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{{Gastric dumping syndrome}}
{{Gastric dumping syndrome}}
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==Overview==
The history of [[Gastric dumping syndrome|dumping syndrome]] has to do with [[Surgery|surgeries]] or [[Disease|diseases]] that alter the [[motility]] or capacity of the [[stomach]]. The most common history of dumping syndrome is a [[bariatric surgery]] history. The most common [[Symptom|symptoms]] of [[Gastric dumping syndrome|dumping syndrome]] are [[diarrhea|diarrhea,]] [[Syncope|fainting]], [[syncope]], [[unconsciousness]], [[desire]] to lay down or sit down, [[Dyspnea|breathlessness]], [[dyspnea]], weakness, [[Fatigue|exhaustion]], [[Somnolence|sleepiness]], [[Somnolence|drowsiness]], [[apathy]], falling  asleep, [[palpitation]], [[Agitation (emotion)|restlessness]], [[dizziness]] and [[shock]].


==Overview==
==History ==
The common surgical, medical and social history findings associated with dumping syndrome include:<ref name="pmid17643905">{{cite journal |vauthors=Tack J |title=Gastric motor disorders |journal=Best Pract Res Clin Gastroenterol |volume=21 |issue=4 |pages=633–44 |year=2007 |pmid=17643905 |doi=10.1016/j.bpg.2007.04.001 |url=}}</ref><ref name="pmid830568">{{cite journal |vauthors=MacGregor I, Parent J, Meyer JH |title=Gastric emptying of liquid meals and pancreatic and biliary secretion after subtotal gastrectomy or truncal vagotomy and pyloroplasty in man |journal=Gastroenterology |volume=72 |issue=2 |pages=195–205 |year=1977 |pmid=830568 |doi= |url=}}</ref><ref name="pmid6919504">{{cite journal |vauthors=Mayer EA, Thompson JB, Jehn D, Reedy T, Elashoff J, Meyer JH |title=Gastric emptying and sieving of solid food and pancreatic and biliary secretion after solid meals in patients with truncal vagotomy and antrectomy |journal=Gastroenterology |volume=83 |issue=1 Pt 2 |pages=184–92 |year=1982 |pmid=6919504 |doi= |url=}}</ref><ref name="pmid9200302">{{cite journal |vauthors=Vecht J, Masclee AA, Lamers CB |title=The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment |journal=Scand. J. Gastroenterol. Suppl. |volume=223 |issue= |pages=21–7 |year=1997 |pmid=9200302 |doi= |url=}}</ref>


==History==
===='''Surgical history'''====
* History of prior gastric surgery
The following [[Surgery|surgical]] procedures are associated with an increased risk of developing dumping syndrome:
*[[Gastrectomy]] (partial and total)
*[[Esophagectomy]]
*Billroth I [[gastroduodenostomy]]
*Billroth II [[gastrojejunostomy]]
*[[Roux-en-Y]] [[gastric bypass surgery]]
*Antiulcer [[surgery]] ([[vagotomy]])
*Antireflux [[surgery]] ([[Nissen fundoplication]], especially in [[Pediatrics|pediatric]] patients)
*[[Cholecystectomy]]
*[[Pyloromyotomy]]
*[[Esophageal]] repair of [[esophageal atresia]]
*[[Laparoscopic surgery|Laparoscopic]] sleeve [[gastrectomy]] (LSG)


==Symptoms==
====Medical History====
Patients suffering from the following diseases are more prone to develop dumping syndrome:
*[[Diabetes mellitus|Diabetes Mellitus]]
*[[Zollinger-Ellison syndrome]]
*[[Ehlers-Danlos syndrome]]
*[[Peptic ulcer|Duodenal ulcer]]
*[[Exocrine gland|Exocrine]] [[Pancreatic insufficiency]]
====Social History====
The following post-surgical diet is associated with dumping syndrome:
*High [[carbohydrate]] ([[sugar]]) intake
== Symptoms ==
[[Symptom|Symptoms]] of [[Gastric dumping syndrome|dumping syndrome]] include [[diarrhea]], [[Syncope|fainting]], [[Palpitation|palpitations]], [[fatigue]], [[bloating]] as well as many others. The [[Symptom|symptoms]] can be subdivided as follows:<ref name="urlPhase II Study Evaluating Efficacy, Safety and Pharmacokinetics of Pasireotide in Patients With Dumping Syndrome - Full Text View - ClinicalTrials.gov">{{cite web |url=https://www.clinicaltrials.gov/ct2/show/NCT01637272?term=NCT01637272 |title=Phase II Study Evaluating Efficacy, Safety and Pharmacokinetics of Pasireotide in Patients With Dumping Syndrome - Full Text View - ClinicalTrials.gov |format= |work= |accessdate=}}</ref><ref name="pmid5507449">{{cite journal |vauthors=Sigstad H |title=A clinical diagnostic index in the diagnosis of the dumping syndrome. Changes in plasma volume and blood sugar after a test meal |journal=Acta Med Scand |volume=188 |issue=6 |pages=479–86 |year=1970 |pmid=5507449 |doi= |url=}}</ref><ref name="pmid20829078">{{cite journal |vauthors=Mine S, Sano T, Tsutsumi K, Murakami Y, Ehara K, Saka M, Hara K, Fukagawa T, Udagawa H, Katai H |title=Large-scale investigation into dumping syndrome after gastrectomy for gastric cancer |journal=J. Am. Coll. Surg. |volume=211 |issue=5 |pages=628–36 |year=2010 |pmid=20829078 |doi=10.1016/j.jamcollsurg.2010.07.003 |url=}}</ref>


Early rapid gastric emptying begins either during or right after a meal. Symptoms include:
{| class="wikitable" style="margin: 1em auto 1em auto"
{| class="wikitable" style="margin: 1em auto 1em auto"
|+ '''Cells left-aligned, table centered'''
|+ '''Symptom classification by Early Dumping or Late Dumping'''
! Duis || aute |
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + | Early dumping
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Late dumping
|-
|-
| dolor  || in reprehenderit |
|'''Abdominal'''
|'''Vasomotor/Systemic'''
| rowspan="2" valign="top" |
* [[Tremor]]
* [[Hunger]]
* [[Perspiration]]
* Difficulty [[Concentration|concentrating]]
* Decreased [[consciousness]]
|-
|-
| esse cillum dolore || eu fugiat nulla |
| valign="top" |
* [[Nausea and vomiting|Nausea]]
* [[Diarrhea]]
* [[Nausea and vomiting|Vomiting]]
* [[Bloating]]
* [[Borborygmus|Borborygmi]]
* [[Epigastric]] [[Satiety|fullness]]
| valign="top" |
* [[Pallor]]
* [[Fatigue]]
* [[Flushing]]
* [[Syncope]]
* [[Headache]]
* [[Diaphoresis]]
* [[Palpitation|Palpitations]]
* [[Lightheadedness and vertigo|Lightheadedness]]
* [[Desire]] to lie down
|}
|}
*[[Nausea]]
*[[Vomiting]]
*[[Bloating]]
*[[Cramping]]
*[[Diarrhea]]
*[[Dizziness]]
*[[Fatigue]]


Late rapid gastric emptying occurs 1 to 3 hours after eating. Symptoms include:
{| class="wikitable" style="margin: 1em auto 1em auto"
*[[Weakness]]
|+ '''Symptom classification by Sigstad's Score'''
*[[Sweating]]
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Most common
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Less common
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Least common
|-
|
*[[Shock]]
*[[Syncope|Fainting]]
*[[Syncope]]
*[[Unconsciousness]]
*[[Desire]] to lay down or sit down
*[[Dyspnea|Breathlessness]]
*[[Dyspnea]]
*Weakness
*[[Fatigue|Exhaustion]]
*[[Somnolence|Sleepiness]]
*[[Somnolence|Drowsiness]]
*[[Apathy]]
*Falling asleep
*[[Palpitation]]
*[[Agitation (emotion)|Restlessness]]
*[[Dizziness]]
*[[Dizziness]]
 
| valign="top" |
Early dumping
*[[Headache|Headaches]]
 
*Feeling of warmth
Symptoms of cramp-like contractions, bloating and diarrhoea in patients with a history of upper GI surgery may also occur as a consequence of complications such as stenosis, fistula formation, adhesions and ischemia. A marginal ulcer or gastritis is generally characterized by pain during meals, acid reflux, and nausea, and the diagnosis can be confirmed via gastroscopy. Symptoms of stenosis or anastomoses are similar to symptoms of marginal ulcer accompanied by dysphagia, and the diagnosis can be confirmed via gastroscopy or a barium or gastrografin swallow. Internal herniation generally results in pain, sometimes colic pain, a sensation of fullness quickly after meals, sometimes ileus and vomiting and no vegetative symptoms. A diagnosis of internal herniation can be confirmed via computed tomography or diagnostic laparoscopy. The main characteristics of obstipation are a feeling of fullness, pain and defecation only once in 3 days. Symptomatic gallstone disease is characterized by colicky pain attacks, with an urge to move, nausea, and, often, vomiting. Pain generally lasts for at least 1 h. Diagnoses can be confirmed with an ultrasound showing gallbladder stones and blood testing confirming liver function abnormalities after colic.
*[[Perspiration|Sweating]]
 
*[[Pallor]]
Late dumping
*[[Clammy]] [[skin]]
 
*[[Nausea and vomiting|Nausea]]
A differential diagnosis of hyperinsulinemic hypoglycemia is important in patients with late dumping symptoms. Late dumping occurs during the postprandial period (1-3 h after eating). In contrast, an insulinoma, which is extremely rare, should be considered if fasting hypoglycemia occurs (i.e. not provoked by a meal) [41, 42]. A fast of up to 72 h (usually 48 h) in a supervised hospital setting to assess hypoglycemia and the pathological lack of decrease in insulin secretion may be indicated in case of doubt [39, 41]. Surreptitious use of glucose-lowering medications (e.g. sulfonylurea derivatives or insulin) should also be excluded in each case, which can be determined via a sulfonylurea and C-peptide assay, respectively. In the case of hypoglycemia resulting from exogenous insulin injection, C-peptide levels are inappropriately low at the time of hyperinsulinemic hypoglycemia. Finally, postprandial syncope may be similar to loss of consciousness, and the two conditions may be difficult to differentiate, especially in elderly patients.
*[[Abdomen|Abdominal]] [[Satiety|fullness]]
Experiencing both forms of gastric emptying is not uncommon.
*[[Tympanites|Meteorism]]
*[[Borborygmus]]
| valign="top" |
*[[Burping|Eructation]]
*[[Nausea and vomiting|Vomiting]]
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs content]]
[[Category:Gastroenterology]]


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Latest revision as of 16:55, 18 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Umar Ahmad, M.D.[2]

Overview

The history of dumping syndrome has to do with surgeries or diseases that alter the motility or capacity of the stomach. The most common history of dumping syndrome is a bariatric surgery history. The most common symptoms of dumping syndrome are diarrhea, fainting, syncope, unconsciousness, desire to lay down or sit down, breathlessness, dyspnea, weakness, exhaustion, sleepiness, drowsiness, apathy, falling asleep, palpitation, restlessness, dizziness and shock.

History

The common surgical, medical and social history findings associated with dumping syndrome include:[1][2][3][4]

Surgical history

The following surgical procedures are associated with an increased risk of developing dumping syndrome:

Medical History

Patients suffering from the following diseases are more prone to develop dumping syndrome:

Social History

The following post-surgical diet is associated with dumping syndrome:

Symptoms

Symptoms of dumping syndrome include diarrhea, fainting, palpitations, fatigue, bloating as well as many others. The symptoms can be subdivided as follows:[5][6][7]

Symptom classification by Early Dumping or Late Dumping
Early dumping Late dumping
Abdominal Vasomotor/Systemic
Symptom classification by Sigstad's Score
Most common Less common Least common

References

  1. ↑ Tack J (2007). "Gastric motor disorders". Best Pract Res Clin Gastroenterol. 21 (4): 633–44. doi:10.1016/j.bpg.2007.04.001. PMID 17643905.
  2. ↑ MacGregor I, Parent J, Meyer JH (1977). "Gastric emptying of liquid meals and pancreatic and biliary secretion after subtotal gastrectomy or truncal vagotomy and pyloroplasty in man". Gastroenterology. 72 (2): 195–205. PMID 830568.
  3. ↑ Mayer EA, Thompson JB, Jehn D, Reedy T, Elashoff J, Meyer JH (1982). "Gastric emptying and sieving of solid food and pancreatic and biliary secretion after solid meals in patients with truncal vagotomy and antrectomy". Gastroenterology. 83 (1 Pt 2): 184–92. PMID 6919504.
  4. ↑ Vecht J, Masclee AA, Lamers CB (1997). "The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment". Scand. J. Gastroenterol. Suppl. 223: 21–7. PMID 9200302.
  5. ↑ "Phase II Study Evaluating Efficacy, Safety and Pharmacokinetics of Pasireotide in Patients With Dumping Syndrome - Full Text View - ClinicalTrials.gov".
  6. ↑ Sigstad H (1970). "A clinical diagnostic index in the diagnosis of the dumping syndrome. Changes in plasma volume and blood sugar after a test meal". Acta Med Scand. 188 (6): 479–86. PMID 5507449.
  7. ↑ Mine S, Sano T, Tsutsumi K, Murakami Y, Ehara K, Saka M, Hara K, Fukagawa T, Udagawa H, Katai H (2010). "Large-scale investigation into dumping syndrome after gastrectomy for gastric cancer". J. Am. Coll. Surg. 211 (5): 628–36. doi:10.1016/j.jamcollsurg.2010.07.003. PMID 20829078.

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