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Nature Reviews. Endocrinology Aug 2020Dumping syndrome is a common but underdiagnosed complication of gastric and oesophageal surgery. We initiated a Delphi consensus process with international... (Review)
Review
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.
Topics: Acarbose; Bariatric Surgery; Blood Glucose; Consensus; Diet Therapy; Dumping Syndrome; Esophagus; Evidence-Based Medicine; Gastrectomy; Gastric Emptying; Gastrointestinal Hormones; Humans; Meals; Postoperative Complications; Practice Guidelines as Topic; Quality of Life; Stomach; Weight Loss
PubMed: 32457534
DOI: 10.1038/s41574-020-0357-5 -
Obesity Reviews : An Official Journal... Jan 2017Dumping syndrome, a common complication of esophageal, gastric or bariatric surgery, includes early and late dumping symptoms. Early dumping occurs within 1 h after... (Review)
Review
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.
Topics: Bariatric Surgery; Diet; Dumping Syndrome; Evidence-Based Medicine; Humans; Postoperative Complications; Quality of Life; Randomized Controlled Trials as Topic; Surveys and Questionnaires
PubMed: 27749997
DOI: 10.1111/obr.12467 -
Diseases of the Esophagus : Official... Jan 2017
Review
Topics: Carcinoma; Dumping Syndrome; Esophageal Neoplasms; Esophagectomy; Humans; Incidence; Postoperative Complications; Risk Factors
PubMed: 27859950
DOI: 10.1111/dote.12488 -
Naika. Internal Medicine Feb 1967
Review
Topics: Adult; Dumping Syndrome; Female; Gastrectomy; Humans; Male; Middle Aged; Postoperative Complications
PubMed: 4861106
DOI: No ID Found -
Nutrition in Clinical Practice :... Oct 2005Anatomic and physiologic changes introduced by gastric surgery result in clinically significant dumping syndrome in approximately 10% of patients. Dumping is the effect... (Review)
Review
Anatomic and physiologic changes introduced by gastric surgery result in clinically significant dumping syndrome in approximately 10% of patients. Dumping is the effect of alteration in the motor functions of the stomach, including disturbances in the gastric reservoir and transporting function. Gastrointestinal hormones play an important role in dumping by mediating responses to surgical resection. Treatment options of dumping syndrome include diet, medications, and surgical revision. Poor nutrition status can be anticipated in patients who fail conservative therapy. Management of refractory dumping syndrome can be a challenge. This review highlights current knowledge about the mechanisms of dumping syndrome and available therapy.
Topics: Combined Modality Therapy; Dumping Syndrome; Gastrointestinal Agents; Humans; Nutrition Therapy; Nutritional Status; Reoperation
PubMed: 16207692
DOI: 10.1177/0115426505020005517 -
Digestive Diseases and Sciences Jan 2016Gastric surgery has long been known to be a cause of dumping syndrome (DS). However, the increasing incidence of gastric bypass surgery, as well as reports of DS... (Review)
Review
Gastric surgery has long been known to be a cause of dumping syndrome (DS). However, the increasing incidence of gastric bypass surgery, as well as reports of DS unrelated to previous gastric surgeries, has increased the importance of understanding DS in recent years. DS is due to the gastrointestinal response to voluminous and hyperosmolar chyme that is rapidly expelled from the stomach into the small intestine. This response involves neural and hormonal mechanisms. This review encompasses the symptoms, diagnosis, and treatment approaches of DS and also focuses on the current research status of the pathophysiology of DS.
Topics: Diagnosis, Differential; Dumping Syndrome; Gastric Bypass; Humans; Predictive Value of Tests; Prognosis; Risk Factors
PubMed: 26396002
DOI: 10.1007/s10620-015-3839-x -
Tidsskrift For Den Norske Laegeforening... Jan 2015Dumping syndrome is the term used to describe a common set of symptoms following gastric surgery, and is characterised by postprandial discomfort which can entail... (Review)
Review
BACKGROUND
Dumping syndrome is the term used to describe a common set of symptoms following gastric surgery, and is characterised by postprandial discomfort which can entail nutritional problems. The condition was well known when surgery was the usual treatment for peptic ulcer disease. The increasing number of operations for morbid obesity means that the condition is once again of relevance, and health personnel will encounter these patients in different contexts. This article discusses the prevalence, symptomatology and treatment of dumping syndrome.
MATERIAL AND METHOD
This review article is based on a selection of articles identified in PubMed and assessed as having particular relevance for elucidating this issue, as well as on the authors' own clinical experience.
RESULTS
Early dumping syndrome generally occurs within 15 minutes of ingesting a meal and is attributable to the rapid transit of food into the small intestine. Nausea, abdominal pain, diarrhoea, a sensation of heat, dizziness, reduced blood pressure and palpitations are typical symptoms. Lethargy and sleepiness after meals are common. Late dumping syndrome occurs later and may be attributed to hypoglycaemia with tremors, cold sweats, difficulty in concentrating, and loss of consciousness. Dumping-related symptoms occur in between 20 and 50% of patients following gastric surgery. Early dumping syndrome is more frequent than late dumping syndrome. It is estimated that 10-20% of patients have pronounced symptoms and 1-5% have severe symptoms. The diagnosis is usually made on the basis of typical symptoms. Most patients experience alleviation of the symptoms over time and with changes in diet and eating habits. Further patient evaluation and drug or surgical intervention may be relevant for some individuals.
INTERPRETATION
Dumping-related symptoms are common after gastric surgery. The extent of obesity surgery in particular means that health personnel should be familiar with this condition.
Topics: Digestive System Surgical Procedures; Dumping Syndrome; Humans
PubMed: 25625992
DOI: 10.4045/tidsskr.14.0550 -
Der Chirurg; Zeitschrift Fur Alle... Sep 2015Dumping syndrome is a common complication after surgery of the upper gastrointestinal tract with symptoms ranging from mild gastrointestinal discomfort and moderate... (Review)
Review
BACKGROUND
Dumping syndrome is a common complication after surgery of the upper gastrointestinal tract with symptoms ranging from mild gastrointestinal discomfort and moderate vasomotor disturbances, to severe hyperinsulinemic hypoglycemia. Due to the increasing number of bariatric procedures being performed worldwide, bariatric surgery has become the most common cause for this disease entity.
OBJECTIVE
The aim of this review is to highlight the evidence for the physiological mechanisms contributing to dumping syndrome after the two most common bariatric surgery procedures, Roux-en-Y gastric bypass and sleeve gastrectomy, to discuss technical aspects of the procedures underlying the development of the syndrome, patient-related predictive factors and other differential diagnoses, together with diagnostic and therapeutic algorithms.
Topics: Dumping Syndrome; Gastric Bypass; Glucose Tolerance Test; Humans; Hyperinsulinism; Hypoglycemia; Postoperative Complications
PubMed: 26127021
DOI: 10.1007/s00104-015-0047-3 -
Medizinische Klinik Feb 1977
Review
Topics: Dumping Syndrome; Female; Gastrectomy; Humans; Male; Methods; Vagotomy
PubMed: 319330
DOI: No ID Found -
Scandinavian Journal of... 1997The dumping syndrome is encountered in approximately 10% of patients after gastric surgery. A postprandial peripheral and splanchnic vasodilatation and ensuing relative... (Review)
Review
The dumping syndrome is encountered in approximately 10% of patients after gastric surgery. A postprandial peripheral and splanchnic vasodilatation and ensuing relative hypovolaemia are pivotal in the pathophysiology of early systemic symptoms. Late dumping symptoms are a consequence of a reactive hypoglycaemia, which results from an exaggerated insulin and glucagon-like peptide-1 release. The diagnosis of dumping syndrome can reliably be made with the aid of a provocation test using 50 g glucose orally. Most patients with dumping can be treated with advice on diet and lifestyle. Octreotide effectively controls the signs and symptoms of dumping in patients refractory to standard therapy. It acts through its inhibitory effects on insulin and gut hormone release, a delay of intestinal transit time and inhibition of food-induced circulatory changes. Its long-term use is somewhat limited by side effects, particularly diarrhoea and steatorrhoea.
Topics: Dumping Syndrome; Humans; Postoperative Complications; Stomach
PubMed: 9200302
DOI: No ID Found