For gastric bypass weight loss surgery patients, an episode of dumping syndrome, or rapid gastric emptying, is physically dramatic and lifestyle altering. Prior to surgery, patients are instructed to avoid sweet processed carbohydrates, fatty fried foods, and all simple processed carbohydrates to avoid dumping syndrome. Some patients who become lactose intolerant with weight loss surgery (WLS) experience dumping after eating foods that contain lactose: milk sugar. While most patients adhere to dietary guidelines, it is inevitable that they will experience an episode of dumping syndrome at some point.
Gastric dumping syndrome occurs when chewed and partially digested food leaves the stomach too quickly and enters the small intestine. This causes the pancreas to release excessive amounts of insulin into the bloodstream and symptoms of hypoglycemia occur. Dumping syndrome is most commonly associated with gastric malabsorption surgery, specifically gastric bypass surgery. The symptoms of dumping syndrome will manifest immediately after eating or within three hours after eating. Each person is unique in gastric unloading response, however, common symptoms may include nausea, vomiting, bloating, cramps, diarrhea, profuse sweating followed by chills, dizziness, and fatigue. When insulin levels return to normal, the symptoms go away.
- Provide physical comfort: At the beginning of a discharge episode, the patient may first notice a feeling of disorientation or confusion. This indicates that the body is beginning to panic from excess insulin flooding the bloodstream. Someone who has experienced dumping in the past will probably feel a sense of despair upon becoming aware of the onset of dumping syndrome. Providing physical comfort at this time is the first response to a dumping episode. Efforts to interrupt or stop the dumping episode are futile. Many gastric bypass patients familiar with dumping prefer to isolate themselves from others in search of a cool place to lie down. Symptoms can include vomiting or diarrhea, so patients should find a quiet place near a bathroom. Many will experience a short period of profuse sweating followed by a longer period of chills – providing a blanket is helpful in relieving chills. A patient will reach for the blanket when needed, the caregiver should not attempt to cover the patient unless requested to do so. The patient may experience symptoms of sensory disturbance, including extreme and abnormal sensitivity to light, sound, and touch. These are transient symptoms and many patients find relief when the lights are dimmed and they rest in a noise-reduced environment. Many patients say they prefer not to be comforted by their caregiver’s touch due to acute sensitivity to touch during the shock event.
- Hydration and Electrolyte Drinks: Gastric bypass patients with dumping syndrome may have been mildly dehydrated prior to the dumping episode. It is important to return the body to a hydrated state by drinking room temperature water or sports drinks fortified with electrolytes. Patients should be discouraged from drinking sugary drinks or juices in an effort to correct the insulin imbalance. The body is already in a reactive and corrective state to the increase in insulin, and efforts to speed up the correction process are rarely successful.
- Seek emergency care: Patients should seek emergency medical attention when the symptoms of dumping syndrome last for a long period of time. If a patient becomes unconscious, immediately seek emergency medical attention and provide patient details, including bariatric procedure, history of diabetes or hypoglycemia, and an account of food intake prior to the dumping episode.
Not all weight-loss surgery patients experience dumping syndrome. It most commonly occurs in patients undergoing malabsorptive procedures, specifically gastric bypass. Adjustable gastric banding (gastric banding) and gastric sleeve patients are not known to have dumping syndrome. After an episode of dumping, patients should see their bariatric center to identify the cause of the event and make a plan to prevent future episodes.