Rapid Gastric Emptying (Dumping Syndrome) Causes, Symptoms, Diagnosis, Treatment, Prevention

Rapid Gastric Emptying (Dumping Syndrome) Causes, Symptoms, Diagnosis, Treatment, Prevention

What is rapid gastric emptying?

Rapid gastric emptying, otherwise known as dumping syndrome, is a condition that occurs after stomach surgery. Rapid gastric emptying occurs if the lower portion of the small intestine, known as the jejunum, fills with food that has passed through the stomach without being fully digested.

Rapid gastric emptying is usually described as early and late dumping, with early dumping occurring very shortly after a meal, while late dumping usually occurs around 3 hours since eating. It is possible to suffer from early and late dumping syndrome.

Rapid gastric emptying can be worrying at first, but it is not a serious or life-threatening condition and it can usually be managed very effectively by making small changes to your diet and eating habits.

What are the causes of Rapid Gastric Emptying (Dumping Syndrome)?

The chief cause of rapid gastric emptying is stomach surgery. Following gastric surgery it can be difficult to control the movement of food through the digestive system, resulting in food which has not been fully digested being ‘dumped’ into the small intestine. Eating foods high in sugar and fat and dairy products can increase the risk of dumping syndrome.

Early symptoms of dumping syndrome are caused by undigested food being pushed into the small intestine, while symptoms of late dumping syndrome may be caused by a rise and rapid fall in blood sugar.

A rare condition called Zollinger-Ellison syndrome can also increase the risk of an individual developing dumping syndrome.

Symptoms of Rapid Gastric Emptying (Dumping Syndrome)

Symptoms of rapid gastric emptying usually differ according to whether an individual has early dumping syndrome or late dumping syndrome. 

Signs of early dumping syndrome include:

  • Nausea.
  • Feeling full (even if you have only eaten a small amount).
  • Severe diarrhoea.
  • Abdominal pain and cramps.
  • Sweating.
  • Feeling light-headed and dizzy.
  • Racing heartbeat.
These symptoms tend to develop around 30 to 60 minutes following eating.

Symptoms of late dumping syndrome include:

  • Tiredness and weakness.
  • Racing heartbeat.
  • Feeling hungry.
  • Loss of concentration and confusion.
  • Shaking and feeling dizzy and faint.
  • Sweating.
These symptoms usually develop around 2-3 hours after eating.

How is Rapid Gastric Emptying (Dumping Syndrome) diagnosed?

Doctors diagnose rapid gastric emptying primarily on the basis of symptoms in people who have had gastric surgery. Tests may be needed to exclude other conditions that have similar symptoms, such as irritable bowel syndrome.

Treatment for Rapid Gastric Emptying (Dumping Syndrome)

Medical management of dumping symptoms involves dietary changes, and at times, the use of medications. A change in diet is tried in most cases as the initial treatment. In moderate to severe cases, medications are taken to slow the stomach emptying and movement of food in the GI tract. Rarely, doctors recommend surgery.

Preventing Rapid Gastric Emptying (Dumping Syndrome)

If you have undergone gastric surgery your care team will advise you about eating and drinking after the procedure. It is important to follow this advice carefully. The steps listed above will help to prevent you from experiencing symptoms related to rapid gastric emptying. If you do experience symptoms lying down may help to ease discomfort.

Rapid Gastric Emptying (Dumping Syndrome) diet

Foods to avoid:

  • Sugary foods (cakes, biscuits and sweets).
  • Fizzy drinks.
  • Pastries and sweet bread.
  • Alcohol.
  • Dairy products.

Foods to eat:

  • Complex carbohydrates (pasta, rice and cereals).
  • Fruit and vegetables.
  • Plenty of water.
You may also be advised to take fibre supplements and change your eating habits. The following steps are often recommended:

  • Eat small meals on a regular basis: try to eat 5-6 small meals, rather than 3 large meals.
  • Chew your food well and cut it up into small, manageable pieces.
  • Have a drink around 30-60 minutes after eating, rather than with your food.
  • Replace sugar with sweeteners.
  • Stop eating when you start to feel full.
  • Have smaller portions.
If symptoms are more severe or persistent your doctor may prescribe medication or recommend surgery, but in the majority of cases these treatments will not be required.

Basic Dietary Guidelines for Dumping Syndrome

  • Eat smaller, more frequent meals. Eating 5 or 6 small meals more often will allow you to eat the equivalent of 3 regular meals without feeling full too fast. Eat slowly and chew all foods thoroughly. Sit upright while eating.
  • Solid foods account for most episodes of dumping. Symptoms are triggered more by solid food that requires breakdown in the stomach such as a piece of steak or pork chop rather than ground meat that is already broken down by the butcher.
  • Limit fluid consumption during meals. Drink liquids 30-60 minutes before or after meals instead of with meals.
  • Avoid nutrient-rich drinks since dumping syndrome is easily triggered by any rich emulsions such as a liquid nutritional supplement or a milk shake.
  • Eat fewer simple sugars. Foods high in simple sugar should be avoided because they pass through your stomach quickly and may cause diarrhea and cramping. Avoid or limit high sugary foods and beverages including the following examples: Kool-Aid, fruit juices/drinks, soda, cakes, pies, candy, doughnuts, cookies.
  • Eat more complex carbohydrates such as whole grains, pastas, potatoes, rice, breads, bagels, unsweetened cereals, etc.
  • Eat more foods high in soluble fiber. Foods high in soluble fiber slow stomach emptying and prevent sugars from being absorbed too quickly. The following examples are foods high in soluble fiber: apples, beets, Brussels sprouts, carrots, oats, spinach, pears.
  • Try increasing the amount of fats in your diet. Fats slow the stomach emptying and may help to prevent dumping syndrome from developing. Butter, margarine, mayonnaise, gravy, vegetable oils, salad dressings, and cream cheese are good choices; use some at all meals and snacks (for those trying to lose weight, an individual meal plan can be designed with a registered dietitian).
  • Increase the protein in your diet. Eat a protein containing food with each meal. Examples of high protein foods include the following: Eggs, meat, poultry, fish, milk, yogurt, cottage cheese, cheese, peanut butter.
  • If milk causes distress, try lactose-free milk. Milk and milk products are often not tolerated; reduce or avoid consumption if this it true for you. It will be important to ensure that adequate calcium and vitamin D are eaten in the diet.
If you have difficulty maintaining your weight, ask to meet with a registered dietitian to help you with a meal plan. One possibility is to drink a nutritional supplement for extra calories; unfortunately, some of these may worsen symptoms. If tried, drink slowly to prevent symptoms.

Most patients have relatively mild symptoms and respond well to dietary manipulations. In patients with low blood pressure after meals (feeling lightheaded or sweaty), lying down for 30 minutes may help. For patients that do not respond to the above dietary treatment, medications are sometimes given. The drug acarbose delays carbohydrate absorption and has been shown to help patients with late dumping. Another drug, octreotide, has been used with some success also. Octreotide is a synthetic form of somatostatin, a naturally occurring hormone in the body. Octreotide and somatostatin delay stomach emptying and exert a strong inhibitory effect on the release of insulin and several gut-derived hormones. Octreotide is a therapy used sparingly since this treatment significantly impairs digestion.

There are several newer agents that are also beginning to be used in attempt to slow gastric emptying (many of these are also used to treat patients with diabetes). In patients who do not respond to medical treatment, surgery is sometimes considered.