    • Decreased consciousness
    • Hunger
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Physical

  • Dumping syndrome is diagnosed based on typical symptoms in patients who have undergone gastric surgery. Typical signs and symptoms can be elicited with an oral glucose challenge of 50 g.
  • Sigstad developed a diagnostic scoring system on weighing factors allocated to the symptoms of dumping. A diagnostic index greater than 7 is suggestive of dumping syndrome.
  • Sigstad's diagnostic index, indicating symptoms and the points assigned for those symptoms, is as follows:
    • Shock: +5
    • Almost fainting, syncope, unconsciousness: +4
    • Desire to lie or sit down: +4
    • Breathlessness, dyspnea: +3
    • Weakness, exhaustion: +3
    • Sleepiness, drowsiness, yawning, apathy, falling asleep: +3
    • Palpitation: +3
    • Restlessness: +2
    • Dizziness: +2
    • Headaches: +1
    • Feeling of warmth, sweating, pallor, clammy skin: +1
    • Nausea: +1
    • Fullness in the abdomen, meteorism: +1
    • Borborygmus: +1
    • Eructation: -1
    • Vomiting: -4
  • The Visick classification is also used to characterize the severity of symptoms after gastric surgery. A rise in the heart rate by 10 beats per minute or more in the first hour after an oral glucose challenge of 50 g was found to be 100% sensitive and 92% specific for early dumping.
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Causes

  • Dumping can be separated into early and late forms depending on the occurrence of symptoms in relation to the time elapsed after a meal. Both forms occur because of the rapid delivery of large amounts of osmotically active solids and liquids to the duodenum. This is a direct result of alterations in the storage function of the stomach and/or pyloric emptying mechanism.
  • The severity of dumping syndrome is proportional to the rate of gastric emptying.
    • Postprandially, the stomach assumes its reservoir function to allow initial chemical digestion by acid and proteases before transferring food to the antrum. In the antrum, high-amplitude contractions triturate solids.
    • Once solids have been reduced to 1-2 mm, they are able to empty through the pylorus. An intact pylorus has a separating function that prevents the passage of larger particles into the duodenum.
    • Gastric emptying is controlled by fundic tone, antropyloric mechanisms, and duodenal feedback. Gastric surgery alters these mechanisms in several ways.
  • Gastric resection can reduce the fundic reservoir, thereby reducing the receptiveness of the stomach to a meal. Similarly, vagotomy increases gastric tone, limiting accommodation.
  • Any operation in which the pylorus is removed, bypassed, or destroyed increases the rate of gastric emptying. Duodenal feedback inhibition of gastric emptying is also lost after bypass of the duodenum with gastrojejunostomy. Accelerated early gastric emptying of liquids is a characteristic feature and a critical step in the pathogenesis of dumping syndrome.
  • Gastric mucosal function is altered by surgery, and acid and enzymatic secretions are decreased. Also, hormonal secretions that sustain the gastric phase of digestion are adversely affected.
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Contributor Information and Disclosures
Author

Alan BR Thomson, MD  Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association, American College of Gastroenterology, American Gastroenterological Association, Canadian Association of Gastroenterology, Canadian Medical Association, College of Physicians and Surgeons of Alberta, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Sukhdeep Padda, MD  Assistant Professor, Department of Internal Medicine, Section of Gastroenterology, University of Arizona Health Sciences Center

Sukhdeep Padda, MD is a member of the following medical societies: American College of Gastroenterology

Disclosure: Nothing to disclose.

Francisco Ramirez, MD, FACG  Chief, Section of Gastroenterology, Carl T Hayden VA Medical Center; Associate Professor, Department of Medicine, University of Arizona

Francisco Ramirez, MD, FACG is a member of the following medical societies: American College of Gastroenterology

Disclosure: Nothing to disclose.

Thomas Aguirre, MD  Gastroenterology Fellow, Department of Internal Medicine, University of Arizona

Thomas Aguirre, MD is a member of the following medical societies: American College of Gastroenterology and American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Vivek V Gumaste, MD  Associate Professor of Medicine, Mt Sinai School of Medicine; Adjunct Clinical Assistant, Mt Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center

Vivek V Gumaste, MD is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

BS Anand, MD  Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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