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DUMPING SYNDROME
Dumping syndrome occurs as an effect of altered gastric reservoir function, abnormal postoperative gastric motor function, and/or pyloric emptying mechanism. It can affect patients after gastric surgery (gastrectomy, vagotomy or pyloroplasty).
Dumping symptoms can be separated into early and late forms, depending on the occurrence of symptoms, in relation to the time elapsed after a meal.
PATHOPHYSIOLOGY:
Postprandially, the function of the body of the stomach is to store food and allow for initial chemical digestion by acid and proteases before transferring the food to the gastric antrum. Solids are then reduced to desired size, before they are able to pass through the pylorus.
An intact pylorus prevents the passage of larger food particles into the duodenum. Therefore, in this way, emptying is controlled and regulated.
AETIOLOGY:
Both early and late forms of dumping syndrome occurs because of rapid delivery of large amounts of osmotically active solids and liquids to the duodenum. This is a direct result of alterations in the storage function of the stomach and/or pyloric emptying mechanism.
However, the severity of dumping syndrome is determined by the rate of gastric emptying. Gastric surgery alters the rate and mechanism of gastric emptying; hence it is a major cause of dumping syndrome.
Any surgery in which the pylorus is removed, bypassed, or destroyed increase the rate of gastric emptying. Also, gastric mucosal function is altered by surgery and acid, and enzymatic secretions are decreased. This would affect the hormonal secretions that sustain the gastric phase of digestion, thereby making the food pass to the duodenum without initial digestion in the stomach.
Also, dumping syndrome is due to inappropriate composition of diet, with sugars being used as a carbohydrate source.
SIGNS AND SYMPTOMS:
1. Diarrhoea
2. Vomiting
3. Weight loss
4. Nausea.
5. Weaknes
6. Sweating
7. Faintness soon after eating.
Due to absence of stomach enzymes or the pyloric sphincter, food enters into the intestines directly and cause dumping.
DIET INDICATION
RATIONALE:
Rationale for diet modification in dumping syndrome is to slow down emptying of food from the stomach, to slow intestinal motility and to supply the body with enough fluid, vitamins and minerals that would help maximize patient’s nutritional status, with regular sugar meals.
HIGH PROTEIN, MODERATE FAT, LOW CARBOHYDRATE DIET (DIET PLAN)
DIET PATTERN
FOOD ALLOWED AND DISALLOWED
100 ─ 120g complex CHO daily Egg ─ 1 (soft or hard boiled)
Avoid simple sugars, Syrups, sweet deserts, etc Low fat milk : 300mls if tolerated
Include liberal protein and moderate fat Fish, poultry, meats of all kinds (boiled, not fried)
Include 6 small meals regularly, every day Bread substitutes: rice, boiled or mashed potato
Take liquids 30 ─ 60 minutes after meals Cereal (1 serving)
Include vegetables and mineral supplements,
Avoid very hot or cold food Vegetables, all fruits and nuts if tolerated (iron, calcium, folate, B12)
Therefore, this sample includes the following:
Calories ─ 1550
Fat ─ 62g
Protein ─ 87g
CHO (Complex) ─ 119g
Sodium ─ 2327mg
Potassium ─ 2372mg
SAMPLE
Breakfast ─ 1 egg, 1 teaspoon margarine, 2 bread slices, ½ grapefruit
Midmorning snack ─ 6 crackers (biscuits), 1─2 banana fingers
Lunch ─ ½ cup fresh fruit salad, brown rice
Snack ─ ½ turkey sandwich, with very little mayonnaise
Dinner ─ ½ chicken breast, wheat or semo and okro soup
Bed time snack ─ 1 small apple (60 minutes after meal)
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