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Internal Medicine (Tokyo, Japan) May 2024We herein report a case in which diazoxide was effective in treating reactive hypoglycemia caused by late dumping syndrome in a patient with end-stage renal disease...
We herein report a case in which diazoxide was effective in treating reactive hypoglycemia caused by late dumping syndrome in a patient with end-stage renal disease (ESRD). A 50-year-old man with ESRD and a history of gastrectomy underwent hemodialysis. Although he was administered voglibose to treat recurrent reactive hypoglycemia caused by late dumping syndrome, he had difficulty continuing treatment because of gastrointestinal side effects. When he began diazoxide treatment, the reactive hypoglycemia improved. The dose was gradually increased with no apparent side effects, and the hypoglycemic attacks disappeared one year after the start of treatment.
Topics: Humans; Diazoxide; Male; Middle Aged; Hypoglycemia; Kidney Failure, Chronic; Gastrectomy; Dumping Syndrome; Treatment Outcome; Renal Dialysis
PubMed: 37813619
DOI: 10.2169/internalmedicine.1704-23 -
Journal of Clinical Medicine Aug 2023The current design of biliopancreatic diversion with duodenal switch (BPD/DS) and single anastomosis duodenal-ileal bypass with sleeve (SADI-S) emphasizes the importance...
BACKGROUND
The current design of biliopancreatic diversion with duodenal switch (BPD/DS) and single anastomosis duodenal-ileal bypass with sleeve (SADI-S) emphasizes the importance of the pylorus' preservation to reduce the incidence of marginal ulcer (MU) and dumping. However, no institutional studies have yet reported data on their prevalence. We aimed to assess the incidence of MU and dumping after duodenal switch (DS) and identify the associative factors.
METHODS
A multi-center review of patients who underwent BPD/DS or SADI-S between 2008 and 2022. Baseline demographics, symptoms, and management of both complications were collected. Fisher's exact test was used for categorical variables and the independent -test for continuous variables.
RESULTS
A total of 919 patients were included (74.6% female; age 42.5 years; BMI 54.6 kg/m) with mean follow-up of 31.5 months. Eight patients (0.9%) developed MU and seven (0.8%) had dumping. Patients who developed MU were more likely to be using non-steroidal anti-inflammatory drugs (NSAID) ( = 0.006) and have a longer operation time ( = 0.047). Primary versus revisional surgery, and BDP/DS versus SADI-S were not associated with MU or dumping.
CONCLUSIONS
The incidences of MU and dumping after DS were low. NSAID use and a longer operation time were associated with an increased risk of MU, whereas dumping was attributed to poor dietary habits.
PubMed: 37685666
DOI: 10.3390/jcm12175600 -
Obesity Surgery Oct 2023
Salvage Surgery for Severe Post-Bariatric Hypoglycemia After Multiple Bariatric Revisions: Reversing Roux-en-Y Gastric Bypass to Sleeve with Roux Limb as Henley-Longmire Interposition.
Topics: Humans; Gastric Bypass; Obesity, Morbid; Salvage Therapy
PubMed: 37646905
DOI: 10.1007/s11695-023-06797-8 -
Cureus Jul 2023Dumping syndrome (DS) is a typical side effect of stomach surgery, which includes cancer, non-cancer esophageal and gastric surgery, and bariatric surgery. It is marked... (Review)
Review
Dumping syndrome (DS) is a typical side effect of stomach surgery, which includes cancer, non-cancer esophageal and gastric surgery, and bariatric surgery. It is marked by the fast evacuation of undigested food from the stomach into the small intestine, which causes a variety of symptoms. Early dumping symptoms include gastrointestinal symptoms such as stomach discomfort, diarrhea, and nausea, as well as vasomotor symptoms such as drowsiness and face flushing, and occur within the first hour following a meal. Late dumping symptoms appear one to three hours after a meal and are related to reactive hypoglycemia, resulting in hypoglycemia, sweating, palpitations, and confusion. Early dumping pathophysiology involves abnormalities in stomach structure and function, which result in rapid transit of stomach contents to the duodenum, insufficient digestion, and fluid transfers from the vascular compartment to the intestine. Late dumping occurs as a result of hyperinsulinemia caused by the fast passage of undigested foods to the gut. Symptom-based questionnaires and diagnostic testing such as plasma glucose measurement and stomach emptying studies can be used to confirm a diagnosis of DS. The primary approach to managing DS is dietary modifications, including eating smaller, more frequent meals and avoiding high glycemic index carbohydrates. Dietary supplements and medications may be used to slow down gastric emptying or control blood glucose levels. Pharmacological options include alpha-glycosidase inhibitors, somatostatin analogs, glucagon-like peptide-1 analogs, and sodium-glucose cotransporter inhibitors. In severe cases, refractory to conservative measures, surgical interventions may be considered. DS can arise in children following gastric surgery for obesity or corrective surgery for congenital abnormalities. It is frequently misdiagnosed and can have serious implications, such as hypoglycemia-related cognition deficits. Screening and early identification using glucose tolerance testing and continuous glucose monitoring (CGM) are critical in at-risk youngsters. Children's treatment techniques are similar to those used in adults, with dietary changes and medication therapies serving as the cornerstone of care. Overall, DS is a complex condition that requires a multidisciplinary approach to diagnosis and management. Further research is needed to improve understanding of its pathophysiology and optimize treatment strategies, particularly in children. This review aims to provide a well-rounded informative summary of the most recent literature on the under-recognized clinical and scientific aspects of DS among the children age group. It incorporates the quality of life, pathophysiology, diagnosis, prevalence, and treatment.
PubMed: 37546099
DOI: 10.7759/cureus.41407 -
Cureus Jun 2023An accurate and timely diagnosis of dumping syndrome after gastric and oesophageal surgery is often difficult. A delay in making this diagnosis and instituting therapy...
An accurate and timely diagnosis of dumping syndrome after gastric and oesophageal surgery is often difficult. A delay in making this diagnosis and instituting therapy can result in significant morbidity and avoidable complications. As bariatric surgery becomes more prevalent, the importance of a timely diagnosis of dumping syndrome is increasing. We present a case of a 77-year-old man who was admitted into the intensive care unit with a reduced conscious state secondary to hypoglycemia. The patient was subsequently diagnosed with late dumping syndrome in the context of an Ivor Lewis procedure seven years prior. Despite having a history of recurrent neuroglycopenic symptoms, there was a delay in diagnosis as dumping syndrome had not previously been considered until this admission. After confirmation of the diagnosis, the patient was commenced on dietary adjustments and acarbose, with a resolution of post-prandial hypoglycaemia. The authors discuss dietary and pharmacological therapy to manage hypoglycaemia associated with dumping syndrome.
PubMed: 37492839
DOI: 10.7759/cureus.40877 -
Obstetric Medicine Jun 2023Hypoglycaemia in non-diabetic pregnancy is rare, the majority of reported cases being due to insulinoma, acute fatty liver of pregnancy, malaria and inborn errors of...
Hypoglycaemia in non-diabetic pregnancy is rare, the majority of reported cases being due to insulinoma, acute fatty liver of pregnancy, malaria and inborn errors of metabolism. A case of hypoglycaemia in a woman with previous laparoscopic sleeve gastrectomy, and hypothalamic-pituitary-adrenal axis insufficiency in the setting of opioid dependence is presented. The timing of low interstitial glucose levels was atypical for late dumping syndrome following bariatric surgery, and a change in the woman's glucocorticoid replacement resulted in resolution of hypoglycaemic symptoms. The incidence of opioid dependence in pregnancy is increasing rapidly. Health professionals should be aware of the possibility of opioids causing hypothalamic-pituitary-adrenal axis insufficiency, and the additional mechanisms by which opioids may cause hypoglycaemia.
PubMed: 37441658
DOI: 10.1177/1753495X211032787 -
Medicine Jun 2023Esophagus cancer patients are at risk for malnourishment. Feeding jejunostomy is used in advanced esophagus cancer patients in order to support and supplement the...
INTRODUCTION
Esophagus cancer patients are at risk for malnourishment. Feeding jejunostomy is used in advanced esophagus cancer patients in order to support and supplement the patients' nutrition needs. In dumping syndrome, the food is rapidly introduced into the intestine at a rate that is faster than normal, it is associated with both digestive system and vasoactive symptoms. Dumping syndrome has an association with both esophagus cancer patients and feeding jejunostomy. In the mid and long term, dumping syndrome is an important issue that contributes to the risk of malnourishment in advanced esophagus cancer patients. In recent studies, acupuncture was effective in regulating digestive symptoms. Acupuncture is considered to be a safe intervention, that was previously shown to be effective in treating digestive-related symptoms.
METHODS
Sixty advanced esophageal cancer patients post-feeding jejunostomy will be divided into 2 equal groups, an intervention group (n = 30) and a control group (n = 30). Patients in the intervention group will receive acupuncture using the following acupoints: ST36 (Zusanli), ST37 (Shangjuxu), ST39 (Xiajuxu), PC6 (Neiguan), LI4 (Hegu), and Liv 3 (Taichung). Patients in the control group will receive shallow acupuncture on 12 non-acupoints (sham points), 1 cm from the above mention points. Patients and assessors will be blind to trial allocation. Both groups will receive acupuncture twice a week for 6 weeks. The main outcome measurements are: body weight, BMI, Sigstad's score, and the Arts' dumping questionnaire.
DISCUSSION
There are no previous studies that have examined the use of acupuncture on patients with dumping syndrome. This single-blind randomized control trial will investigate the effect of acupuncture on dumping syndrome in advanced esophagus cancer patients with feeding jejunostomy. The results will determine if verum acupuncture can affect dumping syndrome and prevent weight loss.
Topics: Humans; Acupuncture Points; Acupuncture Therapy; Dumping Syndrome; Esophageal Neoplasms; Jejunostomy; Randomized Controlled Trials as Topic; Single-Blind Method; Treatment Outcome
PubMed: 37335662
DOI: 10.1097/MD.0000000000033895 -
Malaysian Family Physician : the... 2023Dumping syndrome after bariatric surgery is common. However, it is rarely seen during pregnancy because patients are usually advised to avoid pregnancy immediately after...
Dumping syndrome after bariatric surgery is common. However, it is rarely seen during pregnancy because patients are usually advised to avoid pregnancy immediately after surgery. This case highlights the importance of avoidance of pregnancy after bariatric surgery. We report a case of unplanned pregnancy in a 35-year-old woman with a history of subfertility for 8 years who conceived spontaneously 3 months after gastric bypass surgery. This occurred because there was no contraception offered to her after the procedure. The pregnancy was complicated with recurrent episodes of hypoglycaemia secondary to dumping syndrome. Primary care providers need to be vigilant and have a high index of suspicion for dumping syndrome in pregnant obese women who have undergone bariatric surgery.
PubMed: 37292225
DOI: 10.51866/cr.257