Gastric dumping syndrome medical therapy: Difference between revisions
Line 68: | Line 68: | ||
* 15 grams of [[Guar gum]] or [[Pectin]] is effective. | * 15 grams of [[Guar gum]] or [[Pectin]] is effective. | ||
* [[Glucomannan]] improves [[glucose]] tolerance but isn't as effective | * [[Glucomannan]] improves [[glucose]] tolerance but isn't as effective | ||
* The increased fiber in the supplements leads to [[gas]] and [[bloating]]. This decreases tolerability and in turn reduces [[Compliance (medicine)|compliance]]. | * The increased fiber in the supplements leads to [[gas]] and [[bloating]]. This decreases tolerability and in turn reduces [[Compliance (medicine)|compliance]]. | ||
===='''Dietary Foods''' ==== | ===='''Dietary Foods''' ==== | ||
The following is a table that illustrates the types of food to take and avoid in the case of [[Gastric dumping syndrome|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]]. | ||
Line 294: | Line 294: | ||
|} | |} | ||
<br>'''Effects of Surgery on Medications''' | <br>'''Effects of Surgery on Medications''' | ||
* After RYGB [[surgery]], [[bioavailability]] is decreased in [[:Category:Drugs|drugs]] such as | * After RYGB [[surgery]], [[bioavailability]] is decreased in [[:Category:Drugs|drugs]] such as: | ||
** [[amoxicillin]] | |||
** [[azithromycin]] | |||
** [[Cyclosporine|Cyclosporine A]] | |||
** [[levothyroxine]] | |||
** [[nitrofurantoin]] | |||
** [[Mycophenolate sodium|Mycophenolic acid]] | |||
** [[phenytoin]], [[phenobarbital]] | |||
** [[sirolimus]] | |||
** T[[tacrolimus|acrolimus]] | |||
** [[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]] | |||
** Oral [[iron]] | |||
* Any procedure that causes dumping will | |||
** Increases [[Gastrointestinal tract|gut]] transit time | |||
** Decease [[:Category:Drugs|drug]] [[absorption]] | |||
<br> | <br> | ||
==References== | ==References== |
Revision as of 05:49, 13 December 2017
Gastric dumping syndrome Microchapters |
Differentiating Gastric dumping syndrome from other Diseases |
---|
Diagnosis |
Treatment |
Case Studies |
Gastric dumping syndrome medical therapy On the Web |
American Roentgen Ray Society Images of Gastric dumping syndrome medical therapy |
Risk calculators and risk factors for Gastric dumping syndrome medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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 Supplements (Level III; Grade C)
The following work similarly to each other. These supplements increase viscosity which in turn decreases gastric emptying and causes a delay in glucose absorption.
- Delay glucose absorption:
- 15 grams of Guar gum or Pectin is effective.
- Glucomannan improves glucose tolerance but isn't as effective
- The increased fiber in the supplements leads to gas and bloating. This decreases tolerability and in turn reduces compliance.
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 |
---|---|---|
|
|
|
Fruits | Foods to Choose | Foods To Avoid |
|
|
|
Milk and Dairy Products | Foods To Choose | Foods to Avoid |
|
|
|
Meats, Poultry, Fish, Dry Beans, Peas, Eggs and Cheese | Foods to Choose | Foods to Avoid |
|
|
|
Vegetables | Foods to Choose | Foods to Avoid |
|
|
|
Fats, Condiments and Beverages | Foods to Choose | Foods to Avoid |
|
| |
Snacks, Sweets, and Desserts | Foods to Choose | Foods to Avoid |
|
Drug Therapy
Although there are no FDA approved medications specific for dumping syndrome the following pharmacological interventions are used off-label:
- Acarbose (Glucobay, Precose, Prandase)
- 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 |
|
|
Effect |
|
|
Additional information |
|
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.
- Even though Pasireotide has been safe and effective no results of its clinical trials have been published to date.
Drug summary
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 |
Effects of Surgery on Medications
- After RYGB surgery, bioavailability is decreased in drugs such as:
- Surgeries that decrease the stomach size may increase toxicity of:
- Any procedure that causes dumping will
- Increases gut transit time
- Decease drug absorption
References
- ↑ . doi:10.1111/obr.12467/. Missing or empty
|title=
(help) - ↑ Sigstad H (1969). "Effect of tolbutamide on the dumping syndrome". Scand. J. Gastroenterol. 4 (3): 227–31. PMID 5346670.
- ↑ Niv Y (1988). "The early dumping syndrome and propranolol". Ann. Intern. Med. 108 (6): 910–1. PMID 3369789.
- ↑ Leichter SB, Permutt MA (1975). "Effect of adrenergic agents on postgastrectomy hypoglycemia". Diabetes. 24 (11): 1005–10. PMID 1183731.
- ↑ 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.
- ↑ Tabibian N (1990). "Successful treatment of refractory post-vagotomy syndrome with verapamil (Calan SR)". Am. J. Gastroenterol. 85 (3): 328–9. PMID 2309689.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.