Gastric dumping syndrome pathophysiology: Difference between revisions
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*Dumping is also common for [https://www.wikidoc.org/index.php/Esophageal_cancer esophageal cancer] patients who have had an [https://www.wikidoc.org/index.php/Esophagectomy esophagectomy]; surgery to remove the cancerous portion of their esophagus. The [https://www.wikidoc.org/index.php/Stomach stomach] is pulled into the chest and attached to what remains of the esophagus, leaving a short digestive tract. Both early and late dumping syndrome can occur. | *Dumping is also common for [https://www.wikidoc.org/index.php/Esophageal_cancer esophageal cancer] patients who have had an [https://www.wikidoc.org/index.php/Esophagectomy esophagectomy]; surgery to remove the cancerous portion of their esophagus. The [https://www.wikidoc.org/index.php/Stomach stomach] is pulled into the chest and attached to what remains of the esophagus, leaving a short digestive tract. Both early and late dumping syndrome can occur. | ||
* | *Patients with [https://www.wikidoc.org/index.php/Connective_tissue connective tissue] conditions such as [https://www.wikidoc.org/index.php/Ehlers-Danlos_syndrome Ehlers-Danlos syndrome] can experience "late" dumping as a result of decreased motility. | ||
*In addition, people with this syndrome often suffer from low blood sugar, or [https://www.wikidoc.org/index.php/Hypoglycemia hypoglycemia], because the rapid "dumping" of food triggers the [https://www.wikidoc.org/index.php/Pancreas pancreas] to release excessive amounts of [https://www.wikidoc.org/index.php/Insulin insulin] into the bloodstream. This type of hypoglycemia is referred to as "alimentary hypoglycemia". | *In addition, people with this syndrome often suffer from low blood sugar, or [https://www.wikidoc.org/index.php/Hypoglycemia hypoglycemia], because the rapid "dumping" of food triggers the [https://www.wikidoc.org/index.php/Pancreas pancreas] to release excessive amounts of [https://www.wikidoc.org/index.php/Insulin insulin] into the bloodstream. This type of hypoglycemia is referred to as "alimentary hypoglycemia". | ||
Revision as of 22:00, 14 November 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]
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Overview
The exact pathogenesis of dumping syndrome is not fully understood. Relatively few recent studies have been devoted to elucidating the mechanisms involved in early and late dumping syndromes, and much of our current knowledge is based on older literature[1]. Symptoms of early and late dumping syndrome appear to be caused by distinct pathophysiological mechanisms.
Pathophysiology
Pathogenesis
Dumping syndrome occurs secondary to various conditions such as after gastric surgery (especially on taking meals high in carbohydrates after the procudure), diabetes mellitus, Zolinger-Ellison syndrome, and Ehler-Danlos syndrome. The pathogenesis of dumping syndrome varies according to the etiology but the most essential component is the increased gastric emptying. The exact reason isn't yet concluded, although several known phenomena may contribute to the development of early dumping symptoms.[2]
Flowchart
The following flow chart outlines the major events involved in the pathogenesis of dumping syndrome:[3][4]
| Hyperosmolar meal | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rapid glucose absorption into the blood | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyperglycemia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rapid emptying of stomach | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fluid shift from blood to gut | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Release of hormones : • VIP • GIP • PYY • GLP-1 • Neurotensin | Excessive insulin release | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Reactive hypoglycemia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Symptoms | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Surgical pathogenesis
- Removal of a part of the stomach can cause the contents to not digest and flow down undigested in a hyperosmolar manner. This hyperosmolar chyme will cause an osmotic shift from the blood circulation to the intestinal lumen . This my may cause hypotension which will in turn activate the sympathetic nervous system and its associated side effects.
- Alteration of the pyloric muscle that holds the gastric contents till complete digestion, will cause a free fall of gastric contents into the small intestine. This rapid descent will cause an osmotic shift leading to hypotension which will activate the sympathetic nervous system and its associated side effects.
- Removal of a part of the stomach and small intestine will cause bypassing of the gastric contents straight through to the ileum or jejunum which can cause rapid descent and osmotic shifting.
Non-surgical pathogenesis
- Dumping syndrome is most common in patients with certain types of stomach surgery, such as a gastrectomy or gastric bypass surgery, that allow the stomach to empty rapidly. Dumping syndrome can also occur as a result of complications after a cholecystectomy (gallbladder removal).[1]
- Patients with Zollinger-Ellison syndrome, a rare disorder involving extreme peptic ulcer disease and gastrin-secreting tumors in the pancreas, may also have dumping syndrome.
- Dumping is also common for esophageal cancer patients who have had an esophagectomy; surgery to remove the cancerous portion of their esophagus. The stomach is pulled into the chest and attached to what remains of the esophagus, leaving a short digestive tract. Both early and late dumping syndrome can occur.
- Patients with connective tissue conditions such as Ehlers-Danlos syndrome can experience "late" dumping as a result of decreased motility.
- In addition, people with this syndrome often suffer from low blood sugar, or hypoglycemia, because the rapid "dumping" of food triggers the pancreas to release excessive amounts of insulin into the bloodstream. This type of hypoglycemia is referred to as "alimentary hypoglycemia".
Genetics
Gross Pathology
Microscopic Pathology
References
- ↑ Machella TE (1949). "The Mechanism of the Post-gastrectomy "Dumping" Syndrome". Ann. Surg. 130 (2): 145–59. PMC 1616289. PMID 17859417.
- ↑ 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.
- ↑ van Beek, A. P.; Emous, M.; Laville, M.; Tack, J. (2017). "Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management". Obesity Reviews. 18 (1): 68–85. doi:10.1111/obr.12467. ISSN 1467-7881.
- ↑ "www.practicalgastro.com" (PDF).