What operations produce dumping?

Surgical removal of most or all of the of the stomach (gastrectomy) nearly always involves the removal of  the valve at the bottom of the stomach (the pylorus). This may be for technical reasons  or because the disease requires this step.

In another operation called a gastroenterostomy the surgeon needs to by-pass the valve by making a communication between the stomach and the part of the intestine beyond the valve.  This may be necessary because the valve is blocked.

A third group of patients may have had an operation to cut the vagus nerves to their stomach (vagotomy).,.  the purpose being to reduce the amount of acid that the stomach makes. Unfortunately cutting these nerves not only reduces acid but also diminishes the muscle power of the stomach and so its ability to empty itself.  An operation to increase its drainage overcomes this problem but may lead to dumping. Fortunately modern vagotomy operations can leave the nerves to the valve (pylorus) intact.

How common is dumping?

This is a difficult question to answer because dumping is probably only an exaggeration of what happens in normal life.  We are all familiar with the feeling of abdominal fullness and sleepiness which can follow a large meal but symptoms are usually mild.

Dumping will be most noticeable soon after the operation and will be made worse by larger meals. Probably  20-50%  of patients who have recently undergone a stomach operation as described above will notice such symptoms, and those who do not probably have the same changes going on inside them, but their circulations are less sensitive to the fall in blood volume and their intestines are less sensitive to bloating

As time passes, the symptoms become less, until by twelve months after the operation fewer than 5% of patients still complain of symptoms.  The other 95% may also have them to a minor degree, but have learned to live with them.  This means that they have discovered ways of reducing the impact of the condition on their lives.

What is the Treatment?

Firstly, it is worth remembering that dumping usually improves without any treatment at all. If you are still experiencing symptoms a year after the operation, it would be well worth asking for help from your general practitioner or hospital consutlant.

Meanwhile, however, there are plenty of commonsense measures that you can take for yourself.  Since the symptoms are directly related to each meal, limit the size of your meals:   get up from a meal while you can still eat more. To ensure adequate nutrition, increase the number of meals you take.  This step is not always easy, especially if it does not fit in with your work-pattern.  Take plenty of vitamins, calcium and iron, because gastric operations may result in a tendency to be short of these.

Avoid the feeling of faintness by resting, at least sitting if not lying down, after the meal.  The symptoms usually last only 20-40 minutes, so try not to go straight back to your job or housework immediately after the break.  Again, this may be difficult to achieve.

Think about  what you eat.  Carbohydrates are rapidly broken down into small particles with a large osmotic effect, so you should minimise your intake of carbohydrates, especially of sugars.  Avoid sugar in all forms -jams, cakes and chocolate and in your tea and coffee. You may need to switch to artificial sweeteners, or make the decision to cut out sugar from beverages.

It is best not to have your cup of tea or coffee at the end of a meal, but to defer it for an hour to lessen the amount of fluid entering the bowel.