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Dumping syndrome

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 Dumping Syndrome Consensus Group (DS-CG 2020), the American Society of Anesthesiologists (ASA/ACE/OS/AACE/ASMBS/OMA 2020), and the European Association for the Study of Obesity (EASO 2017).
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Guidelines

1.Screening and diagnosis

Clinical presentation: 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.
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  • Diagnosis

2.Diagnostic investigations

Oral glucose tolerance test: 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

3.Medical management

Acarbose: offer acarbose for the treatment of patients with DS symptoms, especially symptoms of late DS.
B

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  • Diazoxide

  • Octreotide

4.Nonpharmacologic interventions

Dietary modifications: as per AACE 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

5.Surgical interventions

Indications for reoperation: insufficient evidence to recommend surgical interventions (or re-interventions) in patients with DS.
I