For patients of gastric bypass weight loss surgery an episode of dumping syndrome, or rapid gastric emptying, is physically dramatic and lifestyle disruptive. Prior to surgery patients are instructed to avoid sweet processed carbohydrates, greasy fried food and all simple processed carbohydrates in order to avoid dumping syndrome. Some patients who become lactose intolerant with weight loss surgery (WLS) experience dumping after eating food that contains lactose: dairy sugar. While most patients comply with dietary guidelines it is inevitable that at some point they will experience an dumping syndrome episode.
Gastric Dumping Syndrome occurs when chewed and partially digested food exits the stomach too rapidly and enters the small intestine. This causes the pancreas to release excessive amounts of insulin into the bloodstream and symptoms of hypoglycemia occur. Dumping Syndrome is most commonly associated with malabsorptive gastric surgery, specifically gastric bypass surgery. The symptoms of dumping syndrome will manifest immediately after eating or within three hours of eating. Each person is unique in the gastric dumping response, however, the common symptoms may include nausea, vomiting, bloating, cramping, diarrhea, profuse sweating followed by chills, dizziness and fatigue. When insulin levels return to normal symptoms subside.
- Provide for Physical Comfort: At the onset of a dumping episode the patient may first notice a sense of disorientation or confusion. This indicates the body is beginning to panic over an excess of insulin flooding the bloodstream. One who has suffered from dumping previously will probably feel a sense of despair as they realize the onset of dumping syndrome. Providing for physical comfort at this time is the first response to a dumping episode. Efforts to interrupt or halt the dumping episode are futile. Many patients of gastric bypass familiar with dumping prefer to isolate from others finding a cool place in which to lie down. Symptoms may include vomiting or diarrhea so patients should find a restful place near a bathroom. Many will experience a short period of profuse sweating followed by a longer period of chills: providing a blanket is useful to relieve chills. A patient will reach for the blanket when it is needed, the caregiver should not attempt to cover the patient unless asked to do so. The patient may experience symptoms of sensory disorder including extreme and abnormal sensitivity light, sound, and touch. These are transient symptoms and many patients find relief when lights are dimmed and they are resting in a reduced-noise environment. Many patients say they prefer not to be comforted by touch from their caregiver because of acute sensitivity to touch during the dumping event.
- Hydration and Electrolyte Beverages: Gastric bypass patients who are suffering from dumping syndrome may have been mildly dehydrated prior to the dumping episode. It is important to return the body to a hydrated state by sipping room temperature water or electrolyte fortified sports beverages. Patients should be discouraged from partaking of sugar sweetened beverages or juice in an effort to correct the insulin imbalance. The body is already in a reactionary and corrective state to the insulin surge and efforts to speed-up the correction process are seldom successful.
- Seek Emergency Care: Patients should seek emergency medical care when the symptoms of dumping syndrome last for an extended period of time. If a patient loses consciousness immediately seek emergency medical care and provide details for the patient including the bariatric procedure, history of diabetes or hypoglycemia, and an account of food intake prior to the dumping episode.
Not all weight loss surgery patients experience dumping syndrome. It most commonly occurs in patients of malabsorptive procedures, specifically gastric bypass. Patients of adjustable gastric banding (lap-band) and gastric sleeve are not known to have dumping syndrome. Following an episode of dumping patients should consult their bariatric center to identify the cause of the event and make a plan to avoid episodes in the future.