Materiały źródłowe

• #1 Dumping Syndrome: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/173594-overview

  Dumping syndrome is the effect of altered gastric reservoir function, abnormal postoperative gastric motor function, and/or pyloric emptying mechanism. […] Clinically significant dumping syndrome occurs in approximately 10% of patients after any type of gastric surgery and in up to 50% of patients after laparoscopic Roux-en-Y gastric bypass. Dumping syndrome has characteristic alimentary and systemic manifestations. It is a frequent complication observed after a variety of gastric surgical procedures, such as vagotomy, pyloroplasty, gastrojejunostomy, and laparoscopic Nissan fundoplication. Dumping syndrome can be separated into early and late forms, depending on the occurrence of symptoms in relation to the time elapsed after a meal. […] Accelerated gastric emptying of liquids is a characteristic feature and a critical step in the pathogenesis of dumping syndrome. Gastric mucosal function is altered by surgery, and acid and enzymatic secretions are decreased. Also, hormonal secretions that sustain the gastric phase of digestion are affected adversely. All these factors interplay in the pathophysiology of dumping syndrome.

• #1 Dumping Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470542/

  Dumping syndrome can occur after a variety of gastric procedures and occurs due to the rapid movement of hyperosmolar chyme from the stomach into the small intestine. […] Dumping syndrome is likely caused by the rapid movement of chyme. In patients without gastric surgery, digestion is initiated in the stomach, and the transition to the duodenum occurs progressively. Acid and proteases initiate the breakdown of food, promoting smaller food particles to be digested in the duodenum. This physiological process is weakened when there is surgical manipulation of this pathway. The pylorus bypass or alteration of the gastric innervation can produce effects of decreased stomach reserve or rapid transit of hyperosmolar food material into the duodenum. […] In addition, the enteric nervous system plays a major role in the regulation of gastric emptying, involving several gastrointestinal (GI) hormones and the extrinsic innervation.

• #1 Dumping Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20752

  Dumping syndrome is likely caused by the rapid movement of chyme. […] The pylorus bypass or alteration of the gastric innervation can produce effects of decreased stomach reserve or rapid transit of hyperosmolar food material into the duodenum. […] In addition, the enteric nervous system plays a major role in the regulation of gastric emptying, involving several gastrointestinal (GI) hormones and the extrinsic innervation. […] There are two types of problems that can arise from gastric surgery- early and late dumping syndromes. […] In early dumping, the symptoms usually occur within 10 to 30 minutes after a meal. […] The rapid transit of hyperosmolar chyme from the stomach into the duodenum causes fluid to shift from the vasculature to the intestinal lumen, leading to increased volume in the small bowel.

• #1 Pathophysiology, Diagnosis and Management of Postoperative Dumping Syndrome

  https://www.medscape.org/viewarticle/707838

  Dumping syndrome is a frequent complication of esophageal, gastric or bariatric surgery. Rapid gastric emptying, with the delivery to the small intestine of a significant proportion of solid food as large particles that are difficult to digest, is a key event in the pathogenesis of this syndrome. […] Studies conducted in the 1980s demonstrated that a defect in grinding or sieving within the stomach, which resulted in the delivery of a considerable proportion of solid food as large, less easily digested particles to the small intestine (rather than rapid emptying itself), was a key event in the pathogenesis of dumping syndrome. […] Rapid emptying of liquids from the stomach is an important contributor to the pathogenesis of dumping syndrome.

• #1 Dumping Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470542/

  There are two types of problems that can arise from gastric surgery- early and late dumping syndromes. […] In early dumping, the symptoms usually occur within 10 to 30 minutes after a meal. The rapid transit of hyperosmolar chyme from the stomach into the duodenum causes fluid to shift from the vasculature to the intestinal lumen, leading to increased volume in the small bowel. This is believed to be the cause of abdominal cramps, tachycardia, nausea, and diarrhea. […] Late dumping, also known as postprandial hyperinsulinemic hypoglycemia, usually occurs 1 to 3 hours after a high-carbohydrate meal. There is an association with hypoglycemia, but the exact mechanism is unknown. It is proposed that the rapid absorption of carbohydrates exaggerates the glucose-mediated insulin response.

• #1 International consensus on the diagnosis and management of dumping syndrome | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-020-0357-5

  Dumping syndrome is a common but underdiagnosed complication of gastric and oesophageal surgery. […] The panel agreed on the pathophysiological relevance of rapid passage of nutrients to the small bowel, on the role of decreased gastric volume capacity and release of glucagon-like peptide 1. […] Symptoms of early dumping syndrome are attributed to rapid passage of nutrients to the small intestine, which activates a cascade of pathophysiological events. […] The arrival of hyperosmolar contents in the small intestine triggers a shift of fluid from the intravascular component to the intestinal lumen, leading to decreased circulating blood volume, duodenal or jejunal distention and release of several gastrointestinal peptide hormones. […] The second mechanism involved in the pathophysiology of early dumping syndrome is probably enhanced release of several gastrointestinal hormones, including vasoactive agents, incretins and glucose modulators.

• #1 Dumping Syndrome | CEG

  https://www.dovepress.com/dumping-syndrome-pragmatic-treatment-options-and-experimental-approach-peer-reviewed-fulltext-article-CEG

  Dumping syndrome is a common complication after esophageal, gastric and bariatric surgery and has a significant negative impact on the quality of life of patients. […] Dumping syndrome consists of early and late dumping symptoms and can be diagnosed using clinical parameters with the help of the Sigstads score, questionnaires or by provocative testing. […] Upper gastrointestinal (GI) surgery can reduce gastric volume, remove the barrier function of the pylorus, or affect gastric motor function via vagal denervation. All these factors may lead to more rapid delivery of food into the small bowel. The hyperosmolar small bowel chyme may cause a fluid shift from the vascular compartment to the intestinal lumen, resulting in hypotension and occasionally even syncope. […] The occurrence of this fluid shift has previously been confirmed by a rise in hematocrit level in the first hour after meal ingestion or during dumping provocation tests.

• #1 Dumping Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20752

  GI hormones such as enteroglucagon, pancreatic polypeptide, peptide YY, vasoactive intestinal polypeptide, glucagon-like peptide, and neurotensin have been evident with higher values after meals. […] Late dumping, also known as postprandial hyperinsulinemic hypoglycemia, usually occurs 1 to 3 hours after a high-carbohydrate meal. […] It is proposed that the rapid absorption of carbohydrates exaggerates the glucose-mediated insulin response.

• #1 Dumping Syndrome | CEG

  https://www.dovepress.com/dumping-syndrome-pragmatic-treatment-options-and-experimental-approach-peer-reviewed-fulltext-article-CEG

  A second mechanism involved is the enhanced release of various gastrointestinal hormones resulting in (1) stimulation of gastrointestinal motility and secretion, and (2) enhanced release of vasoactive agents affecting both abdominal and systemic blood flow and vasomotor function. […] Postprandial hypoglycemia (PPH) occurs more often after bariatric surgery. […] The terms PPH and late dumping are used interchangeably. Some authors, however, differentiate the two conditions because of differences in the time of onset after surgery: dumping developing shortly after surgery (weeks), while hypoglycemia typically manifests at a later stage, months or sometimes years after bariatric surgery. […] Most importantly, the pathophysiology of dumping and PPH is identical and, in our opinion, PPH should be seen and treated as a late dumping manifestation.

• #1 What Is Dumping Syndrome?

  https://www.uspharmacist.com/article/what-is-dumping-syndrome

  Dumping syndrome (DS) occurs when the stomach empties food into the small bowel at a faster rate than normal. […] Although the precise mechanism of DS is not known, dumping is a phenomenon usually caused by the destruction or bypass of the pyloric sphincter. […] It is believed that the osmotic gradient draws fluid into the intestine, and this may release one or more vasoactive hormones, such as serotonin and vasoactive intestinal polypeptide. […] Early DS refers to dumping that usually happens within 10 to 30 minutes after eating. […] Due to the hyperosmolality of the food, fast fluid shifts from the plasma into the bowel occur, causing hypotension and a sympathetic nervous system response. […] Late DS is currently referred to as postprandial hyperinsulinemic hypoglycemia (PHH) and is a rare complication of bariatric surgery.

• #1 SciELO Brazil – PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENTOF DUMPING SYNDROME AND ITS RELATION TO BARIATRIC SURGERY PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENTOF DUMPING SYNDROME AND ITS RELATION TO BARIATRIC SURGERY

  https://www.scielo.br/j/abcd/a/c85MgtFzcsLqhYTrrWNpHvM/

  The dumping syndrome may be present on bariatric surgical procedures; its prevalence may reach up to 50% in partial gastrectomy. It is probably the most common syndrome that follow gastrectomy. It is characterized by a set of vasomotor and gastrointestinal symptoms associated with rapid gastric emptying or sudden nutrients exposure to the small intestine. It occurs after complete or partial gastrectomy, thereby becoming a significant complication arising from certain types of bariatric procedures involving gastrectomy; it also can happens as a consequence of damage to the vagus nerve. […] The sudden presence of gastric contents in the proximal small intestine has the physiological response to release of bradykinin, serotonin and enteroglucagon, together with the extracellular fluid, leading to early symptoms (need to lie down, palpitations, hypotension, tachycardia, fatigue, dizziness, sweating, headache, flushing, heat sensation of satiety, epigastric pain and fullness, diarrhea, nausea, vomiting, cramps, bloating, and borborygmus) in less than 30 min. Within 90 min to 3 h, the late symptoms (sweating, tremor, trouble concentrating, loss of consciousness and hunger) appears due to high insulin secretion causing hypoglycemia.

• #1 Dumping Syndrome: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/173594-overview

  The accommodation response and the phasic contractility of the stomach in response to distention are abolished after vagotomy or partial gastric resection. […] The late dumping syndrome is suspected in the person who has symptoms of hypoglycemia in the setting of previous gastric surgery, and this late dumping can be proven with an oral glucose tolerance test (hyperinsulinemic hypoglycemia), as well as gastric emptying scintigraphy, which shows the abnormal pattern of initially delayed and then accelerated gastric emptying. […] Rapid delivery of a meal to the small intestine results in an initial high concentration of carbohydrates in the proximal small bowel and rapid absorption of glucose. This is countered by a hyperinsulinemic response. The high insulin levels stay for longer period and are responsible for the subsequent hypoglycemia. […] An exaggerated GLP-1 response likely plays an important role in the hyperinsulinemia and hypoglycemia in patients with late dumping.

• #1 Dumping Syndrome | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816042/all/Dumping_Syndrome?q=Hypoglycemia

  GI and vasomotor symptoms resulting from rapid gastric emptying and delivery of large amounts of hyperosmolar content into the small intestine. […] The pathogenesis of dumping syndrome is multifactorial. […] Alterations in the storage function of the stomach and/or the pyloric emptying mechanism lead to rapid delivery of hyperosmolar material into the intestine. Fluid shifts from the intravascular compartment into the bowel lumen lead to rapid small bowel distention and an increased peristalsis (early dumping). […] Supraphysiologic release of GI peptides/vasoactive mediators lead to paradoxical vasodilation in a relatively volume-contracted state. […] Reactive hypoglycemia occurs secondary to hyperinsulinemia caused by high concentration of carbohydrates in the proximal small intestine and rapid absorption of glucose (late dumping).

• #1 International consensus on the diagnosis and management of dumping syndrome | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-020-0357-5

  Rapid delivery of undigested carbohydrates to the small intestine might result in high concentrations of glucose that induce a hyperinsulinaemic response, resulting in subsequent hypoglycaemia and related late dumping syndrome. […] An exaggerated GLP1 response is the key mediator of the hyperinsulinaemic and hypoglycaemic effect that is characteristic of late dumping syndrome. […] Gastric surgery can reduce gastric volume or remove the barrier function of the pylorus, which allows rapid delivery of food into the small intestine. […] The literature is not clear on the relative prevalence of early dumping syndrome versus late dumping syndrome. […] The success of RYGB surgery is usually attributed to gastric volume reduction and calorie malabsorption secondary to the bypass of the small intestine, which leads to markedly changed eating behaviour and meal patterns.

• #1

  https://link.springer.com/article/10.1007/s10620-005-3046-2

  Exaggerated plasma concentrations of GLP-1 precede reactive hypoglycemia after oral glucose in gastrectomy patients, resulting in late dumping syndrome. […] Because sympathetic activation is thought to be a cause of early dumping, we hypothesized that exaggerated GLP-1 may contribute to the pathophysiology of early dumping syndrome. […] These results suggest that GLP-1 is involved in the pathophysiology of early dumping syndrome.

• #1 Dumping Syndrome: Updated Perspectives on Etiologies and Diagnosis – Practical Gastro

  https://practicalgastro.com/2014/10/18/dumping-syndrome-updated-perspectives-on-etiologies-and-diagnosis/

  Although the surgical treatment of peptic ulcer disease declined following the development of proton pump inhibitors, these surgeries are still performed for intractable disease. Additionally, accidental vagal nerve damage during Nissen fundoplications, as well as an increased number of gastric bypass surgeries, have kept DS very pertinent to current clinical practice. […] DS may also be associated with non-surgical etiologies, the most prominent being diabetes. Diabetes is a well-recognized etiology of rapid gastric emptying and is attributed to early vagal damage from Wallerian nerve degeneration. […] Our report highlights a patient population with a strong representation of non-surgical etiologies of DS. […] As we examined the non-surgical DS patients, we found a large proportion were idiopathic- an unexpected finding.

• #1 Gastroparesis and Dumping Syndrome: Current Concepts and Management

  https://www.mdpi.com/2077-0383/8/8/1127

  Gastroparesis and dumping syndrome both evolve from a disturbed gastric emptying mechanism. While gastroparesis results from significantly delayed gastric emptying, dumping syndrome is a consequence of increased flux of food into the small bowel. […] The occurrence of cardinal symptoms after ingestion of a meal in a patient with high pre-test probability should rise suspicion for the presence of gastroparesis or dumping syndrome. […] In early dumping syndrome, rapid transition of food into the small intestine results in a fluid shift (due to hyperosmolarity) and release of gastrointestinal hormones such as vasoactive substances (neurostatin, vasoactive intestinal peptide (VIP), incretins (gastric inhibitory polypeptide (GIP), GLP1) and glucose-modulators (insulin, glucagon). […] In late dumping, rapid absorption of glucose (due to the presence of undigested carbohydrates in the small intestine) increases incretin release (GLP1), which exaggerates insulin response. […] Although these mechanisms are typically and frequently seen as a postsurgical complication, dumping can also occur in the absence of previous surgery. […] Thus, diabetes can be associated with both delayed (see gastroparesis) and increased gastric emptying.

• #1 Dumping Syndrome: Updated Perspectives on Etiologies and Diagnosis – Practical Gastro

  https://practicalgastro.com/2014/10/18/dumping-syndrome-updated-perspectives-on-etiologies-and-diagnosis/

  Among etiologic factors of DS in our patient group, DM was the most common. […] Another important conclusion to draw from our study is the utility of the scintigraphic GET. This test is key in distinguishing the diagnosis of gastroparesis from DS. […] Many patients without a surgical history exhibit disabling DS symptoms in the setting of rapid gastric emptying. This included patients with DM2, those with a preceding gastroenteritis illness, and also those who had no predisposing factors for their symptoms.

• #1

  https://npistanbul.com/en/what-is-dumping-syndrome

  Dumping syndrome is a term that describes a condition where food leaves the stomach and passes quickly into the small intestine after gastric surgery or due to certain stomach diseases. […] The causes of dumping syndrome can be the following: Gastric Surgery: It commonly occurs after stomach surgery. In particular, this syndrome can be seen after stomach surgeries, stomach cancer treatment or extreme weight loss surgeries (bariatric surgery). Such surgeries can reduce stomach capacity or affect the connection between the stomach and the small intestine, which can cause food to pass quickly into the small intestine. […] Some stomach diseases can speed up gastric emptying and lead to this condition. For example, in a condition called gastroparesis, the stomach muscles do not work normally, which can cause food to leave the stomach quickly.

• #1

  https://journals.lww.com/ajg/fulltext/2018/10001/idiopathic_dumping_syndrome_in_patients_presenting.1185.aspx

  Dumping syndrome is a wellknown complication after gastric surgery. However, limited literature exists on idiopathic dumping syndrome. Our aim is to investigate the clinical characteristics of nonsurgical patients with rapid gastric emptying who present with unexplained chronic nausea. […] Patients with severe idiopathic rapid gastric emptying may present with nausea and gastroparesislike symptoms rather than vasomotor symptoms and diarrhea typically seen in postsurgical dumping syndrome; […] Over half of the patients had risk factors for abnormal gastric motility, such as diabetes, poor water load satiety tests, and gastric dysrhythmias, which may contribute to altered emptying rates; […] Physiological mechanisms underlying rapid gastric emptying warrants further investigations; […] Rapid gastric emptying should be considered in patients who present with chronic unexplained nausea without previous gastric surgeries.

• #1 American Nurse Today January 2018: Dumping Syndrome: Causes, Management, And Patient Education

  https://americannursetoday.mydigitalpublication.com/articles/dumping-syndrome-causes-management-and-patient-education

  Late dumping, which occurs in about 25% of patients, typically presents within 1 to 3 hours after eating. The rapid movement of carbohydrates into the intestine releases an excessive amount of insulin from the pancreas in an attempt to maintain normoglycemia, but ultimately resulting in hypoglycemia. The subsequent symptoms are a direct consequence of the hyperinsulinemic response: fatigue, difficulty concentrating, hunger, confusion, perspiration, tremors, and low blood glucose. […] Another factor that may play a role in the pathophysiology of both early and late dumping is increased secretion of GI hormones, although their exact mechanism is unclear. Hormones such as enteroglucagon, peptide YY, and glucagon-like peptide 1 are suspected to cause irregular GI motility, hemodynamic responses, and increased insulin release.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Dumping-Syndrome-Symptoms-and-Causes.aspx

  LDS is believed to be due to an overwhelming increase in insulin that leads to reactive hypoglycemia (i.e. low blood sugar level). It occurs anywhere between 1 to 3 hours after eating. The hypoglycemia associated with LDS causes symptoms such as: […] GLP-1 is thought to play a crucial role in LDS as it is a potent anti-hyperglycemic hormone. It is often found to have an elevated response in patients who have had operations that speed up gastric emptying and causes increased insulin secretion, further compounding hypoglycemia.

• #1 Dumping Syndrome | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816042/all/Dumping_Syndrome?q=Hypoglycemia

  Pancreatic islet cell hyperplasia, rather than late dumping, is thought to be the underlying mechanism for hyperinsulinemic hypoglycemia with nesidioblastosis after gastric bypass. […] A recent study showed glucagon-like peptide-1 (GLP1) played a key role in the pathogenesis of late hypoglycemia after gastric bypass.

• #1 Bariatric Surgery: Postoperative Concerns – American Society for Metabolic and Bariatric Surgery

  https://asmbs.org/resources/bariatric-surgery-postoperative-concerns/

  Dumping syndrome is a common side effect after Roux-en-Y Gastric Bypass (RNYGB) surgery. About 85% of gastric bypass patients will experience dumping syndrome at some point after surgery. The symptoms can range from mild to severe. […] Dumping usually occurs due to poor food choices. It is related to the ingestion of refined sugars (including high fructose corn syrup) or high glycemic carbohydrates. It can also occur with dairy products, some fats, and fried foods. These foods rapidly empty from the gastric pouch into the small intestine which triggers a cascade of physiologic events. […] Early dumping occurs as a result of rapid emptying of sugars or carbohydrates from the gastric pouch into the small intestine which causes the release of hormones (gut peptides) that effect blood pressure, heart rate, skin flushing and intestinal transit, leading to a light-headed, rapid heart rate and flushing sensation often accompanied by diarrhea. Late dumping symptoms are related to increased insulin after oral glucose (sugar) with subsequent hypoglycemia (low blood sugar).

• #1 Dumping after gastric bypass surgery: what you really need to know

  https://weightworks.nl/en/articles/dumping-syndrome-after-gastric-bypass-surgery-what-you-really-need-to-know/

  Dumping syndrome occurs frequently after gastric bypass surgery. Dumping refers to symptoms that occur when food passes from the stomach to the small intestine too quickly. When this happens, you may experience various abdominal symptoms. These symptoms occur because your body has trouble digesting and absorbing food quickly. This is because your stomach contents move to your small intestine too quickly due to the surgery. Dumping syndrome can occur with different types of gastric bypasses, such as the gastric bypass (GBP), mini gastric bypass (Mini GBP/OAGB), and gastric sleeve (GS). In both gastric bypass and Mini gastric bypass, part of your stomach is bypassed. This causes food to reach your small intestine faster. This increases the risk of dumping syndrome, especially if you eat a lot of sugars. With the gastric sleeve, a large part of your stomach is removed, leaving you with a smaller, tubular stomach. This can also lead to dumping syndrome, although the symptoms are often less severe than with the (mini) gastric bypass.

• #1 What Is Dumping Syndrome?

  https://www.uspharmacist.com/article/what-is-dumping-syndrome

  This phenomenon is not strictly due to alterations of osmotic gradients across the GI tract, but rather is thought to result from hypoglycemia following a postprandial insulin peak. […] Overall, dumping may contribute to weight loss, in part by causing the patient to modify his or her eating habits. […] The diagnosis is made primarily on clinical grounds. […] Treating for DS includes changes in how and what patients eat, medications, and, in some cases, surgery. […] Patients with intractable dumping symptoms in whom dietary and medical therapy are unsuccessful may require reoperation. […] The type of surgery recommended depends on the type of surgery that led to the DS.

• #1 AGEB – Dumping syndrome after bariatric surgery: prevalence, pathophysiology and role inweight reduction – a systematic review

  https://www.ageb.be/ageb-journal/ageb-volume/ageb-article/2115/Dumping%20syndrome%20after%20bariatric%20surgery:%20prevalence,%20pathophysiology%20and%20role%20inweight%20reduction%20%E2%80%93%20a%20systematic%20review/

  Dumping syndrome is a frequent and wellknown adverse event after bariatric surgery and covers a dynamic spectrum of early and late dumping. […] However, there is much uncertainty regarding the exact pathophysiology of dumping. […] The pathophysiology is complex and ambiguous. Currently available data do not support dumping as a necessary condition to induce weight loss after bariatric surgery.

• #1 Dumping syndrome: Causes, management, and patient education

  https://www.myamericannurse.com/dumping-syndrome/

  Another factor that may play a role in the pathophysiology of both early and late dumping is increased secretion of GI hormones, although their exact mechanism is unclear. […] DS isn’t life-threatening, but persistent symptoms can be alarming and cause physiologic and psychologic concerns. Severe dumping can be a precursor to several complications, including malnutrition and weight loss due to nutrient malabsorption and chronic diarrhea. […] Many patients with DS have symptoms similar to irritable bowel syndrome or gastroparesis (delayed gastric emptying), which can result in misdiagnosis. […] The Sigstad scoring system was developed in 1970 to aid in the diagnosis of DS. […] Diet is the most effective way to manage DS. […] If dietary modifications are ineffective, pharmacologic interventions are the next step.

• #1 Pathophysiology, diagnosis and management of postoperative dumping syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/19724252/

  Dumping syndrome is a frequent complication of esophageal, gastric or bariatric surgery. Rapid gastric emptying, with the delivery to the small intestine of a significant proportion of solid food as large particles that are difficult to digest, is a key event in the pathogenesis of this syndrome. This occurrence causes a shift of fluid from the intravascular component to the intestinal lumen, which results in cardiovascular symptoms, release of several gastrointestinal and pancreatic hormones and late postprandial hypoglycemia. […] Somatostatin analogs are the most effective medical therapy for dumping syndrome, and a slow-release preparation is the treatment of choice.

• #1 Dumping syndrome: Update on pathophysiology, diagnosis, and management

  https://lirias.kuleuven.be/4202188

  Dumping syndrome is a complex of gastrointestinal symptoms originally studied in peptic ulcer surgery patients. […] Current pathophysiological concepts and analyses of provocative tests has led to a clear definition of dumping syndrome, including both early and late dumping symptoms. […] The diagnosis relies on recognition of symptoms and signs in a patient with appropriate surgical history; and can be confirmed by provocative testing or registration of spontaneous hypoglycemia. […] The initial treatment focuses on dietary intervention, to which meal viscosity enhancers and/or the glycosidase inhibitor acarbose can be added. […] The most effective therapy is the use of short- or long-acting somatostatin analogues, which is however expensive and entails side effect issues. […] In case of refractory hypoglycemia, diazoxide or SGLT2 inhibitors can be considered, based on limited evidence. […] In refractory patients, continuous enteral feeding or (rarely) surgical reinterventions have been advocated, although not supported by solid evidence. […] A number of emerging therapies targeting intestinal propulsion, peptide hormone effects and hypoglycemic events are under evaluation.

• #2 Dumping Syndrome: Diagnosis, Treatment, Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17835-dumping-syndrome

  If your small intestine receives a concentrated serving of sugar content, it may set off alarms in your digestive system. Your small intestine may signal your pancreas to release extra insulin to regulate your blood sugar. This can cause your blood sugar to drop sharply (reactive hypoglycemia). This drop can cause faintness, shakiness and heart palpitations. […] Dumping syndrome most commonly happens as a complication of surgery on your stomach, or on your esophagus where it connects to your stomach. An estimated 20% to 50% of people who have had stomach surgery develop some symptoms of dumping syndrome. It’s most common in people who have had surgeries that remove or bypass large portions of the stomach, such as gastrectomy or gastric bypass surgery. […] Under normal circumstances, dumping syndrome is not dangerous or life-threatening. A severe case can cause rapid weight loss and nutritional deficiencies. Persistent, unmanaged diarrhea can cause dehydration, but these complications can usually be managed or prevented with self-care. Most people have mild symptoms that ease over time. Dumping syndrome is not usually permanent.

• #2 Dumping syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dumping-syndrome/symptoms-causes/syc-20371915

  Dumping syndrome is a condition in which food, especially food high in sugar, moves from your stomach into your small bowel too quickly after you eat. […] In dumping syndrome, food and gastric juices from your stomach move to your small intestine in an uncontrolled, abnormally fast manner. This is most often related to changes in your stomach associated with surgery, including any stomach surgery or major esophageal surgery, such as removal of the esophagus (esophagectomy). […] Late dumping syndrome starts 1 to 3 hours after you eat a high-sugar meal. It takes time for signs and symptoms to develop because after you eat your body releases large amounts of insulin to absorb the sugars entering your small intestine. The result is low blood sugar.

• #2 Dumping Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20752

  Dumping syndrome is likely caused by the rapid movement of chyme. […] The pylorus bypass or alteration of the gastric innervation can produce effects of decreased stomach reserve or rapid transit of hyperosmolar food material into the duodenum. […] In addition, the enteric nervous system plays a major role in the regulation of gastric emptying, involving several gastrointestinal (GI) hormones and the extrinsic innervation. […] There are two types of problems that can arise from gastric surgery- early and late dumping syndromes. […] In early dumping, the symptoms usually occur within 10 to 30 minutes after a meal. […] The rapid transit of hyperosmolar chyme from the stomach into the duodenum causes fluid to shift from the vasculature to the intestinal lumen, leading to increased volume in the small bowel.

• #2 Dumping Syndrome | CEG

  https://www.dovepress.com/dumping-syndrome-pragmatic-treatment-options-and-experimental-approach-peer-reviewed-fulltext-article-CEG

  A second mechanism involved is the enhanced release of various gastrointestinal hormones resulting in (1) stimulation of gastrointestinal motility and secretion, and (2) enhanced release of vasoactive agents affecting both abdominal and systemic blood flow and vasomotor function. […] Postprandial hypoglycemia (PPH) occurs more often after bariatric surgery. […] The terms PPH and late dumping are used interchangeably. Some authors, however, differentiate the two conditions because of differences in the time of onset after surgery: dumping developing shortly after surgery (weeks), while hypoglycemia typically manifests at a later stage, months or sometimes years after bariatric surgery. […] Most importantly, the pathophysiology of dumping and PPH is identical and, in our opinion, PPH should be seen and treated as a late dumping manifestation.

• #2 What Is Dumping Syndrome?

  https://www.uspharmacist.com/article/what-is-dumping-syndrome

  Dumping syndrome (DS) occurs when the stomach empties food into the small bowel at a faster rate than normal. […] Although the precise mechanism of DS is not known, dumping is a phenomenon usually caused by the destruction or bypass of the pyloric sphincter. […] It is believed that the osmotic gradient draws fluid into the intestine, and this may release one or more vasoactive hormones, such as serotonin and vasoactive intestinal polypeptide. […] Early DS refers to dumping that usually happens within 10 to 30 minutes after eating. […] Due to the hyperosmolality of the food, fast fluid shifts from the plasma into the bowel occur, causing hypotension and a sympathetic nervous system response. […] Late DS is currently referred to as postprandial hyperinsulinemic hypoglycemia (PHH) and is a rare complication of bariatric surgery.

• #2 Dumping syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Dumping_syndrome

  Late dumping syndrome occurs 2 to 3 hours after a meal. It results from excessive movement of sugar into the intestine, which raises the body’s blood glucose level and causes the pancreas to increase its release of the hormone insulin. The increased release of insulin causes a rapid drop in blood glucose levels, a condition known as alimentary hypoglycemia, or low blood sugar.

• #2 International consensus on the diagnosis and management of dumping syndrome | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-020-0357-5

  Rapid delivery of undigested carbohydrates to the small intestine might result in high concentrations of glucose that induce a hyperinsulinaemic response, resulting in subsequent hypoglycaemia and related late dumping syndrome. […] An exaggerated GLP1 response is the key mediator of the hyperinsulinaemic and hypoglycaemic effect that is characteristic of late dumping syndrome. […] Gastric surgery can reduce gastric volume or remove the barrier function of the pylorus, which allows rapid delivery of food into the small intestine. […] The literature is not clear on the relative prevalence of early dumping syndrome versus late dumping syndrome. […] The success of RYGB surgery is usually attributed to gastric volume reduction and calorie malabsorption secondary to the bypass of the small intestine, which leads to markedly changed eating behaviour and meal patterns.

• #2 Dumping Syndrome: Symptoms, Causes | DHP Digestive Health Partners

  https://www.ncdhp.com/news/dumping-syndrome-information

  Dumping syndrome can occur after any type of stomach, gastric, or esophageal surgery. […] In early dumping syndrome, the rapid movement of food into the small intestine also causes fluid to move from the bloodstream to the small intestine also. This is what causes the bloating and diarrhea; and symptoms such as sweating and rapid heart rate are caused by substances released from the small intestine that speed up the heart rate, while at the same time lowering blood pressure. […] Late dumping syndrome has different causes than early dumping syndrome, and it typically occurs one to three hours after a meal. While both include rapid gastric emptying, late phase dumping syndrome occurs because of too much sugar and starch in your intestines. In late dumping syndrome, the influx of sugar causes your blood sugar level to rise. However, your pancreas then injects insulin into your cells, and too much insulin causes the opposite effect, which is low blood sugar (also known as hypoglycemia). […] Dumping syndrome treatment typically involves dietary changes. Those who have more severe, uncontrollable symptoms may be prescribed a medication known as octreotide. This medicine slows down the gastric emptying of your stomach and blocks the release of insulin.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Dumping-Syndrome-Symptoms-and-Causes.aspx

  LDS is believed to be due to an overwhelming increase in insulin that leads to reactive hypoglycemia (i.e. low blood sugar level). It occurs anywhere between 1 to 3 hours after eating. The hypoglycemia associated with LDS causes symptoms such as: […] GLP-1 is thought to play a crucial role in LDS as it is a potent anti-hyperglycemic hormone. It is often found to have an elevated response in patients who have had operations that speed up gastric emptying and causes increased insulin secretion, further compounding hypoglycemia.

• #2 Dumping Syndrome | CEG

  https://www.dovepress.com/dumping-syndrome-pragmatic-treatment-options-and-experimental-approach-peer-reviewed-fulltext-article-CEG

  Dumping syndrome is a common complication after esophageal, gastric and bariatric surgery and has a significant negative impact on the quality of life of patients. […] Dumping syndrome consists of early and late dumping symptoms and can be diagnosed using clinical parameters with the help of the Sigstads score, questionnaires or by provocative testing. […] Upper gastrointestinal (GI) surgery can reduce gastric volume, remove the barrier function of the pylorus, or affect gastric motor function via vagal denervation. All these factors may lead to more rapid delivery of food into the small bowel. The hyperosmolar small bowel chyme may cause a fluid shift from the vascular compartment to the intestinal lumen, resulting in hypotension and occasionally even syncope. […] The occurrence of this fluid shift has previously been confirmed by a rise in hematocrit level in the first hour after meal ingestion or during dumping provocation tests.

• #2 Dumping Syndrome: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/173594-overview

  Dumping syndrome is the effect of altered gastric reservoir function, abnormal postoperative gastric motor function, and/or pyloric emptying mechanism. […] Clinically significant dumping syndrome occurs in approximately 10% of patients after any type of gastric surgery and in up to 50% of patients after laparoscopic Roux-en-Y gastric bypass. Dumping syndrome has characteristic alimentary and systemic manifestations. It is a frequent complication observed after a variety of gastric surgical procedures, such as vagotomy, pyloroplasty, gastrojejunostomy, and laparoscopic Nissan fundoplication. Dumping syndrome can be separated into early and late forms, depending on the occurrence of symptoms in relation to the time elapsed after a meal. […] Accelerated gastric emptying of liquids is a characteristic feature and a critical step in the pathogenesis of dumping syndrome. Gastric mucosal function is altered by surgery, and acid and enzymatic secretions are decreased. Also, hormonal secretions that sustain the gastric phase of digestion are affected adversely. All these factors interplay in the pathophysiology of dumping syndrome.

• #2 Dumping syndrome: Causes, management, and patient education

  https://www.myamericannurse.com/dumping-syndrome/

  Dumping syndrome (DS), a well-established yet under-recognized side effect of upper GI surgery, occurs when the body reacts to food moving too rapidly from the stomach into the intestine, resulting in unpleasant symptoms such as a pounding pulse, sweating, dizziness, and nausea. […] DS clinical manifestations are categorized as either early or late, depending on how soon they begin after a meal. […] Early dumping, experienced by about 75% of those who report symptoms, occurs within 10 to 30 minutes after eating. Symptoms arise when the undigested food moves too quickly into the duodenum, causing fluid to shift from the surrounding tissues into the intestine to aid in the rapid dilution of the concentrated food. […] Late dumping, which occurs in about 25% of patients, typically presents within 1 to 3 hours after eating. The rapid movement of carbohydrates into the intestine releases an excessive amount of insulin from the pancreas in an attempt to maintain normoglycemia, but ultimately resulting in hypoglycemia.

• #2 Dumping Syndrome: Updated Perspectives on Etiologies and Diagnosis – Practical Gastro

  https://practicalgastro.com/2014/10/18/dumping-syndrome-updated-perspectives-on-etiologies-and-diagnosis/

  Although the surgical treatment of peptic ulcer disease declined following the development of proton pump inhibitors, these surgeries are still performed for intractable disease. Additionally, accidental vagal nerve damage during Nissen fundoplications, as well as an increased number of gastric bypass surgeries, have kept DS very pertinent to current clinical practice. […] DS may also be associated with non-surgical etiologies, the most prominent being diabetes. Diabetes is a well-recognized etiology of rapid gastric emptying and is attributed to early vagal damage from Wallerian nerve degeneration. […] Our report highlights a patient population with a strong representation of non-surgical etiologies of DS. […] As we examined the non-surgical DS patients, we found a large proportion were idiopathic- an unexpected finding.

• #2 Dumping Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20752

  GI hormones such as enteroglucagon, pancreatic polypeptide, peptide YY, vasoactive intestinal polypeptide, glucagon-like peptide, and neurotensin have been evident with higher values after meals. […] Late dumping, also known as postprandial hyperinsulinemic hypoglycemia, usually occurs 1 to 3 hours after a high-carbohydrate meal. […] It is proposed that the rapid absorption of carbohydrates exaggerates the glucose-mediated insulin response.

• #2 Dumping Syndrome | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816042/all/Dumping_Syndrome?q=Hypoglycemia

  Pancreatic islet cell hyperplasia, rather than late dumping, is thought to be the underlying mechanism for hyperinsulinemic hypoglycemia with nesidioblastosis after gastric bypass. […] A recent study showed glucagon-like peptide-1 (GLP1) played a key role in the pathogenesis of late hypoglycemia after gastric bypass.

• #2

  https://link.springer.com/article/10.1007/s10620-005-3046-2

  Exaggerated plasma concentrations of GLP-1 precede reactive hypoglycemia after oral glucose in gastrectomy patients, resulting in late dumping syndrome. […] Because sympathetic activation is thought to be a cause of early dumping, we hypothesized that exaggerated GLP-1 may contribute to the pathophysiology of early dumping syndrome. […] These results suggest that GLP-1 is involved in the pathophysiology of early dumping syndrome.

• #2 Dumping Syndrome | CEG

  https://www.dovepress.com/dumping-syndrome-pragmatic-treatment-options-and-experimental-approach-peer-reviewed-fulltext-article-CEG

  The reported incidence and prevalence of dumping syndrome varies widely and depends on (1) which definition and diagnostic criteria are used, and (2) the type and extent of surgery performed. […] The cause of dumping syndrome has shifted from post-upper GI surgery for benign gastric or duodenal ulcer disease to the majority of dumping syndrome being due to post-bariatric surgery and upper gastrointestinal oncologic surgery nowadays. […] After conservative steps have failed to manage symptoms of dumping syndrome, continuous enteral feeding or surgical interventions can be considered. […] Continuous enteral feeding by a jejunostomy or tube in the remnant stomach avoids symptoms triggered by meals but is invasive, associated with complications and has therefore a limited place in the management of dumping syndrome.

• #2 Dumping after gastric bypass surgery: what you really need to know

  https://weightworks.nl/en/articles/dumping-syndrome-after-gastric-bypass-surgery-what-you-really-need-to-know/

  Dumping syndrome occurs frequently after gastric bypass surgery. Dumping refers to symptoms that occur when food passes from the stomach to the small intestine too quickly. When this happens, you may experience various abdominal symptoms. These symptoms occur because your body has trouble digesting and absorbing food quickly. This is because your stomach contents move to your small intestine too quickly due to the surgery. Dumping syndrome can occur with different types of gastric bypasses, such as the gastric bypass (GBP), mini gastric bypass (Mini GBP/OAGB), and gastric sleeve (GS). In both gastric bypass and Mini gastric bypass, part of your stomach is bypassed. This causes food to reach your small intestine faster. This increases the risk of dumping syndrome, especially if you eat a lot of sugars. With the gastric sleeve, a large part of your stomach is removed, leaving you with a smaller, tubular stomach. This can also lead to dumping syndrome, although the symptoms are often less severe than with the (mini) gastric bypass.

• #2 Dumping syndrome after bariatric surgery: prevalence, pathophysiology and role in weight reduction – a systematic review

  https://lirias.kuleuven.be/4118035

  Dumping syndrome is a frequent and wellknown adverse event after bariatric surgery and covers a dynamic spectrum of early and late dumping. […] Accelerated gastric emptying is generally considered to be the cause of gastrointestinal and vasomotor complaints. […] However, there is much uncertainty regarding the exact pathophysiology of dumping. […] The pathophysiology is complex and ambiguous. […] Currently available data do not support dumping as a necessary condition to induce weight loss after bariatric surgery.

• #2 Dumping syndrome: Causes, management, and patient education

  https://www.myamericannurse.com/dumping-syndrome/

  Another factor that may play a role in the pathophysiology of both early and late dumping is increased secretion of GI hormones, although their exact mechanism is unclear. […] DS isn’t life-threatening, but persistent symptoms can be alarming and cause physiologic and psychologic concerns. Severe dumping can be a precursor to several complications, including malnutrition and weight loss due to nutrient malabsorption and chronic diarrhea. […] Many patients with DS have symptoms similar to irritable bowel syndrome or gastroparesis (delayed gastric emptying), which can result in misdiagnosis. […] The Sigstad scoring system was developed in 1970 to aid in the diagnosis of DS. […] Diet is the most effective way to manage DS. […] If dietary modifications are ineffective, pharmacologic interventions are the next step.

• #3 Dumping Syndrome: Diagnosis, Treatment, Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17835-dumping-syndrome

  Dumping syndrome is a medical condition in which your stomach empties its contents into your small intestine more rapidly than it should. Its also called rapid gastric emptying. When your stomach empties too quickly, your small intestine receives uncomfortably large amounts of poorly digested food. This can cause symptoms of nausea, bloating, abdominal cramps and diarrhea. It can also cause sudden blood sugar changes. […] Uncontrolled gastric emptying means that the valve at the bottom of your stomach, the pyloric valve, simply opens and dumps everything out, before your stomach has finished digesting. When your small intestine receives this mass of under-digested food, it makes adjustments to try and accommodate it. It draws in extra fluid volume and releases extra hormones. These adjustments cause the symptoms that people experience shortly after eating.

• #3 American Nurse Today January 2018: Dumping Syndrome: Causes, Management, And Patient Education

  https://americannursetoday.mydigitalpublication.com/articles/dumping-syndrome-causes-management-and-patient-education

  Late dumping, which occurs in about 25% of patients, typically presents within 1 to 3 hours after eating. The rapid movement of carbohydrates into the intestine releases an excessive amount of insulin from the pancreas in an attempt to maintain normoglycemia, but ultimately resulting in hypoglycemia. The subsequent symptoms are a direct consequence of the hyperinsulinemic response: fatigue, difficulty concentrating, hunger, confusion, perspiration, tremors, and low blood glucose. […] Another factor that may play a role in the pathophysiology of both early and late dumping is increased secretion of GI hormones, although their exact mechanism is unclear. Hormones such as enteroglucagon, peptide YY, and glucagon-like peptide 1 are suspected to cause irregular GI motility, hemodynamic responses, and increased insulin release.

• #3 Dumping Syndrome | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816042/all/Dumping_Syndrome?q=Hypoglycemia

  Pancreatic islet cell hyperplasia, rather than late dumping, is thought to be the underlying mechanism for hyperinsulinemic hypoglycemia with nesidioblastosis after gastric bypass. […] A recent study showed glucagon-like peptide-1 (GLP1) played a key role in the pathogenesis of late hypoglycemia after gastric bypass.

• #3 Dumping Syndrome: Causes, Symptoms And Treatment

  https://www.netmeds.com/health-library/post/dumping-syndrome-causes-symptoms-and-treatment?srsltid=AfmBOooWqAkmotNoSitN6BrgNfk2ySuFBDpCt-xpKof6EJfnSdQOEYdo

  Dumping syndrome refers to a condition in which the stomach carries forward its components like food particles mainly sugars and peptic acids into the small intestine swiftly – at a pace much quicker than normal. Also known as rapid gastric emptying, dumping syndrome occurs commonly in individuals who have recently undergone gastrointestinal surgery. […] The primary reason for dumping syndrome is the fast movement of partially digested foods, as well as stomach acids and sugars from the stomach to the duodenum. This happens due to surgical procedures such as gastrectomy, gastric bypass, esophagectomy. […] Dumping syndrome arises in people with pre-existing gastrointestinal problems such as functional dyspepsia in which the upper digestive tract continuously moves food past the stomach, as well as nerve damage in the gut post esophageal surgery.

• #3 Dumping Syndrome | CEG

  https://www.dovepress.com/dumping-syndrome-pragmatic-treatment-options-and-experimental-approach-peer-reviewed-fulltext-article-CEG

  A second mechanism involved is the enhanced release of various gastrointestinal hormones resulting in (1) stimulation of gastrointestinal motility and secretion, and (2) enhanced release of vasoactive agents affecting both abdominal and systemic blood flow and vasomotor function. […] Postprandial hypoglycemia (PPH) occurs more often after bariatric surgery. […] The terms PPH and late dumping are used interchangeably. Some authors, however, differentiate the two conditions because of differences in the time of onset after surgery: dumping developing shortly after surgery (weeks), while hypoglycemia typically manifests at a later stage, months or sometimes years after bariatric surgery. […] Most importantly, the pathophysiology of dumping and PPH is identical and, in our opinion, PPH should be seen and treated as a late dumping manifestation.

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