Dumping syndrome is a condition characterized by the occurrence of severe weakness, dizziness, palpitations, a feeling of heat 10-15 minutes after a meal and is regarded as a reaction of the body’s adaptation to altered digestion processes.
Etiology, pathogenesis of dumping syndrome
The trigger mechanism of dumping syndrome is the accelerated intake of insufficiently processed, concentrated food, mainly easily digestible carbohydrates, from the stomach into the jejunum . Dumping syndrome occurs, as a rule, in patients after surgery on the stomach. Moreover, its severity depends on the nature of the operation. When the duodenum is switched off from the passage, the manifestations of dumping syndrome are more pronounced, but they can also be detected in unoperated patients. Neuromuscular mechanisms are involved in the occurrence and development of dumping syndrome, accompanied by redistribution of blood with an increase in its flow to the digestive canal organs and a violation of the central hemodynamics. In addition, to normalize the processes of absorption and create an isotonic environment, a significant amount of fluid enters the small intestine, which leads to hypovolemia. In dumping syndrome, there are a number of disorders of the digestive function of the stomach, small intestine, liver, and pancreas, due to their functional state and transferred surgical intervention.
Clinic of dumping syndrome
The clinic of dumping syndrome is very characteristic and manifests itself 10-15 minutes after eating. Clinical manifestations begin with a feeling of fullness in the epigastric region and are accompanied by an unpleasant feeling of heat in the upper half of the body or throughout the body. The perspiration sharply amplifies. Then come weakness, drowsiness, dizziness. In some cases, these phenomena reach such strength that the patient is forced to lie down. Attacks are accompanied by tachycardia, sometimes shortness of breath, headache, paresthesia in the upper and lower extremities, vasomotor rhinitis, polyuria. Dyspeptic phenomena during an attack are diverse: salivation, dry mouth, heartburn, belching. Very often there is rumbling in the abdomen, diarrhea at the end of the attack or some time after it. The intensity of the attacks can vary.
In a horizontal position, the general condition of the patient improves, which causes severe manifestations of dumping syndrome to take food in bed and lie for some time after eating. Dumping syndrome is most often triggered by dairy and carbohydrate foods.
Depending on the severity of clinical manifestations, there are 3 degrees of severity of the disease: I ( mild ) degree is characterized by periodically occurring short (15-20 minutes) seizures after ingestion of milk and carbohydrate foods. During an attack, the heart rate increases by 10-15 in 1 min, blood pressure can increase or decrease by 10-15 mm Hg . (1.3-2 kPa). The deficit of body weight does not exceed 5 kg. Performance saved. Drug treatment and the exclusion of foods that cause dumping syndrome from the diet gives a good effect. II ( moderate severity ) degree is characterized by attacks of weakness that constantly occur after eating, dizziness, pain in the heart, sweating, and diarrhea. The duration of attacks is 20-40 minutes with any nature of the food. During an attack, the pulse increases by 20-30 in 1 min, blood pressure rises by 15-20 mm Hg . (2-2.7 kPa). The deficit of body weight is 5-10 kg. Performance reduced. Conservative therapy “gives short-term effect. III of ( severe ) degree – persistent, pronounced attacks with kollaptoid – nym . Condition, diarrhea, do not depend on the nature and quantity of food intake, lasting about 1 hour during the attack on the pulse quickens 20-30 1 min, blood pressure decreases by 20-30 mm Hg (2.7-4 kPa). Weight deficit exceeds 10 kg. Patients are not able to work. Treatment is ineffective.
Forecast and workability of dumping syndrome
With a mild degree of severity of the dumping syndrome, the working capacity is not impaired, with an average – reduced, and with a severe one – patients are not able to work.