Dumping Syndrome After Esophagectomy
Dumping syndrome is a common complication after surgery for esophageal cancer. For most esophageal cancer patients, this unpleasant after-effect eases with time and lifestyle adjustments.
By Madeline R. Vann, MPH
Medically Reviewed by Pat F. Bass III, MD, MPH
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An esophagectomy, in which all or part of the esophagus is removed, is a common treatment for those with esophageal cancer. But the esophagus serves a vital function: It connects the mouth to the stomach, allowing food to be brought into the body. This cancer surgery can disrupt this otherwise smooth process.
Because of this disruption, many patients experience what is called dumping syndrome, which can be mildly unpleasant at best or lead to weight loss and malnutrition at worst.
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What Is Dumping Syndrome?
In a dumping syndrome episode, food and liquids “dump” into the small bowel too quickly, without being fully digested. This triggers a chemical response in the body, flushing excess water into the intestines, and causing the symptoms of dumping syndrome.
Symptoms may include:
- Stomachache and cramping
- Light-headedness or dizziness
- Feeling nauseated or generally unwell
- Diarrhea within 20 minutes of eating
- Rapid heartbeat
Effects of Dumping Syndrome
“Dumping syndrome occurs [often] in patients who have undergone esophagectomy,” explains Wayne L. Hofstetter, MD, associate professor and director of the esophageal surgery program at the University of Texas M.D. Anderson Cancer Center. “The reasons for it aren’t completely clear.”
In esophageal cancer patients who have had an esophagectomy, dumping syndrome probably occurs in part because their “capacity to store food is diminished,” says Dr. Hofstetter.
Hofstetter estimates that 85 percent of esophagectomy patients will experience some dumping episodes. Most of these cases will ease up within a few months after surgery. A smaller percentage of patients — about 5 percent — could experience “problematic” dumping which is recurrent and leads to malnutrition and weight loss.
“One of the things we struggle with after surgery is weight loss. We don’t want a loss of muscle mass,” observes Hofstetter. While most patients experience one or two dumping episodes with no ill effects, repeated or frequent episodes can lead to more serious health consequences in addition to a lower quality of life, warns Hofstetter.
“If you’re continually dumping, you’re getting no benefit from the food you’re eating,” he says. This is because the food is moving so quickly through the body that it cannot get the nutrients it needs.
Management of Dumping Syndrome
For most patients, dumping syndrome will end during the recovery period. Education about dietary changes and behavior change help reduce the number of episodes, says Hofstetter.
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Such changes include:
- Lightening meals.Eat six to eight small meals instead of one or two large meals a day. Large meals mean that too much food is passing through your system, triggering dumping syndrome as the quantity reaches your bowels. If you must have slightly larger meals, make them breakfast or lunch instead of dinner.
- Avoiding triggers.Certain foods, especially those high in fat and refined carbohydrates, are more likely to trigger dumping. “Stay off the junk food,” advises Hofstetter.
- Scheduling liquids.It is still important to stay hydrated — but a good idea to cut back on drinking liquids with a meal. Liquids add to the volume your digestive tract has to manage.
- Chewing thoroughly.This helps to start the process of digestion before food even reaches your stomach.
“Some people have problems with dumping syndrome because they are reluctant to change their habits,” says Hofstetter.
Most patients who follow these guidelines will avoid dumping syndrome. However, Hofstetter acknowledges some will experience what he calls “undeserved hits” — dumping episodes that occur even when you have done everything according to your doctor’s instructions. Since dumping can occur even among people who have not had surgery such as esophagectomy, some of these events may simply be unavoidable.
“As long as they are occurring less than once a week, it is not a major problem,” says Hofstetter.
When Dumping Syndrome Is a Problem
“The expected quality of life after esophagectomy is very high,” says Hofstetter. Most patients who experience repeated dumping syndrome may be able to get relief from medications and nutritional supplementation.
As a general rule, if your quality of life is compromised by events like dumping syndrome, it is important to tell your doctor and nutritionist so that you can work together to develop a strategy for managing dumping syndrome. Hofstetter emphasizes that letting your doctors know about your symptoms is key to your recovery.
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