Table of contents
Dumping syndrome
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of dumping syndrome are prepared by our editorial team based on guidelines from the American Society of Anesthesiologists (ASA/ACE/OS/AACE/ASMBS/OMA 2020), the Dumping Syndrome Consensus Group (DS-CG 2020), and the European Association for the Study of Obesity (EASO 2017).
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Screening and diagnosis
Clinical presentation: as per DS-CG 2020 guidelines, recognize that:
DS is a complication of esophageal or gastric surgery that can comprise both early and late DS symptoms
B
early DS is the typical and most frequent manifestation of DS and can occur in isolation or in association with late symptoms
B
DS affects the QoL and can be associated with weight loss
B
symptoms of early DS are driven by rapid delivery of nutrients to the small bowel, which triggers the release of several gastrointestinal hormones, including vasoactive agents, incretins, and glucose modulators
B
hypoglycemia is the main symptom of late DS and is driven by a hyperinsulinemic response and GLP-1 release
B
DS can contribute to weight loss after bariatric surgery.
B
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Diagnosis
Diagnostic investigations
Oral glucose tolerance test: as per DS-CG 2020 guidelines, obtain a modified oral glucose tolerance test for the diagnosis of DS. Regard the test results as positive for early DS in case of an early (30 minutes) increase in hematocrit > 3% or in pulse rate > 10 bpm. Regard the test results as positive for late DS in case of late (60-180 minutes after ingestion) hypoglycemia (< 50 mg/dL).
B
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Mixed meal tolerance test
Continuous glucose monitoring
Gastric emptying testing
Medical management
Acarbose: as per DS-CG 2020 guidelines, offer acarbose for the treatment of patients with DS symptoms, especially symptoms of late DS.
B
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Diazoxide
Octreotide
Nonpharmacologic interventions
Dietary modifications: as per AACE/ACE/ASA/…/OS 2020 guidelines, eliminate concentrated sweets from the diet after Roux-en-Y gastric bypass to minimize symptoms of DS, as well as after any bariatric procedure to reduce caloric intake.
B
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Dietary supplements
Continuous enteral feeding