Dumping syndrome: diagnosis, causes, treatment

Dumping syndrome is a disease that develops mainly after surgery, namely complete or partial removal of the stomach. This is the most common complication after such an operation. The disease occurs in both men and women, and gastroenterologists say that the latter are more common.

Although the main reason for the dumping syndrome is a resection of the stomach, the disease can also develop in people who have not been to the surgeon's table. This usually occurs in those patients who experience problems with the organs of the gastrointestinal tract. Clinically, the disease does not manifest additional symptoms and is characterized by dizziness and weakness, soreness, impaired stool, malfunction in the heart rhythm, etc. To clarify the diagnosis, a comprehensive examination is carried out, including a number of laboratory tests. Treatment is selected depending on the stage of the disease. In most cases, conservative methods are sufficient, but in especially severe cases, additional surgical intervention may be necessary.

Pathology Description

The essence of dumping syndrome is the rapid entry of undigested food into the duodenal cavity. Rapid emptying and ingestion of coarse, undigested fibers adversely affect the condition of the intestinal walls. The duodenum swells and swells significantly, which leads to the release of extravascular and vascular fluids, which contain nutrients needed by the body. The consequence of such losses is a weakening of the smooth intestinal muscles, as well as a violation of blood circulation and intestinal motility.

As a result of gastrectomy, that is, complete removal of the stomach, motor function is impaired, which leads to the development of dumping syndrome about a week after the operation. In addition, there is a disruption in the functioning of the gastrointestinal tract and endocrine system from the digestive process.

The most common indication for gastrectomy is a stomach ulcer or malignant lesion that affects most of the organ. The syndrome manifests itself most often as a consequence of the following surgical procedures:

1. Complete removal of the stomach according to the method of Bilbrot II.
2. Partial resection by Bilbrot I.
3. Stem or selective proximal vagotomy (the most rare cases of dumping syndrome).

There are also situations where the syndrome manifests itself in patients who have not undergone any operations. In the normal state, the slow and gradual advancement of the contents of the stomach, as well as the long process of digesting the food eaten, prevents the development of dumping syndrome. But every tenth person is at risk for this disease. As a rule, this is due to hormonal disorders in the following diseases:

1. Diabetes.
2. Disturbances in the work of the stomach or small intestine.
3. Enteritis and partial bowel obstruction.
4. The development of tumors and fistulas in the stomach.
5. Prolonged stress.

An unbalanced and irregular diet or overeating, as well as psycho-emotional instability can also provoke the development of dumping stomach syndrome.

Symptoms

Dumping syndrome goes through several stages of development. In this regard, the symptoms will vary depending on the stage of the disease.

The following symptoms are inherent in early dumping syndrome:

1. Weakness for no apparent reason.
2. Headache.
3. Dizziness.
4. Hyperhidrosis and flatulence.
5. Heart palpitations.
6. Anemia, manifested by pale skin.
7. Soreness in the epigastric region.
8. Constant thirst.
9. Diarrhea.
10. Nausea and vomiting.

Signs of a late stage

At a later stage, dumping syndrome is manifested by the following symptoms:

1. Weakness coming on sharply.
2. Pressure in the eyes.
3. Tremors and tremors.
4. A strong, not passing feeling of hunger.
5. Pain in the upper abdomen.
6. Pain and discomfort during bowel movements, as well as frequent urges to her.

The development of dumping syndrome will lead to increased and more vivid expression of symptoms such as:

1. Sleep disturbance and insomnia.
2. Dizziness, not allowing a person to be in a sitting position.
3. Fast fatiguability.
4. The emergence of anxiety, unfounded fears and obsessions.
5. Irritability and aggressiveness.
6. A sharp decrease or complete loss of appetite.
7. Weight loss up to exhaustion.
8. Partial or total disability.

Treatment of dumping syndrome after gastrectomy will be presented below.

Sympathoadrenal type

This type of pathology, like sympathoadrenal, is manifested by such external phenomena as:

1. Physical arousal.
2. Pallor of the skin.
3. Tingling in the fingers and tremors of the limbs.
4. Chills.
5. Cramps.
6. Headache.
7. Dry mouth.
8. Increased blood pressure and increased heart rate.
9. Sensation of anxiety.

Vagotonic type

Vagotonic dumping syndrome is characterized by the following symptoms:

1. Redness of the skin.
2. Hyperhidrosis.
3. Nausea.
4. Diarrhea.
5. Slow heartbeat.
6. Soreness in the abdomen.
7. Frequent urination.
8. Choking sensation.
9. Muscle weakness.
10. Heat in the upper half of the body.
11. Noise and ringing in the ears.
12. Visual impairment.
13. Dizziness.

Sometimes the symptoms are so severe that even getting out of bed can become an insurmountable obstacle for the patient.

Diagnosis of dumping syndrome

To correctly establish the diagnosis, a comprehensive examination will be required. At the initial stage, the following actions are carried out:

1. History taking, that is, oral interviewing of the patient. This will make it possible to determine the approximate duration of the disease, as well as to assess the intensity of symptoms. Thus, it is possible to determine the type of syndrome and the stage of its development.
2. The study of the medical history and lifestyle of the patient. This is done to identify the causes of the syndrome.
3. Examination of the patient, during which a skin examination, palpation of the abdomen and measurement of blood pressure and pulse are performed.

The doctor also prescribes a number of laboratory tests, including a general and biochemical blood test. These studies will show insulin, albumin, and glucose levels. Various dumping tests are also performed. This is necessary to determine the severity of the pathology.

Instrumental methods

Instrumental methods for examining a patient include radiography of the stomach using a contrast medium. During the manipulation, you can observe the rapid release of the operated stomach from its contents.

Differential diagnosis

In addition to the above methods, it is also necessary to conduct differential diagnostics with the following pathologies:

1. Insulinoma.
2. Crohn's disease.
3. Neuroendocrine neoplasm.
4. Intestinal obstruction.
5. Enteritis in chronic form.
6. Pancreatic insufficiency of the secretory type.

Sometimes a neurologist consultation is also prescribed.

How is dumping syndrome treated?

Treatment

The method of treatment directly depends on the type and stage of the disease. With a mild, initial form of the disease, conservative treatment methods can be dispensed with. With a moderate severity of the pathology, drug treatment can alleviate the condition of the patient, but not cure him to the end. In severe stages of the disease, surgery is prescribed.

A conservative treatment method includes the following:

1. High-calorie diet for dumping syndrome.
2. Compliance with the diet, it must be frequent and fractional.
3. The balanced content of vitamins and minerals in the diet.
4. Limited intake of carbohydrates and fluids.
5. Refusal of products that can cause a relapse of the disease.

Under the ban are teas and milk, jelly, cereals, soups and stewed fruit. Do not eat too hot or cold food, as well as semi-liquid and liquid dishes. Medical supportive therapy is also used to reduce intestinal motility and slow gastric emptying.