What is Dumping Syndrome? Understanding Early and Late Symptoms

Early dumping syndrome symptoms

Early symptoms of dumping syndrome include nausea, vomiting, abdominal cramping, and diarrhea. These symptoms usually start 10 to 30 minutes after you eat.

Other early symptoms include:

• bloating or feeling uncomfortably full
• flushing of the face
• sweating
• dizziness
• fast heart rate

Late dumping syndrome symptoms

Late symptoms appear 1 to 3 hours after you eat. They’re caused by low blood sugar and can include:

• dizziness
• weakness
• sweating
• hunger
• fast heart rate
• fatigue
• confusion
• shaking

You might have both early and late symptoms.

Typically when you eat, food moves from your stomach into your intestines over several hours. In the intestines, nutrients from food are absorbed, and digestive juices break down the food even more.

With dumping syndrome, food moves too quickly from your stomach into your intestine.

• Early dumping syndrome happens when the sudden influx of food into your intestine causes a lot of fluid to move from your bloodstream into your intestine as well. This extra fluid causes diarrhea and bloating. Your intestines also release substances that speed your heart rate and lower your blood pressure. This leads to symptoms like a fast heart rate and dizziness.
• Late dumping syndrome happens because of an increase in starches and sugars in your intestines. At first, the extra sugar causes your blood sugar level to rise. Your pancreas then releases the hormone insulin to move sugar (glucose) from your blood into your cells. This extra rise in insulin causes your blood sugar to drop too low. Low blood sugar is called hypoglycemia.

Surgery that reduces the size of your stomach or that bypasses your stomach causes dumping syndrome. After surgery, food moves from your stomach into your small intestine more quickly than usual. Surgeries that affect the way your stomach empties food can also cause this condition.

Types of surgery that can cause dumping syndrome include:

• Gastrectomy. A gastrectomy removes part or all of your stomach.
• Gastric bypass (Roux-en-Y). Gastric bypass creates a small pouch from your stomach to prevent you from eating too much. The pouch is then connected to your small intestine.
• Esophagectomy. Esophagectomy removes part or all of your esophagus. It’s done to treat esophageal cancer or damage to the esophagus.

Treatment for dumping syndrome varies. Your doctor might recommend one or more treatments ranging from medication, dietary changes, and sometimes surgery.

Dietary solutions

You may be able to relieve symptoms of dumping syndrome by making a few changes to your diet:

• Eat five to six smaller meals throughout the day instead of three big meals.
• Avoid or limit sugary foods like soda, candy, and baked goods.
• Eat more protein from foods like chicken, fish, peanut butter, and tofu.
• Get more fiber in your diet. Switch from simple carbohydrates like white bread and pasta to whole grains like oatmeal and whole wheat. You can also take fiber supplements. The extra fiber will help sugar and other carbohydrates get absorbed more slowly in your intestines.
• Don’t drink fluids within 30 minutes before or after meals.
• Chew your food completely before you swallow to make it easier to digest.
• Add pectin or guar gum to your food to thicken it. This will slow the rate at which food moves from your stomach to your intestine.

Certain foods are more tolerable than others. Therefore, avoiding foods that exacerbate dumping syndrome can help relieve symptoms. Allowed foods generally include:

• unsweetened fruit juices
• other sugar-free and caffeine-free drinks
• cooked fresh vegetables
• unsweetened canned fruit
• raw fruits and vegetables, if tolerable
• unsweetened cereals
• white and sweet potatoes
• eggs
• cheese
• dried beans, if tolerable
• beef, pork, poultry, and seafood
• rice and pasta
• margarine and butter
• salad dressing
• sugar-free desserts
• salt and other mild seasonings

Less tolerable foods that can aggravate symptoms include:

• caffeinated drinks
• alcohol
• gas-producing vegetables, if intolerable (broccoli, cauliflower, cabbage, onions)
• canned fruit in syrup
• breads baked with sugar (doughnuts, pancakes, pastries)
• sweetened cereals
• syrup
• candy, cakes, and cookies
• pepper and chili sauce

Dietary supplements

Ask your doctor whether you need a nutritional supplement. Dumping syndrome can affect your body’s ability to absorb nutrients from food.

Medications

For more severe dumping syndrome, your doctor can prescribe octreotide (Sandostatin).

This drug changes how your digestive tract works, slowing down the emptying of your stomach into your intestine. It also blocks the release of insulin. You can take this drug as an injection under your skin, an injection into your hip or arm muscle, or intravenously.

Some side effects of this drug include:

• changes in blood sugar levels
• nausea
• pain where you get the injection
• greasy-looking stools
• foul-smelling stool
• increased chance of fecal leakage

Another medication used for dumping syndrome is acarbose (Prandase, Precose). Its use is also off-label, but it helps reduce the symptoms of late dumping syndrome, according to research.

Side effects of acarbose often include:

• bloating
• diarrhea
• flatulence

Surgery

If none of the treatments above help, your doctor may recommend surgery. There isn’t one specific surgical procedure to treat dumping syndrome, though. The surgery you’ll need depends on the type of surgery that caused the condition.

For example, if symptoms develop after gastric bypass surgery, your doctor may recommend a reverse gastric bypass. Additionally, treating this condition might involve surgery to fix the opening from your stomach to your small intestine (pylorus).

Unfortunately, surgery to reverse dumping syndrome isn’t always successful.

Dumping syndrome is a complication of stomach bypass or stomach reduction surgery. Other complications related to this surgery include:

• poor nutrient absorption
• weakened bones, called osteoporosis, from poor calcium absorption
• anemia, or a low red blood cell count, from poor absorption of vitamins or iron

See a doctor if you develop symptoms of dumping syndrome (nausea, bloating, vomiting, abdominal pain, diarrhea) after meals, especially if you have a history of stomach or esophageal surgery. Keep in mind that dumping syndrome can occur years after surgery.

Your doctor can evaluate your symptoms and order tests to confirm dumping syndrome and rule out other conditions.

If you’ve been diagnosed with dumping syndrome, you should also see a doctor if you’re unable to control symptoms with dietary changes or medication.

Some people lose a lot of weight with dumping syndrome due to malnutrition, in which case you might need to see a dietitian. These are food and nutrition experts who can develop a healthy eating plan for you.

An evaluation of your medical history and symptoms can help your doctor diagnose dumping syndrome. Additionally, the doctor may order one or more tests to make a diagnosis. These might include:

• Blood sugar test. After a doctor takes an initial blood sample, you’ll drink a glucose solution for a blood sugar test. The doctor takes another blood sample immediately after you finish the drink, and additional samples every 30 minutes for up to 3 hours. This test measures how well your body manages glucose after meals.
• Gastric emptying test. Prior to a gastric emptying test, you’ll consume a small amount of a radioactive material. Your doctor then uses a special tool to track this material through your gastrointestinal tract. The test measures how long it takes food to empty out of your stomach.

To rule out other possible medical conditions, a doctor may also schedule an upper GI endoscopy or an upper GI series.

With an endoscopy, a doctor uses a thin flexible tube to look inside the upper digestive system. An upper GI series is an X-ray of the upper gastrointestinal system. This looks for other possible problems, like an intestinal blockage.

There isn’t a way to prevent dumping syndrome after stomach or esophageal surgery.

Even so, making certain dietary changes after surgery could possibly reduce your risk. These changes can include eating five to six small meals a day, limiting or avoiding sugar, drinking plenty of fluids with meals, and eating more protein and fiber.

Early dumping syndrome often gets better without treatment in a few months. Dietary changes and medication may help. If dumping syndrome doesn’t improve, surgery may be needed to relieve the problem.