Dumping syndrome, or rapid gastric emptying, occurs when food moves too quickly from the stomach to the bowel. Whilst it is very rare in those born with short-gap OA, it occurs relatively frequently in long-gap OA. There is good research on the condition in those with long-gap OA repaired by gastric pull-up. Hannon et al. (2020) (31) found 12% of their cohort were formally diagnosed with the condition, whilst 25% were symptomatic but had yet to be formally diagnosed. The research is scanty in those with jejunal or colonic interpositions, but there are a number of adults with these oesophageal replacements who have this diagnosis. However, even some with short-gap OA have dumping syndrome, secondary to anti-reflux surgery, and in fact anti-reflux surgery is the main cause of the condition in childhood. It has also been found in short-gap OA in the absence of anti-reflux surgery, and this is thought to be due to vagal nerve damage during repair triggering abnormal gastric emptying, alongside the congenital neuromuscular anomalies in oesophageal and gastric emptying. (59)
Early dumping systemic symptoms
Within the first hour after the meal, due to rapid transit of nutrients to the small intestine:
Early dumping gastrointestinal symptoms
Within the first hour after the meal:
Late dumping symptoms
Occurs one to three hours post meals:
Weight loss and lower body mass index (BMI)
There is good research to show that many patients lose weight post anti-reflux surgery or oesophageal surgery in adulthood, due to the symptoms of dumping syndrome and avoiding eating or modifying the diet to avoid symptoms. (60)
Whilst there are a number of investigations that can be used to aid in diagnosis, a symptom-based questionnaire can also be used whilst waiting for these to be done. All of the investigations below necessitate referral to secondary care:
Include a protein source at each meal, eg eggs, meat, poultry, fish, milk, yogurt, cheese, pulses and nuts. Foods high in soluble fibre slow gastric emptying and prevent sugars from being absorbed too rapidly. Foods high in soluble fibre include: broccoli, Brussels sprouts, carrots, nuts, oats, okra, peas, pears, prunes, pulses and soya beans.
Eat slowly and chew food thoroughly. Avoid alcohol. (59)
A multinational Delphi consensus process produced the following recommendations for diagnosis and management of dumping syndrome. (61)
The presence of symptoms suggestive of early or late dumping syndrome in a patient who has undergone oesophageal or gastric surgery should raise clinical suspicion. Patients often mention the need to lie down after meals due to profound weakness.
The modified oral glucose tolerance test is the preferred diagnostic method to confirm the diagnosis of dumping syndrome.
Dietary measures, focusing on low-volume meals with elimination of rapidly absorbable carbohydrates and delay of fluid intake, are the preferred initial approach.
In patients who do not respond to diet modification, the use of acarbose is recommended, especially for late dumping syndrome, but with an unclear effect on early dumping syndrome.
In patients who do not respond to diet and/or acarbose, somatostatin analogues can control symptoms of both early and late dumping syndrome. It is unclear whether short-acting analogues are superior to long-acting formulations.