From the Guidelines
The best way to treat dumping syndrome is through dietary modification, which is the initial approach and is usually beneficial for a majority of patients. This approach involves reducing the amount of food consumed at each meal, delaying fluid intake until at least 30 minutes after meals, eliminating rapidly absorbable carbohydrates, and eating a diet consisting of high-fibre and protein-rich foods 1. Patients should also be advised to eat slowly and chew well, and education about the glycemic index of different foods may also be helpful.
For patients who do not respond to dietary modifications, somatostatin analogues such as octreotide may be considered, which can slow gastric emptying and inhibit the release of gastrointestinal hormones 1. Octreotide can be administered subcutaneously three times daily as a short-acting formulation or intramuscularly once every 2 to 4 weeks as a long-acting formulation. However, the most common adverse events associated with somatostatin analogues are diarrhea, nausea, steatorrhea, gallstone formation, and pain at the injection site.
Some key points to consider when treating dumping syndrome include:
- Eating smaller, more frequent meals to reduce symptoms
- Avoiding simple carbohydrates and sugary foods to prevent late dumping symptoms such as hypoglycemia
- Increasing protein and fat intake to help slow gastric emptying
- Considering somatostatin analogues such as octreotide for patients who do not respond to dietary modifications
- Monitoring for adverse events associated with somatostatin analogues, such as diarrhea and nausea.
It is essential to note that most patients can effectively manage symptoms through dietary changes alone, with medications reserved for those with persistent symptoms 1.
From the Research
Treatment Options for Dumping Syndrome
- Dietary modifications to minimize ingestion of simple carbohydrates and to exclude fluid intake during ingestion of the solid portion of the meal can provide effective relief of symptoms 2
- Agents such as pectin and guar, which increase the viscosity of intraluminal contents, can be used to treat dumping syndrome 2
- Drugs such as the alpha-glucosidase inhibitor acarbose, which blunts the rapid absorption of glucose, can be used to treat late dumping symptoms 2, 3, 4
- Somatostatin analogues, such as octreotide, can be used to treat early and late dumping symptoms, and are effective in controlling severe dumping symptoms 5, 2, 3, 4, 6
Long-Term Efficacy of Treatment Options
- The long-term efficacy of octreotide is less favorable compared to short-term treatment, with 41% of patients remaining on therapy after a follow-up of 93 months 5
- Somatostatin analogues can be effective in controlling early and late dumping symptoms in the long term, but may have side effects and are expensive 3, 4
- Dietary adjustments and dietary supplements are often sufficient to manage symptoms for the majority of patients, and are recommended as the first step in treatment 3, 4
Emerging Therapies
- Glucagon-like peptide-1 receptor agonists, endoscopic and surgical (re)interventions are being studied as potential treatment options for refractory dumping syndrome, but their use is not recommended in clinical practice due to limited evidence 3, 4
- Pasireotide, a broad-spectrum somatostatin analogue, GLP-1 receptor antagonists, and administration of stable forms of glucagon are currently under study as potential treatments for dumping syndrome 4