A 58-year-old man presents to his PCP complaining of a week of nausea, vomiting, diarrhea, and intermittent sharp epigastric pain. The patient has tried over the counter pain medications and antacids which have not helped with the symptoms. He denies having any chest pain, palpitations, difficulty breathing, cough, fevers, hematochezia, and melena. However, he notes mild generalized weakness, dizziness, and lightheadedness. Patient immigrated from Japan twenty years ago, and he has been operating his own restaurant handling seafood. Patient is a current smoker and drinks sake occasionally. He had a cholecystectomy five years ago and a partial gastrectomy for gastric ulcer a month ago. He takes multivitamins, atorvastatin, and omeprazole. Physical exam reveals stable vitals, mildly distended abdomen, and hyperactive bowel sounds.
Which of the following will be the most beneficial for the patient?
- A) Fluid repletion and monitor for self-resolution
- B) Start a low-fiber diet
- C) Start a high protein diet
- D) Start a high carbohydrate diet
- E) Discontinue the statin
C) Start a high protein diet
This patient’s presentation is concerning for dumping syndrome status post gastrectomy – a common complication. It can also occur after vagotomy, pyloroplasty, Roux-en-Y bypass, and esophagectomy. Accelerated gastric emptying into the small bowel without proper processing leads to GI symptoms such as nausea, vomiting, diarrhea, and abdominal pain; vasomotor symptoms such as weakness, fatigue, and syncope; and autonomic reactivity symptoms such as palpitations, tremor and irritability. A change in diet such as more frequent meals (around 6 per day) that are high fiber and high protein diet in smaller portions is one of the first steps in the management of dumping syndrome.
Dr. Raj Dasgupta