Rapid gastric emptying: Has anyone had dumping stop and start again?

I'd take the time to explain it to you... but AI may be better. Also... stop in on any of our twice-weekly free EC and Esophagectomy Zoom calls. Need the one-touch link?

Yes, there is a connection: type 2 diabetes can be associated with dumping syndrome (DS), and the conditions can influence each other. Constant blood glucose monitoring is not typically the standard diagnostic method for DS, but it may be a useful tool for monitoring glucose fluctuations in complex cases or for managing treatment in everyday life.
Dumping Syndrome and Type 2 Diabetes
Shared Mechanism: While esophagectomy is a primary cause of DS due to rapid gastric emptying, type 2 diabetes (especially in late stages) can also cause rapid gastric emptying and autonomic neuropathy, which can lead to DS symptoms.
Late Dumping and Hypoglycemia: The "late" form of dumping syndrome (occurring 1-3 hours after a meal) is characterized by reactive hypoglycemia. This happens because the rapid influx of carbohydrates into the small intestine causes an excessive release of insulin, which then results in a sharp drop in blood sugar. This mechanism is a key area of interaction with glucose metabolism issues like diabetes.
Diabetes Remission vs. Risk: Interestingly, bariatric surgery (which also causes dumping syndrome) is often associated with the remission of type 2 diabetes. However, studies have also shown that the long-term risk of developing type 2 diabetes after gastric bypass may increase, or that DS patients with persistent T2D may have different pathophysiological mechanisms for hypoglycemia.
Blood Glucose Monitoring
Diagnostic Tools: The gold standard for diagnosing dumping syndrome is the oral glucose tolerance test (OGTT) or a mixed meal tolerance test (MMTT). These are provocative tests performed under medical supervision to measure blood glucose, pulse, and hematocrit levels at specific intervals (typically every 30 minutes for up to 3 hours). Capillary (finger prick) blood glucose measurements are not reliable for diagnosing hypoglycemia associated with DS.
Role of Continuous Glucose Monitoring (CGM): Constant or continuous glucose monitoring (CGM) is an increasingly used tool in research and clinical management.
Not for Primary Diagnosis: CGM is not recommended as the primary diagnostic test for DS because it can have false positives and does not capture other key markers like pulse rate or hematocrit changes.
Useful for Management: CGM can be very useful for monitoring glucose fluctuations in everyday life, detecting asymptomatic hypoglycemia, and helping patients and clinicians tailor dietary modifications and treatment plans.
In summary, a patient post-esophagectomy with DS symptoms (especially late dumping) should be evaluated for abnormal glucose fluctuations, and while constant monitoring isn't the primary diagnostic test, it can be an important part of long-term management and symptom control.

No diabetes at all. Just wondering if anyone else has had it go away completely then return again. Any tips for dealing with it when happening?

Hi Sue,
I too thought I had past the dumping phase for a while but it snuck back in. Food is not the only trigger for me. If I do any type of moderately strenuous work it will sometimes happen. If I go to an event where there are a lot of people it can sometimes happen. I treat it same way you do, although that sometimes creates a rollercoaster effect that I have to fight all day long. On occasion I use a continuous glucose monitor, it really helps tell a story of what exactly was the cause of the dumping and I can treat it before the glucose gets too low. I would highly recommend trying one of these if you can. I use the Dexcom 7. This one samples every five minutes. I am not diabetic.
A while back I was on a zoom call and was talking about this exact problem. One of the people on the call who is a long time survivor said "things are always changing". I have found this to true.

Sean

Thanks Sean

Hi Sue,
I had an esophajectomy 4.5 years ago.
Seems like everyone’s recovery is a little different.
Since the surgery I’ve been dealing with DS and slow GE.
An esophajectomy involves removing a portion of the Vagus nerve, which controls all of the digestive system,
including the pylorus, pancreas and intestines.
My BM’s were loose, green and sticky.
When I asked my physicians about it, I received a deer in the headlights response.
A couple years back I found a study that mentioned that anyone who has stomach surgery should be on
PERT (Pancreatic enzyme replacement therapy)
After a little research I purchased pancreatic enzymes from Pure encapsulations on Amazon $60.
The next day BM’s improved a lot!
Just after my surgery I went through 10 months of immunotherapy which destroyed my thyroid and who knows what else. It’s taken me awhile to get the correct medication and dosage, which came down to Armour Thyroid. The thyroid gland also helps regulate digestion. About 10 months ago I was able to get off of the pancreatic enzymes. My guess is either the damage to my vagus nerve during surgery has repaired itself or the Armour thyroid medication is working correctly.
I still have an issue with GE. I’ve had my pylorus dilated a couple of times. Didn’t really help.
During the initial surgery some surgeons will relax the pylorus by cutting the muscle (pyloromyotomy) or inject it with Botox. My surgeon is suggesting that I have this procedure. I’ve hesitated because the studies I’ve read have mixed reviews and I’m afraid it will create dumping issues.

If I may, I would like to share something I found out with the help of AI by asking it again and again for 'help' regarding my husbands problems with exactly all these symptoms. He has a massive problem with histamine, and his histamine intolerance caused in the end his surgery 4 years ago. In the last couple of months his dumping and sickness (see my question in this community: https://connect.mayoclinic.org/discussion/feeling-sick-after-eating-can-you-help-please/) became so awful that he was more than desperate, could not eat anything without feeling sick, etc. I asked ChatGPT again but in a different way (a simple question: what is somebody lacking who suffers from histamine intolerance, and my next question was: how can you trigger your body to produce DAO again) and to cut a long story short: the outcome worked. It suggested to take L-Glutamine (my husband has taken this for almost 2 years now) PLUS butyrate sodium. He bought this one here: https://www.naturitas.us/p/supplements/fatty-acids-and-omegas/optim-butyrate-sodium-butyrate-90-capsules-optim-laboratoire. He has taken this now for 2 weeks and the result was phantastic: He could eat anything, really anything without any problems. He is still in the trial phase and since he had to take painkillers for a day due to tooth problems, he had an awful day yesterday, with diarrhea and you name it - a typical reaction and consequence for him since his surgery), but despite this, it seems like this combination really works. He hasn't had any DS or GE ever since, no sickness, no nusea, no nothing. Really, no kidding. His life changed from 0 tolerance for food to 100% tolerance of any food he could not eat before. I don't know if this helps, but perhaps. This is just our experience, this is no scientific or medical proof or something, he is still in the trial phase, as I said, and I am not suggesting anything here, I only wanted to share this experience with you, which is absolutely personal and individual. Have an amazing and healthy 2026!!! All of you!!! Wishing you all the best!
Michaela