Dumping syndrome, a common but often preventable disorder of gastric surgery

Dumping syndrome, a common but often preventable disorder of gastric surgery

A frequent complication of gastric surgery, and more particularly of bariatric surgery, dumping syndrome can considerably alter the quality of life of those affected. However, its occurrence is far from inevitable! Dumping syndrome can most often be avoided by following dietary rules as detailed by Dr Anne Deburge, diabetologist and endocrinologist, specialist in bariatric surgery at the Center Hospitalier Sud Francilien (Corbeil-Essonnes).

In affected individuals, dumping syndrome can occur right after a meal or several hours later. But what are the exact causes? How does it manifest? And above all, what solutions should be put in place to avoid suffering from this? Our answers.

What is dumping syndrome?

Dumping syndrome is a feeling of discomfort occurring after a meal in people who have had stomach surgery. It corresponds either to the rapid arrival in the intestine of a food bolus that is too large and/or too cold and/or too rich in sugars or fats, or to its ingestion too quickly, explains Dr Anne Deburge. “Dumping syndrome refers to a set of symptoms resulting from the rapid arrival of food in the small intestine due to the reduction in stomach volume, particularly following bariatric surgery carried out in a person suffering from obesity. “.

Whatever the technique used (by-pass, sleeve), obesity surgery modifies the anatomy of the digestive system by reducing the volume of the stomach. Digestion time in this organ is therefore reduced, and food arrives more quickly in the intestine.

Dumping syndrome can also result from gastric surgery performed as part of treatment for gastric or esophageal cancer.

What are the causes of dumping syndrome?

Bariatric surgery, the frequency of which has increased in recent years, is a major source of dumping syndrome; but certain techniques are more likely to cause this disorder, notably the gastric bypass which almost completely bypasses the stomach, while a sleeve gastrectomy induces a slower passage of food through this essential organ for digestion, explains Dr Anne Deburge.

There are two types of dumping syndrome, early dumping syndrome and the late dumping syndromedepending on when it occurs after a meal, continues the specialist.

Early dumping syndrome

Early dumping syndrome occurs within 10 minutes to 1 hour after a meal ingested too quickly and/or consisting of foods that are too sweet, too fatty or too cold. “After bariatric surgery, explains the specialist, the food bolus with high osmotic power causes the passage of fluid from the blood to the intestine, causing relative hypovolemia (in other words, an apparent abnormal reduction in the quantity of blood in the body, editor’s note). This phenomenon is accentuated by the release of vasoactive hormones linked to intestinal distension.“. Comparable to hypotension, this mechanism is at the origin of early dumping syndrome.

Late dumping syndrome

Late dumping syndrome, on the other hand, occurs much later than eating a meal.between 1h30 and 4 hours later”. And if the symptoms resemble those of early dumping syndrome, the causes differ, explains Dr Anne Deburge. “Late dumping syndrome corresponds to reactive hypoglycemia (sugar level < 0.5 g/l of blood, editor's note) linked to excessive secretion of insulin after a meal.. This excessive secretion of insulin results from the ingestion of foods with a high glycemic index which cause blood sugar levels to rise quickly. “The example of the French breakfast is the most telling: composed of orange juice, slices of white bread and jam, it causes an insulin spike to manage this massive influx of sugar in the blood and can remotely cause reactive hypoglycemia, in other words a drop in blood sugar levels“. Here again, this reaction is accentuated by bariatric surgery, in particular by-pass, which promotes the secretion of the hormone GLP1 in the intestine, which increases that of insulin.

What are the symptoms of dumping syndrome?

  • THE symptoms of early dumping syndrome combine signs of vagal discomfort (hypotension, tachycardia (palpitations), sweating, fatigue) and digestive signs (abdominal pain, nausea, rumbling or diarrhea.)Symptoms are sometimes very intense, forcing patients to lie down“, says Dr. Deburge.
  • THE symptoms of late dumping syndrome result from hypoglycemia reaction to the ingestion of foods with a high glycemic index. Palpitations, tremors, sweating, fatigue, confusion which can lead to loss of consciousness characterize the late form of dumping syndrome which is associated with a feeling of hunger. It is sometimes difficult for patients to relate these symptoms to the previous meal as they occur so far away from the meals, between 1.5 and 4 hours later. Which makes the endocrinologist say that “the more we are warned, the lower the risk of dumping syndrome. It is therefore essential to inform patients well during preparation for surgery.“.

How to diagnose dumping syndrome?

Unfortunately, this is not always enough. “Although patients are warned before the operation, late dumping syndrome is sometimes difficult to diagnose because it often appears some time after surgery, several months or even years later.“, underlines Dr Deburge. According to this specialist, the prevalence of dumping syndrome is very probably underestimated, with patients not reporting their symptoms when they are not too severe or finding a solution on their own to go better.

The diagnosis of dumping syndrome is based on questioning the patient about the symptoms they experience immediately after a meal or, on the contrary, several hours later. “They are then asked to identify the foods or dishes in question.“. Measuring blood sugar using a meter makes it possible to objectify the reactive hypoglycemia at the origin of late dumping syndrome, “but its use is however rarely necessary“, underlines Anne Deburge.

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How to treat dumping syndrome?

Since dumping syndrome is linked to meals that are too large, or too rich in quickly absorbed sugars, or too fatty, or too cold or eaten too quickly, its treatment essentially consists of adopting new dietary rules. However, these differ somewhat depending on whether you suffer from early dumping syndrome or a late form.

  • In case of early dumping syndrome, it is advisable to reduce the volume of your meals, to extend the duration of meals, to split your diet, to chew well, to limit the consumption of simple sugars, fatty and frozen products, and not to drink during meals so as not to increase the volume of the food bolus. Against all odds, “The most difficult thing for patients is very often to eat slowly“, underlines the specialist.
  • In case of late dumping syndrome, it is essential to limit the quantity of foods with a high glycemic index, especially if they are taken in isolation (sweet foods – sweets, ice cream -, but also mashed potatoes, dates, white bread, certain breakfast cereals). lunch…) and prefer whole foods, or accompany them with foods rich in fiber and protein. Meals must be balanced and contain proteins, fats and slow sugars so as to reduce the rise in postprandial blood sugar (after a meal) and avoid reactive hypoglycemia. Finally, splitting food intake by spreading it over four or five meals (three meals + one or two snacks per day) can also reduce the risk of late dumping syndrome. If these dietary measures are not enough, drug treatment may be considered. “This is acarbose, a drug that prevents carbohydrates from breaking down too quickly, smoothes their intestinal absorption and thus prevents late dumping syndrome.“, says Dr. Deburge.

The latter recommends being accompanied by a dietician or nutritionist.it is so complicated to eat a balanced diet in small quantities“. Support that must be long-term.”Since dumping syndrome sometimes appears a long time after their operation, people who have gastric surgery must benefit from specialized follow-up for several years.“.