Surgical operations on internal organs do not pass without a trace. One of the consequences of this intervention is dumping syndrome. The treatment of this functional pathology requires a thorough approach, as it affects the digestive system and leads to serious malfunctions in the life of the body.
What is dumping syndrome and why does it occur?
This pathology can develop both in the early and in the late postoperative period after an intervention on the stomach or intestines. In the International Classification of Diseases of the Tenth Revision (ICD), dumping syndrome has the code K91.1 and belongs to the category “Syndromes of the operated stomach”.
The essence of this disease is that food that enters the stomach does not have time to digest normally and enters the small intestine. As a result, the patient experiences seizures, the so-called dumping attacks during meals or after eating. Symptoms of dumping syndrome occur due to complications after surgical treatment of the stomach (resection of the organ, its complete removal, pyloroplasty). The disease is very common, as it occurs on average in two to three people after surgery. At risk, mostly women, in men, the disease is diagnosed much less often.
The name of the pathology speaks for itself. Translated from English, “dumping” means “dumping”, “unloading”. With this syndrome, an accelerated dumping of untreated food into the intestine also occurs. The disease is associated with numerous disorders, but at the same time its pathogenesis is still inaccurately studied.
It is only known that the process of passing the food lump (chyme) is accelerated due to the reduction in the length of the digestive tract. After undigested food enters the intestine, the process of its breakdown begins. Due to the absorption of an increased amount of glucose in the patient, there is a jump in the concentration of insulin in the blood with a subsequent drop in sugar level. This process is accompanied by malaise, headache, nausea, drowsiness.
Against the background of irritation of the mucosa of the small intestine, the intensity of blood flow increases and a large volume of fluid enters, which ultimately leads to stretching of the walls and diarrhea. Due to the decrease in the volume of circulating plasma, characteristic manifestations occur in the form of palpitations, increased weakness, sweating.
Causes of pathology
As already noted, this problem is more common in people who have had surgery on the organs of the gastrointestinal tract. Oncological diseases, the formation of a stomach ulcer or duodenal ulcer are often indications for surgical intervention. In addition, dumping syndrome often occurs after gastric bypass surgery in patients who are obese. The disease can be diagnosed in people who have not undergone any operations.
The immediate cause of the rapid evacuation of food from the stomach is a malfunction of the circular muscle, the pylorus, which is the border, the intersection of the duodenal bulb and stomach. Violation of this muscle function can be caused by dissection of the sphincter, the imposition of gastrojejunostomy - artificial digestive tracts, or direct removal of the pylorus.
After resection of the stomach, dumping syndrome develops against a background of impaired motor-evacuation function of the pylorus. In more than half of cases, the disease manifests itself in the first year after surgery. The imposition of gastrojejunostomy increases the risk of developing dumping syndrome, because because of it, the chyme enters the small intestine immediately. Some experts believe that the risk factor for the formation of such a pathology is the type of temperament. According to psychologists, the likelihood that the disease will occur in a choleric or melancholic person is much higher than in a phlegmatic person or sanguine person.
Could occur without surgery
In isolated cases, dumping syndrome occurs in those who did not have to go to bed under the surgeon’s knife. Such a pathology is fully functional in nature, since it appears against the background:
- chronic gastroduodenitis;
- stomach or duodenal ulcers;
- dehydration;
- ulcerative colitis;
- irritable bowel syndrome.
With these diseases, a failure in the motor-evacuation ability of the gastrointestinal tract often occurs, especially with a lack of fluid in the digestive system.
Varieties of pathology
First of all, the symptoms of dumping syndrome in each patient are of varying degrees of severity. The severity of the pathology distinguishes:
- Mild dumping syndrome - seizures usually provoke dairy products or sugar. The disease manifests itself as slight weakness and is felt within an hour, no more. Pathology does not affect general well-being, but at the same time, the patient has a loss of body weight. With mild dumping syndrome, the patient drops up to 5 kg.
- An illness of moderate severity - in this case, episodes can be repeated every day or several times a week. Any food can provoke an attack. With an average degree of dumping syndrome, blood pressure rises in patients, and weight loss can reach 10 kg. This condition requires treatment and strict preventive measures.
- Severe - the disease manifests itself regularly after each meal. Attacks can last 3-4 hours. In severe cases of the disease, it is important to provide the patient with the possibility of horizontal food intake. Patients with this form of pathology are assigned a disability group. There is a rapid process of losing weight, severe weakness, palpitations and a decrease in blood pressure. Methods of conservative treatment practically do not bring relief.
Regardless of the cause of the dumping syndrome, an attack can occur at any time of eating food. If the disease manifests itself in the first 10 minutes after the first sips of food, they speak of an early form. Dumping attack can be of different intensity. Most often, an attack is caused by liquid food, fresh milk, easily digestible carbohydrates. If the first symptoms do not stop eating, the patient will be aggravated. To facilitate health, the patient should take a horizontal position.
If the attack begins a few hours after eating, diagnose late dumping syndrome. The disease is accompanied by a drop in blood sugar against the background of the sudden release of a large volume of insulin, which for several hours continues to circulate in the blood and break down glucose. A sharp drop in blood sugar can lead to fainting and loss of consciousness.
What symptoms are observed
The manifestations of the disease, which could indicate its development, are diverse. The severity of symptoms depends on whether the excitation of which nervous system predominates - sympathetic or parasympathetic. So, with the sympatho-adrenal type of dumping syndrome, the signs of the disease are:
- unexpected blanching of the skin;
- bloating and flatulence;
- lack of full peristalsis;
- chronic constipation and problems with bowel movements;
- a sharp increase in body temperature;
- chills due to spasms of peripheral blood vessels;
- increased irritability;
- irritability.
In addition, the patient may experience numbness in the lower extremities, tremor may appear. Increased blood pressure and increased heart rate with dumping syndrome after gastrectomy are characteristic symptoms.
In the vagotonic type of the disease, when the departments of the parasympathetic nervous system are primarily involved, patients experience pain in the intestine, a decrease in blood pressure. After eating, the patient may be thrown into a fever, sweating increases, the activity of the salivary glands increases, and the pulse rate decreases. With vagotonic dumping syndrome, patients suffer from constant diarrhea.
There is another type of pathology - mixed, which combines the symptoms typical of both the sympathetic and parasympathetic forms. Manifestations of mixed dumping syndrome are accompanied by severe overexcitation.
About the diagnosis of the disease
Unlike chronic diseases of the gastrointestinal tract, dumping syndrome is almost impossible to detect at an early stage. Those clinical manifestations that occur in patients indicate fully occurring digestive disorders. Diagnosis of dumping syndrome involves a comprehensive examination, consultation with a gastroenterologist and psychologist.
For making a diagnosis, it is important to take an anamnesis, get acquainted with the patient's complaints, find out the provoking factors, the exact time of the onset of symptoms. Moreover, it is important to consider not only how long the signs of the disease have been manifested, but also how they are interconnected with meals, intolerance to specific products. Doubt about the diagnosis of dumping syndrome practically does not remain if the patient’s history of surgical treatment of the stomach is mentioned.
For the purpose of examination, the patient will have to pass several tests and undergo diagnostic procedures:
- general examination of blood and urine - the disease is confirmed by low rates of hemoglobin and red blood cells, the presence of sugar in the urine (this phenomenon is called by doctors as glucosuria);
- coprogram - a laboratory study of feces in order to identify undigested food fragments and fat particles;
- biochemical analysis of blood - is necessary in order to determine the level of electrolytes in the body, since with dumping syndrome there is a low level of potassium, sodium, calcium and chlorine.
In addition to laboratory tests, the patient will be prescribed radiography using a contrast medium. Since the gastrointestinal tract consists of abdominal organs, other methods for their visualization are considered ineffective. Before starting the diagnosis, the patient is injected with a contrast medium, which remains for some time in the upper gastrointestinal tract, which makes it possible to clarify the period of time when it is removed from the stomach or its stump, to reveal the anatomical features of the skinny and to evaluate the peristalsis of the small intestine.
Dump syndrome test: what is this test?
If the diagnosis is confirmed, it remains to clarify the severity and type of pathology. Diagnosis of dumping syndrome includes a special test, during which blood pressure is measured and the heart rate is calculated, then the patient is taken for analysis.
The second stage of diagnosis is as follows:
- the patient drinks 150 ml of sugar syrup (50% glucose solution);
- as soon as the attack begins, the examination is repeated;
- if glucose did not provoke a dumping attack, the pressure and pulse rate are counted after another 15 minutes and after a few hours to exclude late dumping syndrome.
Therapeutic diet
The main direction in the treatment of dumping syndrome is compliance with strict dietary restrictions. To control the course of the disease, you need to pay attention to the following points:
- adjust the diet, that is, remove foods provoking a dumping attack from it;
- monitor the diet;
- follow the principles of the diet menu.
The main recommendations for dumping syndrome on compiling a daily menu contain information about the preferred methods of processing products, the number of meals and the qualitative characteristics of the products. With this disease, it is necessary:
- to divide by 5-8 receptions the daily norm of food;
- you can cook food only by steam, simmer with a minimum amount of fat, bake, but at the same time prevent crusting, or boil in water;
- for several months after the operation to resect the stomach, you need to eat food in a homogeneous state, and only after that you can try to eat finely ground dishes;
- liquid and solid foods should be taken separately from each other (if this is soup, then first you need to drink a yushka, and then eat the rest).
In addition, in one meal, patients with dumping syndrome should not take food in large volumes, more than 200 ml. Also, fried foods that are too hot or too cold are not allowed. You can eat that food, the temperature of which is felt by the back surface of the brush is quite comfortable.
Carbohydrates can provoke an attack of dumping syndrome:
- bakery products;
- White bread;
- jam;
- honey;
- chocolate;
- marshmallows and other sweets;
- pasta;
- chips, crackers;
- dairy products;
- mayonnaise, ketchup;
- smoked meats;
- sausages.
Nutrition for dumping syndrome should be made taking into account the daily dietary norm. For a patient with a body weight of 75-80 kg, this amount of food per day is necessary:
- proteins - 140-160 g;
- carbohydrates - 300-350 g;
- fats - 100-110 g;
- salt - no more than 15 g.
At the same time, the calorie content of this volume of food should not exceed 3000 kcal per day.
What should be the menu
An example of creating a menu for the day:
- For breakfast - omelet made with two eggs, tea with sugar substitute.
- Second breakfast - low-fat cottage cheese, baked apple.
- Lunch - vegetable soup with boiled chicken breast.
- Snack - a boiled egg, compote of dried fruits without sugar.
- Dinner - fish cooked in the oven without spices, stewed vegetables, kefir.
If the recovery postoperative period is normal, the patient is expanded on a diet and new products are added to the menu.
Treatment methods
To improve the well-being of the patient, medications are prescribed. Treatment of dumping syndrome with drugs is considered effective only with mild to moderate severity of the disease. In severe cases, they often resort to surgical intervention.
Among the drugs that are necessarily prescribed for dumping syndrome, it is worth noting:
- enzyme-containing substitutes, including gastric juice, pancreatic enzymes (Panzinorm, Festal, Mezim);
- sedative drugs - to normalize the functioning of the central and autonomic nervous systems, stabilize the psychoemotional background ("Gidazepam", "Novo-Passit", "Adaptol"), can be used together with antidepressants and psychotropic drugs;
- antispasmodics - necessary to relieve spasms of the smooth muscles of the intestines and stimulate peristalsis (Atropine, Platifillin, Drotaverin);
- preparations for the production of biologically active substances and block their release into the blood ("Octreotide").
If drug treatment of dumping syndrome does not bring the expected relief, or the patient has developed a severe degree of pathology, the doctor may decide to perform the operation. Repeated intervention is performed to reconstruct nonfunctional areas of the duodenum. To slow down the process of emptying the stomach, a special small bowel transplant is implanted. This operation is called gastroejunoduodenoplasty.
Folk methods
It is difficult to say how effective alternative means are in treating this disease, but judging by the reviews, they are used to alleviate the symptoms of dumping syndrome. Clinical recommendations of specialists also often contain mention of alternative methods of therapy. As a rule, home remedies do not have contraindications and side effects, but it is still better to consult your doctor before use.
- Infusion of dried chamomile leaves. For cooking, take 2 tbsp. l medicinal chamomile, 1 tbsp. l St. John's wort flowers, as many sea buckthorn leaves and calendula flowers. The whole plant mixture is poured with 1 liter of boiling water and insisted all night. Take half a cup every 2 hours in order to relieve inflammation of the small intestine mucosa.
- Infusion of valerian and motherwort is prepared as follows: 2 tbsp. l dry plants pour 100 ml of boiling water, then cool, filter and drink from high pressure and heart rate for 1 tsp.
- Rosehip, St. John's wort, cinquefoil and licorice root need to pour 500 ml of water and put on the stove. Cook for 5 minutes, then allow to cool and strain. Drink 2 tbsp. l 20-30 minutes before meals.
How to prevent a disease
If there has been surgery on the stomach, the patient automatically falls into the risk group for the development of dumping syndrome. The treatment of this disease requires a lot of time and patience. To prevent pathology, you need to follow a diet and all the recommendations of a doctor after surgery. , , , .