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When symptoms of dumping syndrome occur during a meal or within 15 to 30 minutes following a meal, they may include:

• Nausea
• Vomiting
• Abdominal pain, cramps
• Diarrhea
• Dizziness, lightheadedness
• Bloating, belching
• Fatigue
• Heart palpitations, rapid heart rate

When signs and symptoms develop later, usually one to three hours after eating, they may include:

• Sweating
• Weakness, fatigue
• Dizziness, lightheadedness
• Shakiness
• Feelings of anxiety, nervousness
• Heart palpitations, rapid heart rate
• Fainting
• Mental confusion
• Diarrhea
• Low blood sugar (hypoglycemia)

Some people experience both early and late signs and symptoms. Conditions such as dizziness and heart palpitations can occur either early or late — or both. No matter when problems develop, however, they may be worse following a high-sugar meal, especially one that's rich in table sugar (sucrose) or fruit sugar (fructose).

Some people also experience low blood sugar (hypoglycemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Hypoglycemia is more often related to late signs and symptoms. Insulin influences your tissues to take up the sugar present in your bloodstream.

When to see a doctor
Contact your doctor if any of the following apply to you.

• You develop signs and symptoms that might be due to dumping syndrome, even if you haven't had surgery.
• Your symptoms worsen.
• You are losing large amounts of weight due to dumping syndrome. Your doctor may refer you to a registered dietitian to help you create the most appropriate eating plan.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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In dumping syndrome, food and gastric juices from your stomach move to your small intestine in an unregulated, abnormally fast manner. This accelerated process is most often related to changes in your stomach associated with surgery. For example, when the opening (pylorus) between your stomach and the first portion of the small intestine (duodenum) has been damaged or removed during an operation, dumping syndrome may develop.

Dumping syndrome may occur at least mildly in one-quarter to one-half of people who have had gastric bypass surgery. It develops most commonly within weeks after surgery, or as soon as you return to your normal diet. The more stomach removed or bypassed, the more likely that the condition will be severe. It sometimes becomes a chronic disorder.

Gastrointestinal hormones also are believed to play a role in this rapid dumping process.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Several types of stomach surgery increase your risk of dumping syndrome. These include:

• Gastrectomy, in which a portion or all of your stomach is removed. It typically includes removing the pylorus.
• Gastroenterostomy or gastrojejunostomy, in which your stomach is surgically connected directly to your small intestine beyond the pylorus, thus bypassing the pylorus. Doctors sometimes perform this operation in people with cancer of the stomach.
• Vagotomy, in which the nerves to your stomach are cut in order to lower the levels of acid produced by your stomach.
• Fundoplication, which is an operation sometimes performed on people with gastroesophageal reflux disease. It involves wrapping the upper portion of your stomach around the lower esophagus to apply pressure that reduces the reflux of gastric contents into the esophagus. However, on rare occasions, certain nerves to the stomach are unintentionally damaged during surgery, leading to dumping syndrome.
• Gastric bypass surgery (Roux-en-Y operation), which is performed to treat morbid obesity. It surgically creates a stomach pouch that's smaller than the entire stomach, meaning you're no longer able to eat as much as you once did, resulting in weight loss.

Certain underlying conditions and medications also may make you more susceptible to dumping syndrome. These include:

• Diabetes
• Cyclic vomiting syndrome (CVS)
• Zollinger-Ellison syndrome, which causes severe peptic ulcers
• Metoclopramide (Reglan), sometimes prescribed to ease nausea, vomiting and heartburn.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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In people with severe cases of dumping syndrome, marked weight loss and malnutrition may occur. Sometimes people who lose a lot of weight may also develop a fear of eating, related to the discomfort associated with the rapid dumping of undigested food. They may also avoid outdoor physical activity in order to stay close to a toilet. Some have difficulty keeping a job because of their chronic symptoms.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

If you have signs and symptoms of dumping syndrome, you're likely to first see your family doctor or a general practitioner. However, you may be referred to a doctor who specializes in treating digestive system disorders (gastroenterologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along. Sometimes it can be difficult to absorb all the information during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For dumping syndrome, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Other than the most likely cause, what are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• Is there a special diet I need to follow, and should I see a dietitian?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How long after eating do your symptoms begin?
• Have you noticed that certain foods make your symptoms worse?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Your doctor may use some of the following methods to determine if you have dumping syndrome.

• Medical history and evaluation. Your doctor can often diagnose dumping syndrome by taking a careful medical history and then evaluating your signs and symptoms. If you have undergone stomach surgery, that may help lead your doctor to a diagnosis of dumping syndrome.
• Blood sugar test. Because low blood sugar is sometimes associated with dumping syndrome, your doctor may order a test to measure your blood sugar level at the peak time of your symptoms to help confirm the diagnosis.
• Gastric emptying test. A test that uses radioactive material mixed with food measures how quickly the food moves through your stomach.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Most cases of dumping syndrome improve as people learn to eat better for the condition and as the digestive system adjusts. There's a good chance that changing your diet will resolve your symptoms. But if it doesn't, your doctor may advise medications or surgery to slow the emptying of your stomach's contents.

Medications
Your doctor may prescribe certain medications to slow the passage of food out of your stomach, and relieve the signs and symptoms associated with dumping syndrome. These drugs are most appropriate for people with severe signs and symptoms, and they don't work for everyone.

The medications that doctors most frequently prescribe are:

• Acarbose (Precose). This medication delays the digestion of carbohydrates. Doctors prescribe it most often for the management of type 2 diabetes, and it has also been found to be effective in people with late-onset dumping syndrome. Side effects may include sweating, headaches, sudden hunger and weakness.
• Octreotide (Sandostatin). This anti-diarrheal drug can slow down the emptying of food into the intestine. You take this drug by injecting it under your skin (subcutaneously). Be sure to talk with your doctor about the proper way to self-administer the drug, including optimal choices for injection sites. Long-acting formulations of this medication are available. Because octreotide carries the risk of side effects (diarrhea, bulky stools, gallstones, flatulence, bloating) in some people, doctors recommend it only for people who haven't responded to other treatments.

Surgery
Doctors use a number of surgical procedures to treat cases of dumping syndrome that are resistant to more-conservative approaches. Most of these operations are reconstructive techniques, such as reconstructing the pylorus, or they're intended to reverse gastric bypass surgery.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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Here are some dietary treatment strategies that your doctor may recommend and that you can do on your own:

• Eat smaller meals. Try consuming about six small meals a day rather than three larger ones.
• Avoid fluids with meals. Drink liquids only between meals. Avoid liquids for a half-hour before eating and a half-hour after eating.
• Change your diet. Consume more low-carbohydrate foods. In particular, concentrate on a diet low in simple carbohydrates, such as sugar (found in sweets like candy, cookies and cakes). Read labels on packaged foods, and avoid foods with sugar, including glucose, sucrose, fructose, dextrose, honey and corn syrup. Consume more protein. It may help to see a registered dietitian.
• Chew well. Chewing food thoroughly before you swallow can ease digestion.
• Increase fiber intake. Psyllium, guar gum and pectin in food or supplements can delay the absorption of carbohydrates in the small intestine. Pectin is found in many fruits, such as peaches, apples and plums.
• Avoid alcohol.
• Stay away from acidic foods. Tomatoes and citrus fruits are harder for some people to digest.
• Use low-fat cooking methods. Prepare meat and other foods by broiling, baking or grilling.
• Consume adequate vitamins, iron and calcium. These can sometimes become depleted following stomach surgery. Discuss this nutritional issue with a registered dietitian.
• Lie down after eating. This may slow down the movement of food into your intestines.

Even with dietary changes, you may continue to experience symptoms associated with dumping syndrome.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Some people use supplements such as pectin, guar gum, black psyllium and blond psyllium to improve the symptoms associated with dumping syndrome. If you decide to try a supplement, discuss it with your doctor to learn about any potential side effects or interactions with other medications you're taking.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

You can't prevent dumping syndrome. However, measures such as dietary adjustments may prevent recurrences of your symptoms or minimize their severity.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.