Gastric dumping syndrome medical therapy
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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 |
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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:
- Pectin
- 15 grams of Pectin is effective
- Guar gum
- 15 grams of Guar gum is effective
- Glucomannan
- Glucomannan improves glucose tolerance but isn't as effective
- Pectin
- 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 |
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Fruits | Foods to Choose | Foods To Avoid |
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Milk and Dairy Products | Foods To Choose | Foods to Avoid |
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Meats, Poultry, Fish, Dry Beans, Peas, Eggs and Cheese | Foods to Choose | Foods to Avoid |
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Vegetables | Foods to Choose | Foods to Avoid |
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Fats, Condiments and Beverages | Foods to Choose | Foods to Avoid |
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Snacks, Sweets, and Desserts | Foods to Choose | Foods to Avoid |
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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) | |
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Use | Late dumping syndrome | Early and Late dumping syndrome |
Mechanism of Action | Inhibits carbohydrate absorption | Strong inhibitor of the gut hormones (especially insulin) |
Dose |
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Effect |
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Additional information |
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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:[14][15][16][17][18]
- Surgeries that decrease the stomach size may increase toxicity of:
- Any procedure that causes dumping will
- Increases gut transit time
- Decease drug absorption
References
- ↑ Ukleja A (2005). "Dumping syndrome: pathophysiology and treatment". Nutr Clin Pract. 20 (5): 517–25. doi:10.1177/0115426505020005517. PMID 16207692.
- ↑ 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.
- ↑ Padwal R, Klarenbach S, Wiebe N, Hazel M, Birch D, Karmali S, Sharma AM, Manns B, Tonelli M (2011). "Bariatric surgery: a systematic review of the clinical and economic evidence". J Gen Intern Med. 26 (10): 1183–94. doi:10.1007/s11606-011-1721-x. PMC 3181300. PMID 21538168.
- ↑ Smith A, Henriksen B, Cohen A (2011). "Pharmacokinetic considerations in Roux-en-Y gastric bypass patients". Am J Health Syst Pharm. 68 (23): 2241–7. doi:10.2146/ajhp100630. PMID 22095812.
- ↑ Padwal R, Brocks D, Sharma AM (2010). "A systematic review of drug absorption following bariatric surgery and its theoretical implications". Obes Rev. 11 (1): 41–50. doi:10.1111/j.1467-789X.2009.00614.x. PMID 19493300.
- ↑ Brocks DR, Ben-Eltriki M, Gabr RQ, Padwal RS (2012). "The effects of gastric bypass surgery on drug absorption and pharmacokinetics". Expert Opin Drug Metab Toxicol. 8 (12): 1505–19. doi:10.1517/17425255.2012.722757. PMID 22998066.
- ↑ Titus R, Kastenmeier A, Otterson MF (2013). "Consequences of gastrointestinal surgery on drug absorption". Nutr Clin Pract. 28 (4): 429–36. doi:10.1177/0884533613490740. PMID 23835364.