International consensus on the diagnosis and management of dumping syndrome

Emidio Scarpellini, Joris Arts, George Karamanolis, Anna Laurenius, Walter Siquini, Hidekazu Suzuki, Andrew Ukleja, Andre Van Beek, Tim Vanuytsel, Serhat Bor, Eugene Ceppa, Carlo Di Lorenzo, Marloes Emous, Heinz Hammer, Per Hellstrom, Martine Laville, Lars Lundell, Ad Masclee, Patrick Ritz, Jan Tack*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)
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Abstract

Dumping syndrome is a common but underdiagnosed complication of gastric and oesophageal surgery. We initiated a Delphi consensus process with international multidisciplinary experts. We defined the scope, proposed statements and searched electronic databases to survey the literature. Eighteen experts participated in the literature summary and voting process evaluating 62 statements. We evaluated the quality of evidence using grading of recommendations assessment, development and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 33 of 62 statements, including the definition and symptom profile of dumping syndrome and its effect on quality of life. The panel agreed on the pathophysiological relevance of rapid passage of nutrients to the small bowel, on the role of decreased gastric volume capacity and release of glucagon-like peptide 1. Symptom recognition is crucial, and the modified oral glucose tolerance test, but not gastric emptying testing, is useful for diagnosis. An increase in haematocrit >3% or in pulse rate >10 bpm 30 min after the start of the glucose intake are diagnostic of early dumping syndrome, and a nadir hypoglycaemia level <50 mg/dl is diagnostic of late dumping syndrome. Dietary adjustment is the agreed first treatment step; acarbose is effective for late dumping syndrome symptoms and somatostatin analogues are preferred for patients who do not respond to diet adjustments and acarbose.

Original languageEnglish
Pages (from-to)448-466
Number of pages19
JournalNature reviews endocrinology
Volume16
Issue number8
DOIs
Publication statusE-pub ahead of print - 26-May-2020

Keywords

  • Y GASTRIC BYPASS
  • QUALITY-OF-LIFE
  • VASOACTIVE-INTESTINAL-PEPTIDE
  • HYPERINSULINEMIC HYPOGLYCEMIA
  • SOMATOSTATIN ANALOG
  • BARIATRIC SURGERY
  • POSTPRANDIAL HYPOGLYCEMIA
  • WEIGHT-LOSS
  • REACTIVE HYPOGLYCEMIA
  • OCTREOTIDE-THERAPY

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