Dumping syndrome refers to a group of symptoms caused by rapid gastric emptying after gastrectomy, leading to gastrointestinal and vasomotor disturbances postprandially. It may also result from pancreatic islet stimulation, causing hyperinsulinemia and subsequent hypoglycemic syndrome. This condition is most commonly observed after Billroth II subtotal gastrectomy. Symptoms occurring within 30 minutes after a meal, typically 10–14 days post-surgery, are termed early dumping syndrome, often accompanied by hyperglycemia, hence also known as postprandial early hyperglycemic syndrome. Symptoms appearing 1–2 hours after a meal, accompanied by hypoglycemia, are referred to as late dumping syndrome or postprandial hypoglycemic syndrome.

bubble_chart Pathogenesis

Early-onset dumping syndrome is primarily due to the rapid increase of hypertonic food in the small intestine, jejunal distension, and the shift of plasma from blood vessels to the jejunum, leading to reduced blood volume. It is also associated with the release of serotonin and bradykinin from the intestinal mucosa, as well as dysfunction of the autonomic nervous system.

Late-onset dumping syndrome is caused by increased carbohydrates in the intestine, the release of intestinal glucagon, which stimulates pancreatic β-cells to secrete excessive insulin, resulting in hyperglycemia followed by hypoglycemia.

bubble_chart Clinical Manifestations

The manifestations include epigastric fullness, spasmodic abdominal pain, nausea, vomiting, borborygmus, belching followed by diarrhea; and vasomotor disturbance symptoms such as palpitation, vertigo, headache, pale complexion, dry mouth, profuse sweating, and postural hypotension.

The late dumping syndrome is mainly characterized by hypoglycemic symptoms, such as vertigo, weakness, palpitation, profuse sweating, epigastric emptiness and hunger sensation, anxiety, and nervousness.

bubble_chart Diagnosis

Based on medical history, typical symptoms of episodes, and fluctuations in blood sugar levels, this syndrome may be considered. For atypical cases, a provocation test can be performed by administering 150-200ml of 50% glucose solution or a large amount of high-sugar liquid food. If typical symptoms are induced, it can aid in diagnosis.

The primary treatment involves dietary management, including eating small, frequent meals, consuming solid foods, limiting sugary foods, opting for high-protein and high-fat foods, eating slowly, and lying flat for half an hour after meals. For delayed-onset episodes, drinking a small amount of sugar water can help alleviate symptoms. If medical treatment proves ineffective, converting a Billroth II gastrectomy to a Billroth I can significantly improve symptoms.