Dumping syndrome: symptoms, causes, diet and how long it lasts

Macmillan Cancer Support explains that the stomach normally stores food and releases it into the bowel in a controlled way. After an operation to remove the stomach or part of the oesophagus, food can travel more quickly through the digestive system, and this can cause the symptoms called dumping syndrome.

The NHS lists food moving into the small bowel too quickly after you eat (dumping syndrome) among the changes after a gastrectomy that can cause problems, alongside weight loss, diarrhoea, vitamin deficiencies, acid reflux and narrowing of the join in the digestive system.

NHS Lanarkshire describes dumping syndrome as a group of symptoms that may be experienced after surgery when food moves too quickly into the small intestine, with symptoms that can appear immediately after eating or up to 4 hours after a meal.

Macmillan describes two patterns. Early dumping happens within 30 minutes of a meal because food enters the bowel quickly, drawing fluid into the bowel from the surrounding organs and tissues, which causes blood pressure to drop.

Late dumping usually happens a few hours after a meal, or when you have missed a meal, and is caused by low blood sugar levels. Many people have more of one type than the other, and some have both.

Macmillan says that if the symptoms do not stop, tell your cancer doctor or dietitian, and if they continue or are severe your doctor may give you medicine to help. The NHS says to speak to your care team if you have had a gastrectomy and feel dizzy, faint, sick or have tummy cramps after you eat, are losing weight quickly, have difficulty swallowing or feel that food is getting stuck, or have heartburn that will not go away.

The NHS says to get help from NHS 111 if you have had a gastrectomy and have a high temperature, wound problems, leg pain or swelling, or new breathlessness, and to call 999 or go to A&E for severe tummy pain not helped by painkillers, severe difficulty breathing, chest pain or coughing up more than a few spots of blood.

Macmillan lists measures that can help prevent or reduce early or late dumping, and NHS Lanarkshire gives similar advice.

• Eat slowly and chew food well.

• Eat small, frequent meals; the NHS suggests trying 6 small meals a day after a gastrectomy.

• Drink fluids slowly between meals rather than at mealtimes, leaving 15 to 30 minutes between eating and drinking.

• Eat foods that are high in protein, such as fish, meat and eggs, and foods high in starchy carbohydrates, such as pasta, rice, bread and potatoes.

• Avoid foods and drinks with a lot of added sugar, such as sugary cereals, sweet drinks and desserts; if you have them, eat slowly and have only small amounts. NHS Lanarkshire suggests sweeteners where necessary.

• Rest for 15 to 30 minutes straight after eating a meal (Macmillan); NHS Lanarkshire suggests lying down for 30 minutes and eating a snack if symptoms occur.

Macmillan Cancer Support and NHS Lanarkshire give very similar dietary advice. The table sets out the main points; follow the advice of your own dietitian or surgical team, who know your operation.

NHS Lanarkshire says surgery to the oesophagus and/or stomach can increase the risk of vitamin and mineral deficiency because of dietary restrictions, malabsorption or the surgery itself. You may become deficient in calcium, iron or vitamin B12, which can lead to weakened bones and anaemia, and your doctor should be monitoring your blood levels at least annually and recommending supplements as required.

It adds that once you have recovered and your weight is stable you should be able to return to a normal healthy diet as able, although many people need to continue a little-and-often approach because of reduced storage capacity. The NHS says a gastrectomy should not stop you living a full and active life, but you will need to make some changes to the way you eat.

It is not unusual to find life after surgery emotionally challenging, and a GP or specialist nurse can discuss support.

Macmillan says for most people the symptoms of dumping syndrome slowly reduce over time, and that many people find early dumping syndrome gets better on its own, with symptoms becoming less severe and less frequent after a few months.

If symptoms persist, a dietitian can review eating patterns, and a specialist can consider medicines. Because the pattern differs by operation and by person, the team that carried out the surgery is best placed to advise.

On the NHS, dumping syndrome is managed by the surgical team, specialist nurses and dietitians who looked after you for the operation, with GP support for blood tests and supplements. Referral back to the dietitian is the usual first step if symptoms are troublesome.

If surgery was done privately, ask the surgical team how follow-up with a dietitian will be arranged, and keep the GP informed so that blood tests for vitamins and minerals are continued.