Dumping syndrome (DS) has historically been associated with gastric surgery and vagotomy, as well as diabetes mellitus (DM). This article provides an update on the etiologies and clinical spectrum that represent the current DS patient population. A retrospective chart review was conducted of patients who were referred to a tertiary GI motility center and met criteria for DS. 35 patients met the diagnostic criteria for DS. 10 patients had comorbid DM (8 type II), 5 had a previous Nissen fundoplication with presumed vagal damage, and 1 had a gastric bypass. 19 (54%) patients were determined to have "idiopathic" DS. Of these idiopathic patients, 32% were able to describe an event consistent with a viral or bacterial gastroenteritis which immediately preceded the onset of DS symptoms. Among all patients with DS, 37% patients had been previously labeled with a diagnosis of gastroparesis prior to their referral.