Gastric dumping syndrome medical therapy: Difference between revisions

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=== Diet  ===
=== Diet  ===
'''Dietary Modifications (Level III; Grade B)'''
'''Dietary Modifications (Level III; Grade B)'''
* Decrease carbohydrate intake
* Decrease [[carbohydrate]] intake
** Avoid simple sugars like soda, candy sweets, and cookies
** Avoid simple [[Sugar|sugars]] like soda, candy sweets, and cookies
* Fluid restriction
* [[Fluid]] restriction
** Wait at least 30 minutes after a meal before drinking
** Wait at least 30 minutes after a meal before drinking
* Increase protein intake
* Increase [[protein]] intake
* Increase fat intake
* Increase [[fat]] intake
* Increase fiber intake
* Increase fiber intake
* Dairy and dairy product restriction
* [[Dairy]] and [[dairy]] product restriction
* Shorter meals
* Shorter meals
* Eat slowly
* Eat slowly
* Chew properly
* [[Mastication|Chew]] properly
* Lying supine for 30 minutes after a meal
* Lying [[supine]] for 30 minutes after a meal
* Glycemic index education of foods is important
* [[Glycemic index]] education of foods is important


====                                                                                                                                              '''Dietary Foods''' ====
====                                                                                                                                              '''Dietary Foods''' ====
The following is a table that illustrates the types of food to take and avoid in the case of dumping syndrome.
The following is a table that illustrates the types of food to take and avoid in the case of [[Gastric dumping syndrome|dumping syndrome]].
{| class="wikitable" style="margin: 1em auto 1em auto"
{| class="wikitable" style="margin: 1em auto 1em auto"
!'''Breads, Cereals, Rice and Pasta'''
!'''Breads, Cereals, Rice and Pasta'''
Line 74: Line 74:
** 1/2 cup cooked cereal, rice, or pasta
** 1/2 cup cooked cereal, rice, or pasta
|
|
* Breads, bagels, rolls, unsweetened cereals, pasta, potatoes, rice, crackers, and soup (only if taken one hour after solid foods at medium temperature).
* Breads, bagels, rolls, unsweetened cereals, pasta, potatoes, rice, crackers, and soup (only if taken one hour after [[solid]] foods at medium temperature).
|
|
* Sweet rolls and doughnuts
* Sweet rolls and doughnuts
Line 170: Line 170:
* Ice cream and sherbet
* Ice cream and sherbet
* Honey, syrup, and jelly
* Honey, syrup, and jelly
* Sugar alcohols such as sorbitol, xylitol, and mannitol
* Sugar alcohols such as [[sorbitol]], [[xylitol]], and [[mannitol]]
|} 
|} 
'''Dietary Supplements (Level III; Grade C)'''
'''Dietary Supplements (Level III; Grade C)'''
* Delay glucose absorption:
* Delay [[glucose]] absorption:
** Pectin
** [[Pectin]]
** Guar gum
** [[Guar gum]]
** Glucomannan
** [[Glucomannan]]


'''Drug Therapy'''
'''Drug Therapy'''


The two main stays for pharmacological intervention are Acarbose (Glucobay, Precose, Prandase) and Somatostatin analogues such as Octreotide (Sandostatin).
The two main stays for [[Pharmacology|pharmacological]] intervention are [[Acarbose]] (Glucobay, Precose, Prandase) and [[Somatostatin]] analogues such as [[Octreotide]] (Sandostatin).
{| class="wikitable"
{| class="wikitable"
!
!
Line 187: Line 187:
|-
|-
|Use
|Use
|Late dumping syndrome
|Late [[Gastric dumping syndrome|dumping syndrome]]
|Early and Late dumping syndrome
|Early and Late [[Gastric dumping syndrome|dumping syndrome]]
|-
|-
|Mechanism of Action
|Mechanism of Action
|Inhibits carbohydrate absorption
|Inhibits [[carbohydrate]] absorption
|Strong inhibitor of the gut hormones (especially insulin)
|Strong inhibitor of the gut [[Hormone|hormones]] (especially [[insulin]])
|-
|-
|Dose
|Dose
|
|
* Rebound hypoglycemia: 25mg before breakfast, lunch and dinner
* Rebound [[hypoglycemia]]: 25 mg before breakfast, lunch and dinner
* Initiate effect: 50mg daily (QD)
* Initiate effect: 50 mg daily (QD)
* For complete resolution of symptoms: 50/100mg three times daily (TID). Especially beneficial in diabetics with dumping syndrome
* For complete [[resolution]] of [[Symptom|symptoms]]: 50/100 mg three times daily (TID). Especially beneficial in [[Diabetes mellitus|diabetics]] with [[Gastric dumping syndrome|dumping syndrome]]
|
|
* Initiate effect: 25-50μg S.C two-three times daily (BID or TID)
* Initiate effect: 25-50 μg S.C two-three times daily (BID or TID)
* Maximum effect: 100-200μg S.C two-three times daily (BID or TID)
* Maximum effect: 100-200 μg S.C two-three times daily (BID or TID)
* Long-acting (New) I.M once monthly
* Long-acting (New) I.M once monthly
|-
|-
|Effect
|Effect
|
|
* Decrease postprandial hyperglycemia
* Decrease [[postprandial]] [[hyperglycemia]]
* Decrease postprandial hypotention
* Decrease [[postprandial]] [[hypotension]]
* Decrease gastric emptying
* Decrease [[Stomach|gastric]] emptying
* Increase Insulin secretion
* Increase [[Insulin]] secretion
|
|
* Decrease symptoms
* Decrease [[Symptom|symptoms]]
* Improves Sigstad's score
* Improves Sigstad's score
* Inhibits vasodilation
* Inhibits vasodilation
* Decrease Insulin levels
* Decrease [[Insulin]] levels


* Decrease gastric emptying
* Decrease [[Stomach|gastric]] emptying
* Inhibits splanchnic vasoconstriction
* Inhibits [[splanchnic]] [[vasoconstriction]]
|-
|-
|Additional information
|Additional information
|
|
* Limited to diarrhea severity
* Limited to [[diarrhea]] severity
* Therapy role not yet clarified
* [[Therapy]] role not yet clarified
|
|
* Good for long-term refractory dumping syndrome
* Good for long-term [[refractory]] [[Gastric dumping syndrome|dumping syndrome]]
* Side effects are the reason for stopping long-term therapy. Treat this by giving an extra dose before sleeping or a pancreatic enzyme replacement.
* [[Adverse effect (medicine)|Side effects]] are the reason for stopping long-term therapy. Treat this by giving an extra [[dose]] before sleeping or a [[Pancreas|pancreatic]] [[Enzyme replacement therapy|enzyme replacement]].
* Short-acting improves symptoms
* Short-acting improves symptoms
* New long-acting release is effective, increases weight and improves the quality of life
* New long-acting release is effective, increases [[weight]] and improves the [[quality of life]]
* Safe
* Safe
* Last resort drug
* Last resort drug
Line 233: Line 233:


'''Somatostatin analogues'''
'''Somatostatin analogues'''
* Pasireotide has a higher affinity than Octreotide and is more effective but it does not reduce dumping syndrome symptoms as well as Octreotide.
* [[Pasireotide]] has a higher [[Chemical affinity|affinity]] than [[Octreotide]] and is more effective but it does not reduce [[Gastric dumping syndrome|dumping syndrome]] [[Symptom|symptoms]] as well as [[Octreotide]].
* Even though it has been safe and effective no results of its clinical trials have been published to date.
* Even though it has been safe and effective no results of its clinical trials have been published to date.
{| class="wikitable"
{| class="wikitable"
Line 240: Line 240:
!Effect
!Effect
|-
|-
|Tolbutamide<ref name="pmid5346670">{{cite journal |vauthors=Sigstad H |title=Effect of tolbutamide on the dumping syndrome |journal=Scand. J. Gastroenterol. |volume=4 |issue=3 |pages=227–31 |year=1969 |pmid=5346670 |doi= |url=}}</ref>
|[[Tolbutamide]]<ref name="pmid5346670">{{cite journal |vauthors=Sigstad H |title=Effect of tolbutamide on the dumping syndrome |journal=Scand. J. Gastroenterol. |volume=4 |issue=3 |pages=227–31 |year=1969 |pmid=5346670 |doi= |url=}}</ref>
|0.25-0.75 g, TID
|0.25-0.75 g, TID
|Subjective improvement
|Subjective improvement
|-
|-
|Propranolol<ref name="pmid3369789">{{cite journal |vauthors=Niv Y |title=The early dumping syndrome and propranolol |journal=Ann. Intern. Med. |volume=108 |issue=6 |pages=910–1 |year=1988 |pmid=3369789 |doi= |url=}}</ref>
|[[Propranolol]]<ref name="pmid3369789">{{cite journal |vauthors=Niv Y |title=The early dumping syndrome and propranolol |journal=Ann. Intern. Med. |volume=108 |issue=6 |pages=910–1 |year=1988 |pmid=3369789 |doi= |url=}}</ref>
|10 mg, QID
|10 mg, QID
|Reduced early dumping
|Reduced early dumping
|-
|-
|Cyproheptadine<ref name="pmid1183731">{{cite journal |vauthors=Leichter SB, Permutt MA |title=Effect of adrenergic agents on postgastrectomy hypoglycemia |journal=Diabetes |volume=24 |issue=11 |pages=1005–10 |year=1975 |pmid=1183731 |doi= |url=}}</ref>
|[[Cyproheptadine hydrochloride|Cyproheptadine]]<ref name="pmid1183731">{{cite journal |vauthors=Leichter SB, Permutt MA |title=Effect of adrenergic agents on postgastrectomy hypoglycemia |journal=Diabetes |volume=24 |issue=11 |pages=1005–10 |year=1975 |pmid=1183731 |doi= |url=}}</ref>
|4-8 mg, TID
|4-8 mg, TID
|Preventing vasomotor symptoms
|Preventing vasomotor [[Symptom|symptoms]]
|-
|-
|Methysergide maleate<ref name="pmid5439191">{{cite journal |vauthors=Bernard PF, Baschet C, Le Henand F, Bouderlique JR, Lortat-Jacob JL |title=[Treatment of 65 cases of dumping syndrome with methysergide in recently gastrectomized patients] |language=French |journal=Presse Med |volume=78 |issue=12 |pages=549–50 |year=1970 |pmid=5439191 |doi= |url=}}</ref>
|[[Methysergide|Methysergide maleate]]<ref name="pmid5439191">{{cite journal |vauthors=Bernard PF, Baschet C, Le Henand F, Bouderlique JR, Lortat-Jacob JL |title=[Treatment of 65 cases of dumping syndrome with methysergide in recently gastrectomized patients] |language=French |journal=Presse Med |volume=78 |issue=12 |pages=549–50 |year=1970 |pmid=5439191 |doi= |url=}}</ref>
|4-8 mg, TID
|4-8 mg, TID
|Reduced vasomotor symptoms
|Reduced vasomotor [[Symptom|symptoms]]
|-
|-
|Verapamil<ref name="pmid2309689">{{cite journal |vauthors=Tabibian N |title=Successful treatment of refractory post-vagotomy syndrome with verapamil (Calan SR) |journal=Am. J. Gastroenterol. |volume=85 |issue=3 |pages=328–9 |year=1990 |pmid=2309689 |doi= |url=}}</ref>
|[[Verapamil]]<ref name="pmid2309689">{{cite journal |vauthors=Tabibian N |title=Successful treatment of refractory post-vagotomy syndrome with verapamil (Calan SR) |journal=Am. J. Gastroenterol. |volume=85 |issue=3 |pages=328–9 |year=1990 |pmid=2309689 |doi= |url=}}</ref>
|120-240 mg, QD
|120-240 mg, QD
|Reduced vasomotor symptoms
|Reduced vasomotor [[Symptom|symptoms]]
|-
|-
|Acarbose<ref name="pmid9918426">{{cite journal |vauthors=Hasegawa T, Yoneda M, Nakamura K, Ohnishi K, Harada H, Kyouda T, Yoshida Y, Makino I |title=Long-term effect of alpha-glucosidase inhibitor on late dumping syndrome |journal=J. Gastroenterol. Hepatol. |volume=13 |issue=12 |pages=1201–6 |year=1998 |pmid=9918426 |doi= |url=}}</ref>
|[[Acarbose]]<ref name="pmid9918426">{{cite journal |vauthors=Hasegawa T, Yoneda M, Nakamura K, Ohnishi K, Harada H, Kyouda T, Yoshida Y, Makino I |title=Long-term effect of alpha-glucosidase inhibitor on late dumping syndrome |journal=J. Gastroenterol. Hepatol. |volume=13 |issue=12 |pages=1201–6 |year=1998 |pmid=9918426 |doi= |url=}}</ref>
|50-100 mg, TID
|50-100 mg, TID
|Reduced late dumping
|Reduced late dumping
|-
|-
|Octreotide<ref name="pmid9200302">{{cite journal |vauthors=Vecht J, Masclee AA, Lamers CB |title=The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment |journal=Scand. J. Gastroenterol. Suppl. |volume=223 |issue= |pages=21–7 |year=1997 |pmid=9200302 |doi= |url=}}</ref>
|[[Octreotide]]<ref name="pmid9200302">{{cite journal |vauthors=Vecht J, Masclee AA, Lamers CB |title=The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment |journal=Scand. J. Gastroenterol. Suppl. |volume=223 |issue= |pages=21–7 |year=1997 |pmid=9200302 |doi= |url=}}</ref>
|25-100 mcg, TID
|25-100 mcg, TID
|Reduced vasomotor symptoms
|Reduced vasomotor [[Symptom|symptoms]]
|-
|-
|Pantoprazole (PPI)<ref name="pmid20012198">{{cite journal |vauthors=Sanaka M, Yamamoto T, Kuyama Y |title=Effects of proton pump inhibitors on gastric emptying: a systematic review |journal=Dig. Dis. Sci. |volume=55 |issue=9 |pages=2431–40 |year=2010 |pmid=20012198 |doi=10.1007/s10620-009-1076-x |url=}}</ref>
|[[Pantoprazole]] (PPI)<ref name="pmid20012198">{{cite journal |vauthors=Sanaka M, Yamamoto T, Kuyama Y |title=Effects of proton pump inhibitors on gastric emptying: a systematic review |journal=Dig. Dis. Sci. |volume=55 |issue=9 |pages=2431–40 |year=2010 |pmid=20012198 |doi=10.1007/s10620-009-1076-x |url=}}</ref>
|
|
|Subjective improvement
|Subjective improvement
|-
|-
|Cholestyramine<ref name="pmid24199211">{{cite journal |vauthors=Barkun AN, Love J, Gould M, Pluta H, Steinhart H |title=Bile acid malabsorption in chronic diarrhea: pathophysiology and treatment |journal=Can. J. Gastroenterol. |volume=27 |issue=11 |pages=653–9 |year=2013 |pmid=24199211 |pmc=3816948 |doi= |url=}}</ref>
|[[Cholestyramine]]<ref name="pmid24199211">{{cite journal |vauthors=Barkun AN, Love J, Gould M, Pluta H, Steinhart H |title=Bile acid malabsorption in chronic diarrhea: pathophysiology and treatment |journal=Can. J. Gastroenterol. |volume=27 |issue=11 |pages=653–9 |year=2013 |pmid=24199211 |pmc=3816948 |doi= |url=}}</ref>
|
|
|Subjective improvement
|Subjective improvement
|-
|-
|Diazoxide<ref name="pmid26901345">{{cite journal |vauthors=Vilarrasa N, Goday A, Rubio MA, Caixàs A, Pellitero S, Ciudin A, Calañas A, Botella JI, Bretón I, Morales MJ, Díaz-Fernández MJ, García-Luna PP, Lecube A |title=Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry |journal=Obes Facts |volume=9 |issue=1 |pages=41–51 |year=2016 |pmid=26901345 |pmc=5644871 |doi=10.1159/000442764 |url=}}</ref>
|[[Diazoxide]]<ref name="pmid26901345">{{cite journal |vauthors=Vilarrasa N, Goday A, Rubio MA, Caixàs A, Pellitero S, Ciudin A, Calañas A, Botella JI, Bretón I, Morales MJ, Díaz-Fernández MJ, García-Luna PP, Lecube A |title=Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry |journal=Obes Facts |volume=9 |issue=1 |pages=41–51 |year=2016 |pmid=26901345 |pmc=5644871 |doi=10.1159/000442764 |url=}}</ref>
|75-260 mg, QD
|75-260 mg, QD
|Subjective improvement
|Subjective improvement
|-
|-
|Nifedipine<ref name="pmid19625246">{{cite journal |vauthors=Guseva N, Phillips D, Mordes JP |title=Successful treatment of persistent hyperinsulinemic hypoglycemia with nifedipine in an adult patient |journal=Endocr Pract |volume=16 |issue=1 |pages=107–11 |year=2010 |pmid=19625246 |pmc=3979460 |doi=10.4158/EP09110.CRR |url=}}</ref>
|[[Nifedipine]]<ref name="pmid19625246">{{cite journal |vauthors=Guseva N, Phillips D, Mordes JP |title=Successful treatment of persistent hyperinsulinemic hypoglycemia with nifedipine in an adult patient |journal=Endocr Pract |volume=16 |issue=1 |pages=107–11 |year=2010 |pmid=19625246 |pmc=3979460 |doi=10.4158/EP09110.CRR |url=}}</ref>
|30 mg, QD
|30 mg, QD
|Reduced hypoglycemic symptoms
|Reduced [[Hypoglycemia|hypoglycemic]] [[Symptom|symptoms]]
|-
|-
|Exendin 9-39<ref name="pmid24315990">{{cite journal |vauthors=Salehi M, Gastaldelli A, D'Alessio DA |title=Blockade of glucagon-like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass |journal=Gastroenterology |volume=146 |issue=3 |pages=669–680.e2 |year=2014 |pmid=24315990 |pmc=3943944 |doi=10.1053/j.gastro.2013.11.044 |url=}}</ref>
|Exendin 9-39<ref name="pmid24315990">{{cite journal |vauthors=Salehi M, Gastaldelli A, D'Alessio DA |title=Blockade of glucagon-like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass |journal=Gastroenterology |volume=146 |issue=3 |pages=669–680.e2 |year=2014 |pmid=24315990 |pmc=3943944 |doi=10.1053/j.gastro.2013.11.044 |url=}}</ref>
|7500 pmol/kg prime 
|7500 pmol/kg prime 
|Reduced hypoglycemic symptoms
|Reduced [[Hypoglycemia|hypoglycemic]] [[Symptom|symptoms]]
|}
|}
* After RYGB surgery, bioavailability is decreased in drugs such as (eg, amoxicillin, azithromycin, cyclosporine A, levothyroxine, nitrofurantoin, mycophenolic acid, phenytoin, phenobarbital sirolimus, tacrolimus, tamoxifen). Surgeries that decrease the stomach size may increase toxicity of nonsteroidal anti-inflammatory drugs, salicylates, oral bisphosphonates, and oral iron tablet formulations. Any procedure that causes dumping; increases gut transit time and may decease drug absorption.
* After RYGB [[surgery]], [[bioavailability]] is decreased in [[:Category:Drugs|drugs]] such as (eg, [[amoxicillin]], [[azithromycin]], [[Cyclosporine|cyclosporine A]], [[levothyroxine]], [[nitrofurantoin]], [[Mycophenolate sodium|mycophenolic acid]], [[phenytoin]], [[phenobarbital]], [[sirolimus]], [[tacrolimus]], [[tamoxifen]]). Surgeries that decrease the [[stomach]] size may increase [[toxicity]] of [[Non-steroidal anti-inflammatory drug|nonsteroidal anti-inflammatory drugs]], [[Salicylic acid|salicylates]], oral [[Bisphosphonate|bisphosphonates]], and oral [[iron]] tablet formulations. Any procedure that causes dumping; increases [[Gastrointestinal tract|gut]] transit time and may decease [[:Category:Drugs|drug]] [[absorption]].


{{Reflist|2}}
{{Reflist|2}}

Revision as of 18:28, 12 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

The main therapy for the management of dumping syndrome includes diet and pharmacological intervention.

Medical Therapy

Medical therapy for dumping syndrome includes diet and drug therapy.[1]

Level of evidence Type of evidence
I Evidence from meta-analysis of multiple, well-designed, controlled studies (randomized trials with low false-positive and low false-negative errors)
II Evidence from at least 1 well-designed, quasi-experimental study (randomized trials with high false-positive and high false-negative errors)
III Evidence from well-designed, quasi-experimental studies (nonrandomized, controlled, single-group, pre–post, cohort and time or matched case–control series)
IV Evidence from well-designed, non-experimental studies (comparative and correlational descriptive and case studies)
V Evidence from case reports
Grade of recommendation Level of evidence
A Level I evidence or consistent findings from multiple studies (level II, III or IV)
B Level II, III or IV evidence with generally consistent findings
C Level II, III or IV evidence with inconsistent findings
D Little or no systematic empirical evidence

Diet

Dietary Modifications (Level III; Grade B)

  • Decrease carbohydrate intake
    • Avoid simple sugars like soda, candy sweets, and cookies
  • Fluid restriction
    • Wait at least 30 minutes after a meal before drinking
  • Increase protein intake
  • Increase fat intake
  • Increase fiber intake
  • Dairy and dairy product restriction
  • Shorter meals
  • Eat slowly
  • Chew properly
  • Lying supine for 30 minutes after a meal
  • Glycemic index education of foods is important

Dietary Foods

The following is a table that illustrates the types of food to take and avoid in the case of dumping syndrome.

Breads, Cereals, Rice and Pasta Foods To Choose  Foods to Avoid
  • 6-11 servings each day
  • One serving equals: 1 slice bread, 1 cup ready-to-eat cereal
    • 1/2 cup cooked cereal, rice, or pasta
  • Breads, bagels, rolls, unsweetened cereals, pasta, potatoes, rice, crackers, and soup (only if taken one hour after solid foods at medium temperature).
  • Sweet rolls and doughnuts
  • Sweetened cereals
  • Pancakes and waffles with syrup
  • Soup (taken with solid foods)
 Fruits Foods to Choose Foods To Avoid
  •  2-4 servings each day
  • One serving equals: 1 medium size fresh, 1/2 cup canned, 3/4 cup juice 
  •  All fresh fruit
  • Drained, unsweetened canned fruit
  • Unsweetened frozen fruit
  • 100 percent pure juice (taken one hour after meals)
  • Canned fruits in heavy syrup
  • Sweetened frozen fruit
  • Sweetened juice (that is, punch or sports drinks)
  • Candied fruit
Milk and Dairy Products Foods To Choose Foods to Avoid
  • Limit to 2 servings each day
  • One serving equals: 1 cup milk or yogurt
  • Plain or unsweetened yogurt
  • Skim, 2 percent, or whole milk (taken one hour after meals)
  • Milkshakes and chocolate milk
  • Sweetened yogurt 
Meats, Poultry, Fish, Dry Beans, Peas, Eggs and Cheese Foods to Choose Foods to Avoid
  •  2-3 servings or a total of six ounces daily
    • One serving equals: 2-3 ounces cooked meat, chicken, or fish (about the size of a deck of cards)
    • or 1/2 to 3/4 cup cottage cheese or tuna fish
    • or one egg, 1/2 cup cooked beans, two tablespoons peanut butter, or one ounce of cheese.
  • Choose leaner cuts of beef and meat and limit the amount of high-fat items like eggs and cheese.
  • All meat, fish, poultry, peanut butter, cheese, eggs, and dried beans or legumes
  • Any not tolerated
Vegetables Foods to Choose Foods to Avoid
  •  3-5 servings each day
  • One serving equals: 1 cup raw, 1/2 cup cooked or chopped. 
  • All vegetables
  • Any not tolerated
Fats, Condiments and Beverages Foods to Choose Foods to Avoid
 
  • All butter, margarine, cream, oil, and salad dressings
  • Salt, herbs, spices, and condiments
  • Any sugar-free beverage (coffee, tea, diet soda, etc., taken one hour after solids)
  • Sweet pickles or relish
  • Sweetened drinks (regular lemonade, soda)
  • Any others not tolerated
Snacks, Sweets, and Desserts Foods to Choose Foods to Avoid
 
  • Sugar-free gelatin
  • Sugar-free pudding
  • Sugar-free candy
  • Sugar substitutes
  • Sugar
  • Candy and chocolate
  • Cakes and cookies
  • Ice cream and sherbet
  • Honey, syrup, and jelly
  • Sugar alcohols such as sorbitol, xylitol, and mannitol

 

Dietary Supplements (Level III; Grade C)

Drug Therapy

The two main stays for pharmacological intervention are Acarbose (Glucobay, Precose, Prandase) and Somatostatin analogues such as Octreotide (Sandostatin).

Acarbose (Level III; Grade B) Octreotide (Level II; Grade A)
Use Late dumping syndrome Early and Late dumping syndrome
Mechanism of Action Inhibits carbohydrate absorption Strong inhibitor of the gut hormones (especially insulin)
Dose
  • Initiate effect: 25-50 μg S.C two-three times daily (BID or TID)
  • Maximum effect: 100-200 μg S.C two-three times daily (BID or TID)
  • Long-acting (New) I.M once monthly
Effect
  • Decrease symptoms
  • Improves Sigstad's score
  • Inhibits vasodilation
  • Decrease Insulin levels
Additional information

Somatostatin analogues

Drug Dose Effect
Tolbutamide[2] 0.25-0.75 g, TID Subjective improvement
Propranolol[3] 10 mg, QID Reduced early dumping
Cyproheptadine[4] 4-8 mg, TID Preventing vasomotor symptoms
Methysergide maleate[5] 4-8 mg, TID Reduced vasomotor symptoms
Verapamil[6] 120-240 mg, QD Reduced vasomotor symptoms
Acarbose[7] 50-100 mg, TID Reduced late dumping
Octreotide[8] 25-100 mcg, TID Reduced vasomotor symptoms
Pantoprazole (PPI)[9] Subjective improvement
Cholestyramine[10] Subjective improvement
Diazoxide[11] 75-260 mg, QD Subjective improvement
Nifedipine[12] 30 mg, QD Reduced hypoglycemic symptoms
Exendin 9-39[13] 7500 pmol/kg prime  Reduced hypoglycemic symptoms
  1. ↑ . doi:10.1111/obr.12467/. Missing or empty |title= (help)
  2. ↑ Sigstad H (1969). "Effect of tolbutamide on the dumping syndrome". Scand. J. Gastroenterol. 4 (3): 227–31. PMID 5346670.
  3. ↑ Niv Y (1988). "The early dumping syndrome and propranolol". Ann. Intern. Med. 108 (6): 910–1. PMID 3369789.
  4. ↑ Leichter SB, Permutt MA (1975). "Effect of adrenergic agents on postgastrectomy hypoglycemia". Diabetes. 24 (11): 1005–10. PMID 1183731.
  5. ↑ Bernard PF, Baschet C, Le Henand F, Bouderlique JR, Lortat-Jacob JL (1970). "[Treatment of 65 cases of dumping syndrome with methysergide in recently gastrectomized patients]". Presse Med (in French). 78 (12): 549–50. PMID 5439191.
  6. ↑ Tabibian N (1990). "Successful treatment of refractory post-vagotomy syndrome with verapamil (Calan SR)". Am. J. Gastroenterol. 85 (3): 328–9. PMID 2309689.
  7. ↑ Hasegawa T, Yoneda M, Nakamura K, Ohnishi K, Harada H, Kyouda T, Yoshida Y, Makino I (1998). "Long-term effect of alpha-glucosidase inhibitor on late dumping syndrome". J. Gastroenterol. Hepatol. 13 (12): 1201–6. PMID 9918426.
  8. ↑ Vecht J, Masclee AA, Lamers CB (1997). "The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment". Scand. J. Gastroenterol. Suppl. 223: 21–7. PMID 9200302.
  9. ↑ Sanaka M, Yamamoto T, Kuyama Y (2010). "Effects of proton pump inhibitors on gastric emptying: a systematic review". Dig. Dis. Sci. 55 (9): 2431–40. doi:10.1007/s10620-009-1076-x. PMID 20012198.
  10. ↑ Barkun AN, Love J, Gould M, Pluta H, Steinhart H (2013). "Bile acid malabsorption in chronic diarrhea: pathophysiology and treatment". Can. J. Gastroenterol. 27 (11): 653–9. PMC 3816948. PMID 24199211.
  11. ↑ Vilarrasa N, Goday A, Rubio MA, Caixàs A, Pellitero S, Ciudin A, Calañas A, Botella JI, Bretón I, Morales MJ, Díaz-Fernández MJ, García-Luna PP, Lecube A (2016). "Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry". Obes Facts. 9 (1): 41–51. doi:10.1159/000442764. PMC 5644871. PMID 26901345.
  12. ↑ Guseva N, Phillips D, Mordes JP (2010). "Successful treatment of persistent hyperinsulinemic hypoglycemia with nifedipine in an adult patient". Endocr Pract. 16 (1): 107–11. doi:10.4158/EP09110.CRR. PMC 3979460. PMID 19625246.
  13. ↑ Salehi M, Gastaldelli A, D'Alessio DA (2014). "Blockade of glucagon-like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass". Gastroenterology. 146 (3): 669–680.e2. doi:10.1053/j.gastro.2013.11.044. PMC 3943944. PMID 24315990.

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