From the Guidelines
Treatment of dumping syndrome after gastric bypass surgery should prioritize dietary modifications, with medications added if necessary, and consider somatostatin analogues like octreotide for severe cases, as they have been shown to improve symptoms and quality of life 1.
Key Recommendations
- Dietary changes should be tried first, including eating smaller, more frequent meals, avoiding liquids within 30 minutes of eating, reducing simple carbohydrates, and increasing protein, fat, and complex carbohydrates.
- Acarbose (25-100 mg three times daily with meals) can be added to slow carbohydrate digestion and reduce symptoms.
- Octreotide, a somatostatin analog, is effective for severe cases at doses of 25-100 mcg subcutaneously 2-3 times daily or as a long-acting monthly injection (10-30 mg) 1.
Considerations for Treatment
- Somatostatin analogues may be administered subcutaneously three times daily as a short-acting formulation or intramuscularly once every 2 to 4 weeks as a long-acting formulation.
- Long-acting formulations are preferred by patients due to less frequent administration and associated improvements in quality of life 1.
- Surgical interventions like pouch revision or creation of a neosphincter might be considered for patients with persistent severe symptoms despite medical therapy, though these are typically last resorts.
Evidence Base
- A study published in Obesity Reviews in 2017 found that octreotide was effective in improving dumping symptoms, hypoglycemia, and pulse rate, and was preferred by patients due to its ease of administration and improvement in quality of life 1.
- Another study published in the same journal found that pasireotide, a multireceptor-targeted somatostatin analogue, was effective in controlling postprandial hypoglycemia and improving changes in pulse rate and haematocrit in patients with dumping syndrome 1.
From the Research
Treatment Options for Dumping Syndrome
Dumping syndrome is a common complication after gastric bypass surgery, and various treatment options are available. The following are some of the treatment options:
- Dietary adjustment and dietary supplements: These are often sufficient to manage symptoms for the majority of patients 2
- Acarbose: Effective for late dumping symptoms, but its use is limited due to side effects 2
- Somatostatin analogues: Indicated after dietary adjustment and acarbose have failed, and are very effective for controlling early and late dumping 2, 3, 4
- Octreotide: A somatostatin analogue that has been shown to improve early dumping syndrome potentially through incretins 4
- Endoscopic management: Endoscopic transoral outlet reduction (TORe) has been shown to be safe and effective in improving dumping syndrome and reducing rates of surgical revision 5
- Surgical reintervention: May be considered for refractory cases, but is not recommended as a first-line treatment due to the risk of weight regain and recrudescence of comorbidities 6, 5
Diagnosis and Prevalence
Dumping syndrome can be diagnosed using clinical parameters, such as the Sigstad's score, questionnaires, or provocative testing 2, 6. The prevalence of dumping syndrome varies depending on the definition used, but it is more frequent nowadays due to the increasing number of upper gastrointestinal and bariatric surgeries being performed 2.
Management Strategies
A proposed management strategy for dumping syndrome includes:
- Dietary measures and acarbose as first-line treatment
- Somatostatin analogues, such as octreotide, as second-line treatment
- Endoscopic management, such as TORe, as an adjunct to lifestyle and pharmacologic therapy for refractory dumping syndrome
- Surgical reintervention as a last resort for refractory cases 2, 6, 5