Definition

 Chase syndrome is a digestive disorder affecting the stomach. We speak of "hunting syndrome" or "dumping syndrome" when gastric emptying is too rapid. This means that food passes from the stomach to the small intestine too quickly. The hunting syndrome can be early or late.

Etiology

The most common causes of flushing syndrome are gastric surgeries, such as weight loss surgery. These surgeries aim to remove all or part of the stomach, which speeds up the passage of food to the small intestine and leads to flushing syndrome.

Early versus late

The hunting syndrome can be early or late depending on when it occurs after meals.

In the case of early hunting syndrome, it appears between 15 to 60 minutes after a meal. The emptying of undigested food from the stomach to the small intestine is very rapid. This causes a rapid and large entry of fluid from plasma and nearby tissues into the small intestine and triggers the symptoms of early flushing syndrome.

In the case of late hunting syndrome, it occurs between one to three hours after a meal and more particularly following the consumption of carbohydrates. Similar to early hunting syndrome, undigested food, especially carbohydrates, passes quickly from the stomach to the small intestine. These carbohydrates are then absorbed quickly by the body, which increases blood sugar levels. In response to this increase, the pancreas produces a large amount of insulin. This leads to a rapid decrease in blood sugar levels, hypoglycemia, and triggers the symptoms of late hunting syndrome.

Symptoms

Symptoms of chase syndrome vary depending on its early or late nature.

If it is early, gastrointestinal symptoms may be a feeling of fullness, diarrhea, rumbling (gurgling), abdominal pain (eg cramps), bloating, nausea and vomiting. Symptoms may also include fatigue, a need to lie down after eating, palpitations, sweating (sweating), tachycardia (a heart beating too fast), hypotension and unconsciousness (syncope).

If it is late, symptoms may include fatigue, weakness, hunger, confusion, fainting, sweating, palpitations, shaking, and irritability.

Finally, the symptoms of hunting syndrome can also vary depending on the nature of the food consumed. For example, symptoms may be exacerbated after eating a meal that is high in carbohydrates.

Diagnostic

Your doctor will review your medical history and recent surgeries and ask you questions about your symptoms. He will be able to make you pass one of the many existing tests to make a diagnosis as precise as possible.

• The glucose load test  determines whether the body responds to glucose in a normal way. A sweet solution (glucose) should be drunk. An hour later, a health technician measures blood sugar levels.
• A gastric emptying scan  measures the rate at which food is digested. A tiny amount of a radioactive substance needs to be eaten at the same time as a small meal. The speed at which food travels through the digestive system can be followed by using a camera at certain intervals to determine where the radioactive food is. If emptying occurs too quickly, it could signal the presence of flushing syndrome.
• One gastro-duodenal transit (TOGD)  is in fact   consuming a barium drink in front of an x-ray machine. Barium is a chalky liquid that appears on an x-ray.
• Gastroscopy isusing a small flexible tube with a camera and a light (endoscope) to examine the upper part of the digestive system, including the esophagus, stomach and duodenum.

Treatment

Treatment for hunting syndrome begins with making certain dietary changes. They often help reduce symptoms during the healing period following surgery. Sometimes, medication may also be necessary to slow gastric emptying (eg, ocreotide) or to reduce the absorption of carbohydrates (eg: acarbose). Finally, if the hunting syndrome persists despite dietary changes and medication, surgery may be necessary.

Dietary modifications

At the nutritional level, the changes aim to ensure adequate nutrition, prevent or correct nutritional deficiencies, reduce gastrointestinal symptoms, limit weight loss and promote recovery in individuals who have undergone gastric surgery. Dietary modifications that are generally recommended for hunting syndrome include:

• Eat small, frequent meals throughout the day (6 or more). This helps reduce the volume of food that is poured into the small intestine and the risk of triggering symptoms of the syndrome.
• Drink fluids at least 30 to 60 minutes before or after meals, as they drain faster than solids. It also reduces the volume in the stomach and the risk of triggering symptoms of the syndrome.
• Make sure you have adequate hydration on a daily basis by drinking enough fluids between meals.
• Eat slowly and chew food well.
• Avoid foods that are too hot or too cold.
• Use seasonings and spices according to individual tolerance.
• Avoid alcoholic drinks.
• Favor complex carbohydrates (eg: whole grains, vegetables, legumes, etc.) over simple carbohydrates (eg: sugar, lactose, juice, sugary drinks, etc.).
• Avoid or limit lactose, a simple carbohydrate that is often poorly tolerated (eg: milk).
• Promote fiber, as it slows gastric emptying and moderates the absorption of carbohydrates.
• Eat a diet higher or lower in fat depending on the presence or absence of steatorrhea.
• Eat a protein food with each meal (eg: eggs, meat, fish, cheese, tofu, etc.).
• Lie down 30 minutes after meals to slow gastric emptying.
• Take somenutritional supplements if necessary (e.g .: iron, vitamin B₁₂, calcium, etc.) and make sure they are low in carbohydrates and lactose free. This is because flushing syndrome and gastric surgeries can decrease the absorption of certain nutrients.
• Use dietary fiber supplements, such as guar gum, pectin, and glucomannan. Dietary fiber supplements increase the viscosity of food, which helps slow gastric emptying. Also, because fiber uses water to help promote stool formation, it's important to get adequate hydration with these dietary supplements.

Finally, as with all nutritional recommendations, those for hunting syndrome should also be tailored to the symptoms and unique needs of each individual. The personalization of diet is essential for the development of an effective nutritional approach.

References

1. Bouthillier, Lise. January 2019. Diseases of the digestive tract. NUT 2047 Clinical nutrition 2. Montreal: University of Montreal.al.
2. https://www.cancer.ca/fr-ca/cancer-information/diagnosis-and-treatment/managing-side-effects/dumping-syndrome/region=qc#:~:text=Le%20syndrome%20de%20chasse % 20est, talk% 20de% 20vidange% 20gastric% 20faste
3. https://badgut.org/centre-information/sujets-de-a-a-z/syndrome-de-chasse/lang=frr
4. https://badgut.org/centre-information/sujets-de-a-a-z/syndrome-de-chasse/lang=frr