Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management

A. P. van Beek*, M. Emous, Maurice Laville, Johannes Tack

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

73 Citations (Scopus)
1106 Downloads (Pure)

Abstract

Background: Dumping syndrome, a common complication of esophageal, gastric or bariatric surgery, includes early and late dumping symptoms. Early dumping occurs within 1 h after eating, when rapid emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and release of gastrointestinal hormones, resulting in gastrointestinal and vasomotor symptoms. Late dumping occurs 1-3 h after carbohydrate ingestion, caused by an incretin-driven hyperinsulinemic response resulting in hypoglycemia. Clinical recommendations are needed for the diagnosis and management of dumping syndrome.

Methods: A systematic literature review was performed through February 2016. Evidence-based medicine was used to develop diagnostic and management strategies for dumping syndrome.

Results: Dumping syndrome should be suspected based on concurrent presentation of multiple suggestive symptoms after upper abdominal surgery. Suspected dumping syndrome can be confirmed using symptom-based questionnaires, glycemia measurements and oral glucose tolerance tests. First-line management of dumping syndrome involves dietary modification, as well as acarbose treatment for persistent hypoglycemia. If these approaches are unsuccessful, somatostatin analogues should be considered in patients with dumping syndrome and impaired quality of life. Surgical re-intervention or continuous enteral feeding may be necessary for treatment-refractory dumping syndrome, but outcomes are variable.

Conclusions: Implementation of these diagnostic and treatment recommendations may improve dumping syndrome management.

Original languageEnglish
Pages (from-to)68-85
Number of pages18
JournalObesity Reviews
Volume18
Issue number1
DOIs
Publication statusPublished - Jan-2017

Keywords

  • dumping syndrome
  • hyperinsulinemic hypoglycemia
  • pasireotide
  • somatostatin
  • analogue
  • ACTING SOMATOSTATIN-ANALOG
  • NONINSULINOMA PANCREATOGENOUS HYPOGLYCEMIA
  • SMALL-BOWEL MOTILITY
  • GUT HORMONE-RELEASE
  • CECUM TRANSIT-TIME
  • QUALITY-OF-LIFE
  • HYPERINSULINEMIC HYPOGLYCEMIA
  • BYPASS-SURGERY
  • POSTPRANDIAL HYPOGLYCEMIA
  • SLEEVE GASTRECTOMY

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