Dumping Syndrome Clinical Presentation

Updated: Oct 03, 2017
  • Author: Rajan Kanth, MD; Chief Editor: BS Anand, MD  more...
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Presentation

History

The clinical presentation of dumping syndrome can be divided into GI symptoms and vasomotor symptoms. [20] 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 syndrome generally occurs within 15 minutes of ingesting a meal and is attributable to the rapid transit of food into the small intestine, whereas late dumping syndrome occurs later and may be attributed to hypoglycemia with tremors, cold sweats, difficulty in concentrating, and loss of consciousness. [21]

Early dumping systemic symptoms are as follows:

  • Desire to lie down
  • Palpitations
  • Fatigue
  • Faintness
  • Syncope
  • Diaphoresis
  • Headache
  • Flushing

Early dumping abdominal symptoms are as follows:

  • Epigastric fullness
  • Diarrhea
  • Nausea
  • Abdominal cramps
  • Borborygmi

Late dumping symptoms are as follows:

  • Perspiration
  • Shakiness
  • Difficulty to concentrate
  • Decreased consciousness
  • Hunger
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Physical Examination

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 (distention because of gas): +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.

A self-assessment questionnaire, the Dumping Symptom Rating Scale (DSRS) has also been used to identify patients with pronounced dumping symptoms after 6 months to 1 year after surgery. [25]

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