Dumping syndrome is a frequent complication of esophageal, gastric or
bariatric surgery. Rapid gastric emptying, with the delivery to the small intestine of a significant proportion of solid food as large particles that are difficult to digest, is a key event in the pathogenesis of this syndrome. This occurrence causes a shift of fluid from the intravascular component to the intestinal lumen, which results in cardiovascular symptoms, release of several gastrointestinal and
pancreatic hormones and late
postprandial hypoglycemia. Early dumping symptoms comprise both gastrointestinal and vasomotor symptoms. Late dumping symptoms are the result of
reactive hypoglycemia. Besides the assessment of clinical alertness and endoscopic or radiological imaging, a modified oral
glucose tolerance test might help to establish a diagnosis. The first step in treating
dumping syndrome is the introduction of dietary measures.
Acarbose can be added to these measures for patients with
hypoglycemia, whereas several studies advocate
guar gum or
pectin to slow gastric emptying.
Somatostatin analogs are the most effective medical
therapy for
dumping syndrome, and a slow-release preparation is the treatment of choice. In patients with treatment-refractory
dumping syndrome, surgical reintervention or continuous
enteral feeding can be considered, but the outcomes of such approaches are variable.