Materiały źródłowe

• #1 International consensus on the diagnosis and management of dumping syndrome | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-020-0357-5

  Dumping syndrome is a common but underdiagnosed complication of gastric and oesophageal surgery. […] Dietary adjustment is the agreed first treatment step; acarbose is effective for late dumping syndrome symptoms and somatostatin analogues are preferred for patients who do not respond to diet adjustments and acarbose. […] Dietary modification is the initial approach, and is usually beneficial for the majority of patients. […] Clinicians should advise patients with dumping syndrome to reduce the amount of food consumed at each meal; moreover, patients should delay fluid intake until at least 30min after meals. […] Rapidly absorbable carbohydrates should be eliminated from the diet to prevent symptoms of late dumping syndrome, such as hypoglycaemia. […] Patients with dumping syndrome should be advised to eat a diet consisting of foods high in fibre and rich in protein, eaten slowly and chewed well.

• #1 Gastroparesis and Dumping Syndrome: Current Concepts and Management

  https://www.mdpi.com/2077-0383/8/8/1127

  Gastroparesis and dumping syndrome both evolve from a disturbed gastric emptying mechanism. […] Treatment strategies are quite similar in gastroparesis and dumping syndrome. In a multidisciplinary setting, a step-wise approach should be followed, where dietary modifications and patient education represent the first step, pharmacological interventions the second, and surgical interventions the last option. […] Similarly to gastroparesis, dietary modifications and patient education by a nutritional expert are the first steps in the treatment of dumping syndrome. Smaller and more frequent meals (around six per day) are recommended. Intake of fluids should be delayed by at least 30 min. Rapidly absorbable carbohydrates and alcoholic beverages should be avoided, while intake of high-fibre, high-protein food is recommended.

• #1 Dumping syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dumping-syndrome/diagnosis-treatment/drc-20371922

  Early dumping syndrome is likely to resolve on its own within three months. In the meantime, there’s a good chance that dietary changes will ease your symptoms. If not, your health care provider may recommend medications or surgery. […] If changes to your diet don’t improve symptoms, your health care provider may prescribe octreotide (Sandostatin). This anti-diarrheal drug, administered by injection under your skin, can slow the emptying of food into the intestine. Possible side effects include nausea, diarrhea and fatty stools (steatorrhea). […] If conservative approaches don’t help, surgery may be recommended. Depending on your situation, surgical procedures to treat dumping syndrome may include reconstructing the pylorus or surgery to reverse gastric bypass surgery.

• #1 Dumping Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470542/

  Dumping syndrome can occur after a variety of gastric procedures and occurs due to the rapid movement of hyperosmolar chyme from the stomach into the small intestine. Most cases of dumping syndrome are successfully treated with dietary adjustments. Specifically, meals should be divided so that smaller portions of food are consumed with greater frequency, and liquids should not be consumed until 30 minutes after each meal. Additionally, simple sugars and milk products should be avoided and protein and fat calories should be increased to compensate for a decreased carbohydrate intake. Fiber-rich food is encouraged as it promotes a longer transit time in the bowel. […] Most cases of dumping syndrome are successfully treated with dietary adjustments. The suggested division of meals recommended is at least six times per day. Liquids should be withheld until 30 minutes after the meal. In addition, simple sugars and milk products should be avoided. Protein and fat calories should be increased to compensate for the decreased carbohydrate intake. Fiber-rich food is encouraged and has shown to promote a longer transit time in the bowel.

• #1 Dumping Syndrome: Diagnosis, Treatment, Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17835-dumping-syndrome

  Eat more dietary fiber to add bulk to your meal and slow down its transit time. Fiber slows down sugar absorption in your digestive system. […] Lie down on your back for 30 minutes after eating. This may slow down gastric emptying and help maintain blood pressure during digestion. […] Don’t drink fluids within 30 minutes before or after eating. Fluids encourage motility. […] Certain medications can help modify the symptoms of early and late dumping syndrome, including: Octreotide acetate. Octreotide inhibits certain hormones in your digestive system, which slows down gastric emptying and small intestinal transit time. […] Acarbose. This medicine regulates blood sugar by slowing the rate at which your body absorbs carbohydrates. This has been shown to reduce hypoglycemia in late dumping syndrome.

• #1 Dumping Syndrome Causes + Natural Treatments – Dr. Axe

  https://draxe.com/health/dumping-syndrome/

  If lifestyle changes and medications dont relieve dumping symptoms, doctors may use a number of surgical procedures. These include reconstructive techniques that reverse gastric bypass surgery. Reconstructive operations are reserved for severely affected patients. Research shows that their results often provide limited effectiveness. […] With dietary changes, like avoiding simple carbohydrates and lactose foods, eating high-fiber and high-protein foods, sticking to smaller meals throughout the day, and waiting to drink liquids until at least 30 minutes after eating, people with dumping syndrome typically find comfort. Its also helpful to use high-fiber, gel-like substances, such as pectin, guar gum, glucomannan and psyllium husk.

• #1 International consensus on the diagnosis and management of dumping syndrome | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-020-0357-5

  Pharmacological intervention has to be considered in the management of dumping syndrome in patients who do not respond to dietary modification. […] Acarbose can be used as a treatment for symptoms of late dumping syndrome. […] Somatostatin analogues are the preferred treatment option for patients with well-established dumping syndrome who do not respond to initial dietary modification with or without acarbose treatment. […] Short-acting somatostatin analogue formulations are more effective than long-acting formulations at improving symptoms of dumping syndrome. […] The need for repeated injections of somatostatin analogues throughout the day is a major limitation to the long-term administration of short-acting formulations. […] In patients who do not respond to treatments, the value of continuous enteral feeding and especially of surgical re-intervention and pancreatic resection is uncertain and a conservative approach is recommended.

• #1 Dumping Syndrome: Symptoms, Causes, and Treatment

  https://www.verywellhealth.com/what-to-do-for-dumping-syndrome-1945209

  Most likely, yes. Dumping syndrome typically resolves without treatment within three months. Dietary changes should help reduce or eliminate dumping, and medications can help relieve uncomfortable symptoms. […] If dumping syndrome does not go away on its own, talk to your bariatric team about other options. Dumping syndrome treatments include medications and possibly corrective surgery. […] Prescription dumping syndrome treatments include Sandostatin (octreotide) and Prandase (acarbose). […] Sandostatin is an injectable medicine that mimics the hormone somatostatin, which regulates the activity of the gastrointestinal tract. […] Late dumping syndrome is often treated with the diabetes drug Prandase. This medication is taken before meals and prompts the pancreas to produce more insulin, preventing blood sugar spikes and dips. […] Imodium (loperamide) is commonly recommended to treat dumping syndrome-induced diarrhea.

• #1 Complications of Bariatric Surgery: Dumping Syndrome and Drug Disposition

  https://www.pharmacytimes.com/view/complications-of-bariatric-surgery-dumping-syndrome-and-drug-disposition

  Dumping syndrome is a side effect of malabsorptive bariatric procedures such as RYGB and biliopancreatic diversion. […] Clinicians treat dumping syndrome through dietary alterations by encouraging patients to reduce simple carbohydrate intake. Patients must avoid forbidden foods and change their eating behaviors (patients should cut food into small pieces, chew thoroughly, eat slowly, and wait 1 hour after a meal before drinking beverages). […] Patients whose symptoms persist often respond to octreotide 25 to 100 mcg subcutaneously 30 minutes before meals or long-acting depot injections of octreotide 10 to 20 mg/month. This somatostatin analogue slows gastric emptying, delays small bowel transit, and inhibits vasoactive peptide release. […] For late dumping syndrome, administering acarbose 25 mg before breakfast, lunch, and dinner often alleviates rebound hypoglycemia. Acarbose inhibits carbohydrate absorption in the small intestine, prevents postprandial hyperinsulinemia, and reduces insulin concentrations. Acarbose alleviates postprandial hypotension and tachycardia by slowing the gastric empting rate and subsequently delivering high-osmolality nutrients to the duodenum in a more measured way.

• #1 Gastric dumping syndrome medical therapy – wikidoc

  https://www.wikidoc.org/index.php/Gastric_dumping_syndrome_medical_therapy

  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) […] Good for long-term refractory dumping syndrome […] Side effects are the reason for stopping long-term therapy. Treat this by giving an extra dose before sleeping or a pancreatic enzyme replacement. […] Short-acting improves symptoms […] New long-acting release is effective, increases weight and improves the quality of life […] Safe […] Last resort drug.

• #1 Dumping Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470542/

  In a patient who continues to demonstrate symptoms despite dietary modifications, drug therapy may be considered. Several options include tolbutamide and propranolol. Octreotide is a somatostatin analog which inhibits several GI hormones. The therapeutic effects occur with delayed gastric emptying, decreased the release of GI hormones, prolonged small intestine transit time, decreased insulin release, and splanchnic vasoconstriction. Multiple studies have shown that octreotide was alleviating symptoms of dumping syndrome both as short and long-term therapy. Acarbose is a competitive inhibitor of intestinal brush border -glucosidase that has a higher affinity to the enzyme compared to the normal substrate. However, since it is a reversible interaction, the breakdown of oligosaccharides to monosaccharides is slowed. This delayed conversion helps prevent the adverse effects of late dumping. Studies have demonstrated a reduction in symptoms of postprandial hypoglycemia.

• #1 Dumping syndrome: Causes, management, and patient education

  https://www.myamericannurse.com/dumping-syndrome/

  Octreotide has been shown to improve both early and late dumping. Its administered by injecting 50 to 100 micrograms subcutaneously three to four times a day, 30 minutes before each meal. It causes a delay in gastric emptying, resulting in a smaller amount of food entering the intestine at one time. […] As a last resort, surgical intervention may be necessary for DS sufferers who have been compliant with dietary or pharmacologic therapy for at least 1 year but continue to be troubled by their symptoms. Several surgical procedures have been deemed somewhat successful in treating DS, but they arent always curative. […] Nurses play a unique role in the education of patients, ensuring that they understand their condition and its treatments. Primary interventions for patients with DS include teaching them how to maintain a symptom journal, providing dietary instruction, and promoting self-management. Stress the importance of learning what foods trigger or aggravate their symptoms because patient self-management has been shown to be the best approach to controlling early and late dumping.

• #1 Dumping Syndrome Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/173594-treatment

  Octreotide improves the symptoms in about 90% of patients with severe dumping refractory to other forms of medical interventions. […] During octreotide treatment, fecal fat excretion increases significantly. […] Octreotide appears to be safe in the long-term management of refractory dumping syndrome; however, the occurrence of diarrhea in patients who already have malabsorption and maldigestion may be a major limiting factor. […] Preventing dumping syndrome is preferable to treating its symptoms. […] Remedial surgery can be considered in patients whose condition is refractory to medical treatment or in patients unwilling to continue medical therapy. […] Several surgical procedures have been designed to rectify the symptoms of dumping. […] Conversion of a Billroth II to a Billroth I gastroduodenostomy improves dumping syndrome in 75% of patients.

• #1 Dumping Syndrome Causes + Natural Treatments – Dr. Axe

  https://draxe.com/health/dumping-syndrome/

  When dietary changes or supplements dont relieve dumping syndrome symptoms, doctors may prescribe medications like octreotide and acarbose. Octreotide is an anti-diarrheal drug that slows the emptying of food into the small intestine. It is usually injected at a doctors office, in the hospital or at home by a trained family member or friend. Short-acting formulas have to be administered 2-3 times per day into a vein under the skin. Long-acting formulas are injected into the buttocks muscles once every 4 weeks. Some octreotide side effects and complications include: diarrhea, gas, dizziness, drowsiness, headache, vision changes, gallstones and pain at the injection site. […] Acarbose controls high blood sugar. Doctors commonly prescribe it to people with type-2 diabetes. Acarbose works by slowing the breakdown of carbohydrates from food into sugar so that blood sugar levels dont rise as much after eating. Side effects of acarbose include diarrhea, gas, upset stomach, stomach pain and constipation.

• #1 List of 5 Dumping Syndrome Medications Compared

  https://www.drugs.com/condition/dumping-syndrome.html

  Dumping syndrome occurs when the contents of the stomach empty too quickly into the small intestine. The medications listed below are related to or used in the treatment of this condition. […] The drug name pantoprazole is used off-label to treat Dumping Syndrome. […] The drug name cholestyramine is used off-label to treat Dumping Syndrome. […] The drug name acarbose is used off-label to treat Dumping Syndrome. […] The drug name methscopolamine is used off-label to treat Dumping Syndrome. […] The drug name octreotide is used off-label to treat Dumping Syndrome.

• #1 Dumping Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470542/

  Surgical interventions are reserved for patients who fail conservative measures. There are several options, including stomal revision, Billroth II to Billroth I anastomoses, pyloric reconstruction, jejunal interposition, and Roux-en-Y conversion. The Billroth II to Billroth I conversion anastomosis resumes the transit of food to the duodenum. It is a simple intervention with minimal complications. The risk of gastric outlet obstruction is avoided here as well. The Roux-en-Y conversion into Roux-en-Y gastrojejunostomy delays gastric emptying and the transit through the Roux limb. Even though the mechanism for improved symptoms of Dumping syndrome is not known, favorable outcomes have been demonstrated. […] Most cases of dumping syndrome are successfully treated with dietary adjustments. If dietary adjustments fail, the healthcare provider might recommend medical or surgical management but the success of such interventions is not well established. […] Dumping syndrome is best managed by an interprofessional team that includes nurses, dietitians and pharmacist. The key is to be patient and consider dietary changes as the initial treatment of choice. Most patients will benefit from dietary changes but the response may take a few weeks or months.

• #1 Dumping Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20752

  Surgical interventions are reserved for patients who fail conservative measures. There are several options, including stomal revision, Billroth II to Billroth I anastomoses, pyloric reconstruction, jejunal interposition, and Roux-en-Y conversion. […] Most cases of dumping syndrome are successfully treated with dietary adjustments. If dietary adjustments fail, the healthcare provider might recommend medical or surgical management but the success of such interventions is not well established. […] Dumping syndrome is best managed by an interprofessional team that includes nurses, dietitians and pharmacist. The key is to be patient and consider dietary changes as the initial treatment of choice. Most cases of dumping syndrome are successfully treated with dietary adjustments. The suggested division of meals recommended is at least six times per day. Liquids should be withheld until 30 minutes after the meal. In addition, simple sugars and milk products should be avoided. Protein and fat calories should be increased to compensate for the decreased carbohydrate intake. Fiber-rich food is encouraged and has shown to promote a longer transit time in the bowel. […] Medications and surgery to enhance persistalsis are not consistently effective and may even worsen the symptoms. Overall, most patients will benefit from dietary changes but the response may take a few weeks or months.

• #1 Dumping Syndrome Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/173594-treatment

  Conversion to a Roux-en-Y gastrojejunostomy as a remedial operation has gained favor relatively recently. […] Hyperinsulinemic hypoglycemia with neuroglycopenia (shortage of glucose in the brain) is an increasingly recognized complication of Roux-en-Y gastric bypass due to the changes in gut hormonal milieu. […] Management includes strict low carbohydrate diet, followed by pharmacotherapy. […] Dietary prohibitions and instructions are very important in the management of dumping syndrome. […] Most patients have relatively mild symptoms and respond well to dietary manipulations. […] Supplementation with dietary fiber has proven effective in the treatment of hypoglycemic episodes. […] This dietary change to a low-carbohydrate, high protein diet, as well as the use of alpha-glucosidase inhibitors, may be useful to control the symptoms of dumping.

• #1 Bariatric Surgery: Postoperative Concerns – American Society for Metabolic and Bariatric Surgery

  https://asmbs.org/resources/bariatric-surgery-postoperative-concerns/

  Dumping syndrome is a common side effect after Roux-en-Y Gastric Bypass (RNYGB) surgery. About 85% of gastric bypass patients will experience dumping syndrome at some point after surgery. The symptoms can range from mild to severe. […] Management of early dumping can be relatively straightforward. First, the symptoms should be discussed with the Bariatric Surgeon. Dietary compliance with avoidance of refined sugars, high glycemic carbohydrates, or other foods that may be associated with the syndrome would be the primary treatment. […] Management of late dumping that persists in spite of the above dietary measures may be treated with a small amount of sugar (such as one-half glass of orange juice) about one hour after a meal, which may prevent the attack. Medications such as Acarbose or Somatostatin may be helpful if still symptomatic despite dietary changes.

• #1 Dumping Syndrome Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/173594-treatment

  Acarbose, an alpha-glycoside hydrolase inhibitor, interferes with carbohydrate absorption and thus may decrease the time delay between hyperglycemia and insulin response. This may lead to coinciding the peak of glucose and insulin levels and thus prevent hypoglycemic symptoms in patients with late dumping. […] Acarbose use may be limited by the occurrence of diarrhea secondary to fermentation of unabsorbed carbohydrates as manifested by increased breath hydrogen excretion and symptoms such as flatulence. […] Somatostatin and its synthetic analogue octreotide (Sandostatin, SMS 201-995) have been used with short-term success in patients with dumping syndrome, but the long-term efficacy of octreotide is much less favorable. […] The effectiveness of octreotide in controlling the symptoms of both early and late dumping has been demonstrated in several randomized control trials.

• #1 Dumping Syndrome | Stomach Cancer | Cancer Council NSW

  https://www.cancercouncil.com.au/stomach-cancer/managing-side-effects/dumping-syndrome/

  If surgery has changed the structure of your stomach, partially digested food can go into the small bowel too quickly. This can especially be a problem with fluids containing high amounts of simple sugar, such as soft drinks, juices and cordial. […] You may have cramps, nausea, racing heart, sweating, bloating, diarrhoea or dizziness. This combination of symptoms is called dumping syndrome. Symptoms usually begin 15–30 minutes after eating. […] Sometimes symptoms occur 1–2 hours after a meal. These are called late symptoms, which tend to cause weakness, light-headedness and sweating, and are usually worse after eating foods high in sugar. […] Have small meals throughout the day. Chew your food well. […] Eat slowly so your body can sense when it is full. […] Surgery may affect how you tolerate certain foods. Keep a record of foods that cause problems and talk to a dietitian for suggestions on what to eat to reduce the symptoms.

• #1 Dumping syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dumping-syndrome/symptoms-causes/syc-20371915

  Generally, you can help prevent dumping syndrome by changing your diet after surgery. Changes might include eating smaller meals and limiting high-sugar foods. In more-serious cases of dumping syndrome, you may need medications or surgery. […] Your doctor may refer you to a registered dietitian to help you create an eating plan.

• #1 Dumping Syndrome – Harbin Clinic

  https://harbinclinic.com/glossary/dumping-syndrome/

  Treatment for dumping syndrome includes changes in eating, diet, and nutrition; medication; and, in some cases, surgery. Many people with dumping syndrome have mild symptoms that improve over time with simple dietary changes. […] The first step to minimizing symptoms of dumping syndrome involves changes in eating, diet, and nutrition, and may include eating five or six small meals a day instead of three larger meals, delaying liquid intake until at least 30 minutes after a meal, increasing intake of protein, fiber, and complex carbohydrates—found in starchy foods such as oatmeal and rice, avoiding simple sugars such as table sugar, which can be found in candy, syrup, sodas, and juice beverages, and increasing the thickness of food by adding pectin or guar gum—plant extracts used as thickening agents.

• #1 Dumping Syndrome: Symptoms, Causes, and Treatment

  https://www.verywellhealth.com/what-to-do-for-dumping-syndrome-1945209

  Dumping Syndrome Treatment If your symptoms persist in spite of making dietary changes, speak with your healthcare provider. People who have more significant dumping syndrome symptoms are at risk for eating avoidance and nutritional deficiencies. […] Your practitioner will evaluate you and advise you as to the best course of action. If you have late dumping syndrome, your medical professional might recommend you increase your fiber intake through food or a supplement, in order to slow down the absorption of glucose and reduce the chance of hypoglycemia. […] Another option for either type is for your healthcare provider to prescribe one of the medications that are available for treating dumping syndrome. […] In extremely severe cases, a surgical procedure might be considered. However, as most cases of dumping syndrome improve over time, surgery would most likely not even be considered for at least one year following the original gastric procedure.

• #1 Gastroparesis and Dumping Syndrome: Current Concepts and Management

  https://www.mdpi.com/2077-0383/8/8/1127

  Pharmacological interventions are the third step in the therapeutic ladder. However, it should be kept in mind that as of yet no treatment has been approved for dumping syndrome. The currently available options are (1) acarbose and (2) for severe cases somatostatin analogues. […] Surgical interventions (revision surgery) should be discussed on a case to case basis, since data for their efficacy are limited.

• #1 Dumping Syndrome | CEG

  https://www.dovepress.com/dumping-syndrome-pragmatic-treatment-options-and-experimental-approach-peer-reviewed-fulltext-article-CEG

  Dumping syndrome is a common complication after esophageal, gastric and bariatric surgery and has a significant negative impact on the quality of life of patients. This narrative review describes the clinical syndrome, pathophysiology, diagnosis and reports on standard and pragmatic therapeutical treatment options in order to improve the clinical outcome of patients with dumping syndrome. First treatment step includes dietary adjustment and dietary supplements, which are often sufficient to manage symptoms for the majority of patients. Next step of therapy includes acarbose, which is effective for late dumping symptoms, but the use is limited due to side effects. Somatostatin analogues are indicated after these two steps have failed. Somatostatin analogues are very effective for controlling early and late dumping, also in the long term. Glucagon like peptide-1 receptor agonists, endoscopic and surgical (re)interventions are reported as treatment options for refractory dumping syndrome; however, their use is not recommended in clinical practice due to the limited evidence on and uncertainty of outcomes. These alternatives should be considered only as last resort options in patients with otherwise refractory and invalidating dumping syndrome. Therapy for dumping syndrome mainly relies on dietary and lifestyle adjustments. The first step in the management of dumping syndrome consists of dietary modifications. This step is essential and usually effective in patients with mild to moderate dumping symptoms. In case of insufficient control of dumping symptoms with dietary measures, use of dietary supplements should be considered. Acarbose is an alpha glycosidase hydrolase inhibitor that is taken before a meal (50 to 100 mg 3 times daily) to delay the conversion of oligosaccharides to monosaccharides in the small bowel that results in attenuated post-prandial hyperglycemia. Somatostatin (SST) is a brain-gut peptide that exerts its effects by interacting with specific receptors that belong to the family of G-protein coupled receptors. Octreotide (OCT) is a synthetic analogue of SST with pronounced gastrointestinal inhibitory effects including the inhibition of secretion of incretin hormones and insulin. After an initial positive response to short-acting somatostatin analogues lasting from several weeks to months, patients can be converted to long-acting somatostatin analogues providing equal symptomatic benefit. Surgical re-intervention after conservative steps have failed to manage symptoms of dumping syndrome, continuous enteral feeding or surgical interventions can be considered.

• #2 Dumping Syndrome | CEG

  https://www.dovepress.com/dumping-syndrome-pragmatic-treatment-options-and-experimental-approach-peer-reviewed-fulltext-article-CEG

  Dumping syndrome is a common complication after esophageal, gastric and bariatric surgery and has a significant negative impact on the quality of life of patients. This narrative review describes the clinical syndrome, pathophysiology, diagnosis and reports on standard and pragmatic therapeutical treatment options in order to improve the clinical outcome of patients with dumping syndrome. First treatment step includes dietary adjustment and dietary supplements, which are often sufficient to manage symptoms for the majority of patients. Next step of therapy includes acarbose, which is effective for late dumping symptoms, but the use is limited due to side effects. Somatostatin analogues are indicated after these two steps have failed. Somatostatin analogues are very effective for controlling early and late dumping, also in the long term. Glucagon like peptide-1 receptor agonists, endoscopic and surgical (re)interventions are reported as treatment options for refractory dumping syndrome; however, their use is not recommended in clinical practice due to the limited evidence on and uncertainty of outcomes. These alternatives should be considered only as last resort options in patients with otherwise refractory and invalidating dumping syndrome. Therapy for dumping syndrome mainly relies on dietary and lifestyle adjustments. The first step in the management of dumping syndrome consists of dietary modifications. This step is essential and usually effective in patients with mild to moderate dumping symptoms. In case of insufficient control of dumping symptoms with dietary measures, use of dietary supplements should be considered. Acarbose is an alpha glycosidase hydrolase inhibitor that is taken before a meal (50 to 100 mg 3 times daily) to delay the conversion of oligosaccharides to monosaccharides in the small bowel that results in attenuated post-prandial hyperglycemia. Somatostatin (SST) is a brain-gut peptide that exerts its effects by interacting with specific receptors that belong to the family of G-protein coupled receptors. Octreotide (OCT) is a synthetic analogue of SST with pronounced gastrointestinal inhibitory effects including the inhibition of secretion of incretin hormones and insulin. After an initial positive response to short-acting somatostatin analogues lasting from several weeks to months, patients can be converted to long-acting somatostatin analogues providing equal symptomatic benefit. Surgical re-intervention after conservative steps have failed to manage symptoms of dumping syndrome, continuous enteral feeding or surgical interventions can be considered.

• #2 International consensus on the diagnosis and management of dumping syndrome | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-020-0357-5

  Dumping syndrome is a common but underdiagnosed complication of gastric and oesophageal surgery. […] Dietary adjustment is the agreed first treatment step; acarbose is effective for late dumping syndrome symptoms and somatostatin analogues are preferred for patients who do not respond to diet adjustments and acarbose. […] Dietary modification is the initial approach, and is usually beneficial for the majority of patients. […] Clinicians should advise patients with dumping syndrome to reduce the amount of food consumed at each meal; moreover, patients should delay fluid intake until at least 30min after meals. […] Rapidly absorbable carbohydrates should be eliminated from the diet to prevent symptoms of late dumping syndrome, such as hypoglycaemia. […] Patients with dumping syndrome should be advised to eat a diet consisting of foods high in fibre and rich in protein, eaten slowly and chewed well.

• #2 Dumping Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20752

  Most cases of dumping syndrome are successfully treated with dietary adjustments. The suggested division of meals recommended is at least six times per day. Liquids should be withheld until 30 minutes after the meal. In addition, simple sugars and milk products should be avoided. Protein and fat calories should be increased to compensate for the decreased carbohydrate intake. Fiber-rich food is encouraged and has shown to promote a longer transit time in the bowel. […] In a patient who continues to demonstrate symptoms despite dietary modifications, drug therapy may be considered. Several options include tolbutamide and propranolol. […] Octreotide is a somatostatin analog which inhibits several GI hormones. The therapeutic effects occur with delayed gastric emptying, decreased the release of GI hormones, prolonged small intestine transit time, decreased insulin release, and splanchnic vasoconstriction. Multiple studies have shown that octreotide was alleviating symptoms of dumping syndrome both as short and long-term therapy.

• #2 Dumping Syndrome: Diagnosis, Treatment, Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17835-dumping-syndrome

  Most people can successfully manage dumping syndrome with dietary changes. […] When severe symptoms don’t respond to diet, medication may be an option. […] But medications can have side effects and aren’t ideal for long-term use. […] Rarely, when dumping syndrome results from surgery, and when all other treatments have failed, your healthcare provider might suggest another surgery to fix the problem. […] Healthcare providers recommend following these general guidelines to reduce symptoms: Eat smaller meals more frequently. Aim for six small meals instead of three. Eat slowly and chew thoroughly. […] Avoid simple sugars, carbohydrates and milk products. This will prevent rapid blood sugar shifts. […] Complex carbs, such as whole grains, are better. […] Eat more protein and healthy fats to replace carbohydrates in your diet. Fats slow down digestion and provide a steadier form of energy.

• #2 Dumping syndrome – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/dumping-syndrome/

  What treatment is available for dumping syndrome? The main treatment involves dietary changes as most patients have relatively mild symptoms they respond well to this approach. In patients with low blood pressure after meals (which can cause a feeling of lightheadedness or sweating), lying down for 30 minutes may help. In cases where dietary changes have not been successful, or when symptoms are severe, medications are taken to slow the stomach emptying and movement of food into the intestine. Very rarely, if neither dietary changes nor medications are successful, surgery may be recommended. […] Advice is usually given by a dietitian and usually includes several measures to stop the stomach emptying so quickly: Eat smaller meals. You will need to eat more often – at least five or six times a day to get the nutrients that you need. Eat slowly and chew your food well to help prepare it for digestion, you may also find ground meat such as mince easier than steak or chops. Avoid sugary foods such as sweets, sugary breakfast cereals, honey, syrups and sugary drinks such as cola. Avoid nutrient-rich supplement drinks as the condition is often triggered by the high sugar content of milk shake or juice style supplement drinks that are commonly advised by healthcare professionals. If you are struggling to maintain your weight ask your doctor to refer you to a dietitian who can advise a more suitable option for you. Eat more complex carbohydrates such as whole grains, pasta, potato, rice, wholemeal breads and unsweetened cereals. Eat more foods high in soluble fibre which slow the emptying of the stomach and prevent sugars from being absorbed too quickly. The following foods are high in soluble fibre: broccoli, brussel sprouts, carrots, nuts, oats, okra, peas, pears, prunes, pulses and soya beans. Eat a protein containing food with each meal. High protein foods include eggs, meat, poultry, fish, milk, yogurt, cheese, pulses and nuts. Avoid alcoholic drinks.

• #2 Dumping Syndrome: Symptoms, Causes, Complications, Treatment

  https://www.healthline.com/health/dumping-syndrome

  Treatment for dumping syndrome varies. Your doctor might recommend one or more treatments ranging from medication, dietary changes, and sometimes surgery. […] You may be able to relieve symptoms of dumping syndrome by making a few changes to your diet: Eat five to six smaller meals throughout the day instead of three big meals. Avoid or limit sugary foods like soda, candy, and baked goods. Eat more protein from foods like chicken, fish, peanut butter, and tofu. Get more fiber in your diet. Switch from simple carbohydrates like white bread and pasta to whole grains like oatmeal and whole wheat. You can also take fiber supplements. The extra fiber will help sugar and other carbohydrates get absorbed more slowly in your intestines. Don’t drink fluids within 30 minutes before or after meals. Chew your food completely before you swallow to make it easier to digest. Add pectin or guar gum to your food to thicken it. This will slow the rate at which food moves from your stomach to your intestine.

• #2 Dumping Syndrome Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/173594-treatment

  Acarbose, an alpha-glycoside hydrolase inhibitor, interferes with carbohydrate absorption and thus may decrease the time delay between hyperglycemia and insulin response. This may lead to coinciding the peak of glucose and insulin levels and thus prevent hypoglycemic symptoms in patients with late dumping. […] Acarbose use may be limited by the occurrence of diarrhea secondary to fermentation of unabsorbed carbohydrates as manifested by increased breath hydrogen excretion and symptoms such as flatulence. […] Somatostatin and its synthetic analogue octreotide (Sandostatin, SMS 201-995) have been used with short-term success in patients with dumping syndrome, but the long-term efficacy of octreotide is much less favorable. […] The effectiveness of octreotide in controlling the symptoms of both early and late dumping has been demonstrated in several randomized control trials.

• #2 Dumping syndrome – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/dumping-syndrome/

  Acarbose delays carbohydrate absorption and has been shown to help patients with late dumping symptoms. Octreotide is a synthetic form of somatostatin (a naturally occurring hormone in the body) and can have a beneficial effect by delaying stomach emptying and reducing the release of insulin and several gut hormones. Octreotide is a therapy used sparingly since this treatment can impair digestion. There are several newer medicines that are also beginning to be used to slow gastric emptying (many of these are also used to treat patients with diabetes); however, there is not enough evidence to make any recommendations yet.

• #2 Dumping Syndrome Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/173594-treatment

  Octreotide improves the symptoms in about 90% of patients with severe dumping refractory to other forms of medical interventions. […] During octreotide treatment, fecal fat excretion increases significantly. […] Octreotide appears to be safe in the long-term management of refractory dumping syndrome; however, the occurrence of diarrhea in patients who already have malabsorption and maldigestion may be a major limiting factor. […] Preventing dumping syndrome is preferable to treating its symptoms. […] Remedial surgery can be considered in patients whose condition is refractory to medical treatment or in patients unwilling to continue medical therapy. […] Several surgical procedures have been designed to rectify the symptoms of dumping. […] Conversion of a Billroth II to a Billroth I gastroduodenostomy improves dumping syndrome in 75% of patients.

• #2

• #2 What Is Dumping Syndrome?

  https://www.uspharmacist.com/article/what-is-dumping-syndrome

  TREATMENT […] Treating for DS includes changes in how and what patients eat, medications, and, in some cases, surgery. In many cases people have mild DS, and symptoms improve over time with simple changes in eating habits and diet; see TABLE 1. If changing eating habits and diet does not improve symptoms, patients may be prescribed medications, most commonly octreotide or acarbose. […] […] Pharmacotherapy […] Octreotide (Sandostatin): Somatostatin and its synthetic analogue octreotide have been used with short-term success in patients with DS. A study of 30 patients with DS treated with either SC octreotide, three times a day, or monthly octreotide LAR depot (a long-acting octapeptide with pharmacologic properties mimicking those of the natural hormone somatostatin) significantly reduced dumping symptoms and improved quality of life. Patients preferred monthly treatments.

• #2 Dumping syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dumping-syndrome/diagnosis-treatment/drc-20371922

  Early dumping syndrome is likely to resolve on its own within three months. In the meantime, there’s a good chance that dietary changes will ease your symptoms. If not, your health care provider may recommend medications or surgery. […] If changes to your diet don’t improve symptoms, your health care provider may prescribe octreotide (Sandostatin). This anti-diarrheal drug, administered by injection under your skin, can slow the emptying of food into the intestine. Possible side effects include nausea, diarrhea and fatty stools (steatorrhea). […] If conservative approaches don’t help, surgery may be recommended. Depending on your situation, surgical procedures to treat dumping syndrome may include reconstructing the pylorus or surgery to reverse gastric bypass surgery.

• #2 Dumping Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470542/

  In a patient who continues to demonstrate symptoms despite dietary modifications, drug therapy may be considered. Several options include tolbutamide and propranolol. Octreotide is a somatostatin analog which inhibits several GI hormones. The therapeutic effects occur with delayed gastric emptying, decreased the release of GI hormones, prolonged small intestine transit time, decreased insulin release, and splanchnic vasoconstriction. Multiple studies have shown that octreotide was alleviating symptoms of dumping syndrome both as short and long-term therapy. Acarbose is a competitive inhibitor of intestinal brush border -glucosidase that has a higher affinity to the enzyme compared to the normal substrate. However, since it is a reversible interaction, the breakdown of oligosaccharides to monosaccharides is slowed. This delayed conversion helps prevent the adverse effects of late dumping. Studies have demonstrated a reduction in symptoms of postprandial hypoglycemia.

• #2 SciELO Brazil – PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENTOF DUMPING SYNDROME AND ITS RELATION TO BARIATRIC SURGERY PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENTOF DUMPING SYNDROME AND ITS RELATION TO BARIATRIC SURGERY

  https://www.scielo.br/j/abcd/a/c85MgtFzcsLqhYTrrWNpHvM/

  Initial therapy is made by subcutaneous administration of short-acting agents – for example, 50 to 100 g octreotide -, and in case of efficacy and tolerance, a dose of slow-release 20 mg can be administered intramuscularly. In more severe cases, can be considered surgical methods such as the reconstruction of a gastric reservoir, add restrictive intervention, undo the operation or, if possible, insert a short antiperistaltic loop. […] Reconstructive operations are treatment alternatives, but only reserved for severely affected patients. However, their results often are irrelevant and of limited effectiveness. […] Early treatment is easily performed, since it is based on dietary change. The cases in which crises are moderate or severe drug therapy or even surgery may be required. Surgical treatment is reserved only to treat severely affected patients, with intense and disabling symptoms.

• #2 Dietary advice ‘Dumping Syndrome’ after Surgery – Leeds Teaching Hospitals NHS Trust

  https://www.leedsth.nhs.uk/patients/resources/dietary-advice-dumping-syndrome-after-surgery/

  Symptoms from early dumping usually resolve without any treatment as the gut adapts to the post-surgery changes but this can take several months. Sometimes, symptoms can improve or be prevented by a combination of dietary changes and medications. Post-prandial hypoglycaemia (late dumping syndrome) may present several months or years after surgery. […] There is no single medication to prevent or treat dumping syndrome. A doctor may recommend a medication to help with your symptoms. Anti-diarrhoeal medication can help reduce diarrhoea associated with dumping syndrome as it works by slowing down the time it takes food to pass through the gut. […] If you have any further questions in relation to your diet and ‘Dumping Syndrome’ after Surgery, please speak to your Dietitian who will be able to advise further.

• #2 Dumping Syndrome | Stomach Cancer | Cancer Council NSW

  https://www.cancercouncil.com.au/stomach-cancer/managing-side-effects/dumping-syndrome/

  If surgery has changed the structure of your stomach, partially digested food can go into the small bowel too quickly. This can especially be a problem with fluids containing high amounts of simple sugar, such as soft drinks, juices and cordial. […] You may have cramps, nausea, racing heart, sweating, bloating, diarrhoea or dizziness. This combination of symptoms is called dumping syndrome. Symptoms usually begin 15–30 minutes after eating. […] Sometimes symptoms occur 1–2 hours after a meal. These are called late symptoms, which tend to cause weakness, light-headedness and sweating, and are usually worse after eating foods high in sugar. […] Have small meals throughout the day. Chew your food well. […] Eat slowly so your body can sense when it is full. […] Surgery may affect how you tolerate certain foods. Keep a record of foods that cause problems and talk to a dietitian for suggestions on what to eat to reduce the symptoms.

• #2 Bariatric Surgery: Postoperative Concerns – American Society for Metabolic and Bariatric Surgery

  https://asmbs.org/resources/bariatric-surgery-postoperative-concerns/

  Dumping syndrome is a common side effect after Roux-en-Y Gastric Bypass (RNYGB) surgery. About 85% of gastric bypass patients will experience dumping syndrome at some point after surgery. The symptoms can range from mild to severe. […] Management of early dumping can be relatively straightforward. First, the symptoms should be discussed with the Bariatric Surgeon. Dietary compliance with avoidance of refined sugars, high glycemic carbohydrates, or other foods that may be associated with the syndrome would be the primary treatment. […] Management of late dumping that persists in spite of the above dietary measures may be treated with a small amount of sugar (such as one-half glass of orange juice) about one hour after a meal, which may prevent the attack. Medications such as Acarbose or Somatostatin may be helpful if still symptomatic despite dietary changes.

• #2 Complications of Bariatric Surgery: Dumping Syndrome and Drug Disposition

  https://www.pharmacytimes.com/view/complications-of-bariatric-surgery-dumping-syndrome-and-drug-disposition

  Dumping syndrome is a side effect of malabsorptive bariatric procedures such as RYGB and biliopancreatic diversion. […] Clinicians treat dumping syndrome through dietary alterations by encouraging patients to reduce simple carbohydrate intake. Patients must avoid forbidden foods and change their eating behaviors (patients should cut food into small pieces, chew thoroughly, eat slowly, and wait 1 hour after a meal before drinking beverages). […] Patients whose symptoms persist often respond to octreotide 25 to 100 mcg subcutaneously 30 minutes before meals or long-acting depot injections of octreotide 10 to 20 mg/month. This somatostatin analogue slows gastric emptying, delays small bowel transit, and inhibits vasoactive peptide release. […] For late dumping syndrome, administering acarbose 25 mg before breakfast, lunch, and dinner often alleviates rebound hypoglycemia. Acarbose inhibits carbohydrate absorption in the small intestine, prevents postprandial hyperinsulinemia, and reduces insulin concentrations. Acarbose alleviates postprandial hypotension and tachycardia by slowing the gastric empting rate and subsequently delivering high-osmolality nutrients to the duodenum in a more measured way.

• #2 Dumping Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470542/

  Surgical interventions are reserved for patients who fail conservative measures. There are several options, including stomal revision, Billroth II to Billroth I anastomoses, pyloric reconstruction, jejunal interposition, and Roux-en-Y conversion. The Billroth II to Billroth I conversion anastomosis resumes the transit of food to the duodenum. It is a simple intervention with minimal complications. The risk of gastric outlet obstruction is avoided here as well. The Roux-en-Y conversion into Roux-en-Y gastrojejunostomy delays gastric emptying and the transit through the Roux limb. Even though the mechanism for improved symptoms of Dumping syndrome is not known, favorable outcomes have been demonstrated. […] Most cases of dumping syndrome are successfully treated with dietary adjustments. If dietary adjustments fail, the healthcare provider might recommend medical or surgical management but the success of such interventions is not well established. […] Dumping syndrome is best managed by an interprofessional team that includes nurses, dietitians and pharmacist. The key is to be patient and consider dietary changes as the initial treatment of choice. Most patients will benefit from dietary changes but the response may take a few weeks or months.

• #2 Dumping syndrome: Causes, management, and patient education

  https://www.myamericannurse.com/dumping-syndrome/

  Octreotide has been shown to improve both early and late dumping. Its administered by injecting 50 to 100 micrograms subcutaneously three to four times a day, 30 minutes before each meal. It causes a delay in gastric emptying, resulting in a smaller amount of food entering the intestine at one time. […] As a last resort, surgical intervention may be necessary for DS sufferers who have been compliant with dietary or pharmacologic therapy for at least 1 year but continue to be troubled by their symptoms. Several surgical procedures have been deemed somewhat successful in treating DS, but they arent always curative. […] Nurses play a unique role in the education of patients, ensuring that they understand their condition and its treatments. Primary interventions for patients with DS include teaching them how to maintain a symptom journal, providing dietary instruction, and promoting self-management. Stress the importance of learning what foods trigger or aggravate their symptoms because patient self-management has been shown to be the best approach to controlling early and late dumping.

• #2 Dumping syndrome: Symptoms, causes, and phases

  https://www.medicalnewstoday.com/articles/320479

  Dumping syndrome can be treated through dietary and lifestyle changes. More severe cases may require medication or surgery. […] Treatment can largely be managed through lifestyle and dietary changes. […] Lifestyle and dietary changes can be used to ease the symptoms of dumping syndrome and are often very effective. […] More severe cases that are not improved with lifestyle and dietary changes may require medications or surgery. […] If dietary changes do not improve symptoms, a doctor may prescribe an octreotide injection. This is an anti-diarrheal drug that slows the rate at which food empties into the small intestine. It can also prevent the release of insulin to reduce the risk of low blood sugar levels. […] If dumping syndrome does not respond to other treatments, or if it is caused by previous surgery, a doctor may suggest surgery as a treatment. […] However, the National Institute of Diabetes and Digestive and Kidney Diseases warn that corrective surgery for dumping syndrome is often unsuccessful. […] In some cases, medicine or surgery may be necessary to relieve dumping syndrome.

• #2 International consensus on the diagnosis and management of dumping syndrome | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-020-0357-5

  Pharmacological intervention has to be considered in the management of dumping syndrome in patients who do not respond to dietary modification. […] Acarbose can be used as a treatment for symptoms of late dumping syndrome. […] Somatostatin analogues are the preferred treatment option for patients with well-established dumping syndrome who do not respond to initial dietary modification with or without acarbose treatment. […] Short-acting somatostatin analogue formulations are more effective than long-acting formulations at improving symptoms of dumping syndrome. […] The need for repeated injections of somatostatin analogues throughout the day is a major limitation to the long-term administration of short-acting formulations. […] In patients who do not respond to treatments, the value of continuous enteral feeding and especially of surgical re-intervention and pancreatic resection is uncertain and a conservative approach is recommended.

• #3 Treatment of Dumping Syndrome – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/dumping-syndrome/treatment

  Doctors treat dumping syndrome by recommending changes to how and what you eat, medicines, and, in some cases, surgery. […] The first step in treating dumping syndrome is changing how and what you eat. Many people with dumping syndrome have mild symptoms that improve over time with simple changes in eating and diet. […] If changing your eating habits doesn’t improve your symptoms, your doctor may prescribe medicines. […] Octreotide (Sandostatin) may help reduce the symptoms of dumping syndrome. […] Doctors may prescribe acarbose (Prandase, Precose) to help reduce the symptoms of late dumping syndrome. […] If stomach or esophagus surgery caused your dumping syndrome and other treatments don’t improve your symptoms enough, your doctor may recommend another surgery to try to correct dumping syndrome. […] Surgery to correct dumping syndrome doesn’t always work. […] If you have dumping syndrome, you may be able to prevent future symptoms with treatments such as changing your eating habits.

• #3 Dumping Syndrome Diet Plan | UPMC HealthBeat

  https://share.upmc.com/2016/03/dumping-syndrome-diet-plan/

  Patients who have undergone any stomach operation, such as gastric bypass or gastric sleeve surgery, may experience dumping syndrome. […] Changing your diet following surgery can help prevent dumping syndrome. […] Follow our tips and diet plan to help stop the symptoms of dumping syndrome. […] What you should do: Eat small, frequent meals. Eat at least 6 times a day. […] Lie down as soon as you finish eating. This reduces the symptoms of dumping syndrome by slowing the emptying of food from the stomach. […] What you should avoid: Avoid simple sugars such as sweets, candy, soda, cakes, and cookies. […] Do not drink liquids with your meal. Instead, drink liquids at least a 30 minutes to an hour after eating solid food. […] Note: Dairy products such as milk, cottage cheese, ice cream, and pudding may cause diarrhea in some people after stomach surgery. You may need to avoid milk products at first and then try them in small amounts as you advance your diet.

• #3 Dumping Syndrome: Symptoms, Causes | DHP Digestive Health Partners

  https://www.ncdhp.com/news/dumping-syndrome-information

  Eliminate or limit overly sugary foods. These include candy, baked goods, and soda. […] Chew your food completely and slowly. This aids in the process of digestion. […] Eat smaller meals instead of larger ones. Instead of having three large meals a day, opt for six smaller ones, spaced throughout the day. […] Thicken your meals by adding guar gum or pectin. These won’t alter the taste but will thicken your food so that it digests more slowly. […] Ask your doctor if you may need a nutritional supplement. A side effect of dumping syndrome involves minerals and vitamins not being properly absorbed into the bloodstream because of the rapid rate of digestion.

• #3 Gastric dumping syndrome medical therapy – wikidoc

  https://www.wikidoc.org/index.php/Gastric_dumping_syndrome_medical_therapy

  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) […] Good for long-term refractory dumping syndrome […] Side effects are the reason for stopping long-term therapy. Treat this by giving an extra dose before sleeping or a pancreatic enzyme replacement. […] Short-acting improves symptoms […] New long-acting release is effective, increases weight and improves the quality of life […] Safe […] Last resort drug.

• #3

  https://link.springer.com/article/10.1007/s11938-002-0061-7

  This study demonstrates that octreotide blunts many of the exaggerated responses associated with dumping syndrome, providing physiologic rationale for its therapeutic use. […] Long-term results of octreotide-therapy in severe dumping syndrome. […] Octreotide, a longacting somatostatin analog, in the management of postoperative dumping syndrome. An update. […] Efficacy of octreotide acetate in treatment of severe postgastrectomy dumping syndrome. […] Therapeutic value of octreotide for patients with severe dumping syndromea review of randomised controlled trials. […] Long-acting somatostatin analogue in dumping syndrome.

• #3 Dumping Syndrome: Diagnosis, Treatment, Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17835-dumping-syndrome

  Surgery is rarely recommended for dumping syndrome. […] But if surgery was the original cause of your distress, surgery again might undo it. […] When nothing else has helped and dumping syndrome is severely affecting your quality of life, you might choose to undergo reconstructive surgery. This usually means: Reconstructing or modifying a part of your stomach that isn’t functioning well. […] Reversing or converting gastric bypass operations to a less severe alternative.

• #3 What Is Dumping Syndrome?

  https://www.uspharmacist.com/article/what-is-dumping-syndrome

  Acarbose (Precose): Acarbose is an inhibitor of alpha glycosidase that is approved for treatment of diabetes mellitus. It inhibits the upper GI enzymes (alpha-glucosidases), which convert carbohydrates into monosaccharides. It is believed to reduce the symptoms of late DS by interfering with carbohydrate absorption and thus decreasing the time delay between hyperglycemia and insulin response. This may lead to peak glucose and insulin levels coinciding and thus prevent hypoglycemic symptoms in patients with late dumping. […] Surgery […] Patients with intractable dumping symptoms in whom dietary and medical therapy are unsuccessful may require reoperation. In patients who had a distal gastrectomy, conversion from a loop gastrojejunostomy to a Roux-en-Y reconstruction is the procedure of choice. Roux-en-Y gastric bypass is a weight-loss surgery that reduces the size of the stomach and restricts the amount of food a person can eat. It involves creating a stomach pouch out of a small portion of the stomach and attaching it directly to the small intestine, bypassing a large part of the stomach and duodenum. It is often done as a laparoscopic surgery, with small incisions in the abdomen. This operation slows gastric emptying by impairing motility of the Roux loop. The type of surgery recommended depends on the type of surgery that led to the DS. Surgery to correct DS does not always work.

• #3 Dumping Syndrome: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.dumping-syndrome-care-instructions.abp1938

  Dumping syndrome can make you feel faint, shaky, and sick to your stomach, and may give you diarrhea. […] You may be able to prevent dumping syndrome by being careful about what you eat. If your dumping syndrome is severe or doesn’t get better with a change in your diet, your doctor may have you try some medicines. Follow your doctor’s directions carefully. […] Follow-up care is a key part of your treatment and safety. […] Talk with a dietitian to help you plan menus that pack good nutrition into several small meals. […] If you often have diarrhea, taking an over-the-counter medicine for diarrhea (such as Imodium) 30 to 60 minutes before eating may help. Take this medicine only if your doctor tells you it’s okay.

• #3

  https://www.ambarinutrition.com/blogs/health-and-weight-loss-journal/dumping-syndrome-triggers-home-treatments-everything-you-need-to-know-kh1?srsltid=AfmBOooIc4sC0oRONsgfcoBC7HStOyQtQvIMk4EMy-OUCOO-LwTETnZ2

  Dumping syndrome can also occur in people who haven’t had surgery. […] The prognosis for controlling dumping syndrome is good. Most patients see great improvement through dietary changes, medication, and learning methods to shorten attacks when they occur. […] In addition to medical management, there are many helpful at-home care strategies that can alleviate dumping syndrome episodes when they occur and help prevent future attacks. […] When dumping symptoms strike, the priority is helping your body cope with the rapid fluid shifts and reducing discomfort. […] Proactive steps to take in your daily routine to prevent repeat dumping attacks include: Stick closely to the recommended post-surgery diet guidelines, Eat 5-6 small, portion controlled meals spaced evenly, Limit concentrated sweets – opt for complex carbs and fruit (not fruit juices), Increase fiber and protein intake between meals, Stay well hydrated by drinking fluids between meals, not during, Avoid drinking 30 minutes before to 2 hours after meals, Relax after eating by lying down or going for a leisurely walk, Note symptom triggers in a journal so your doctor can optimize treatment, Reach/maintain goal weight to eliminate additional gastric surgery. […] Implementing lifestyle adaptations takes dedication but can dramatically improve comfort and quality of life on an ongoing basis.

• #4 Dumping Syndrome — No Stomach For Cancer

  https://nostomachforcancer.org/after-diagnosis/life-without-a-stomach/special-concerns/dumping-syndrome/

  Up to 75 % of patients who have had a partial or total gastrectomy may experience dumping syndrome. […] Symptoms of dumping syndrome are more common in the immediate post-operative period and often subside over time. […] General Guidelines to Prevent Dumping Syndrome: Eat six to eight small meals daily to avoid eating too much at a time. You may be able to tolerate larger portions over time but keep servings small at first. Have a protein food with each meal and snack such as meat, poultry, fish, eggs, milk, cheese, yogurt, nuts, tofu, or peanut butter. Do not drink liquids with meals. Drink 30 to 60 minutes before or after meals. Eventually, you may tolerate small amounts of liquid with meals. Limit high-sugar foods such as soda, juice, Ensure, Boost, cakes, pies, candy, doughnuts, cookies, fruit cooked or canned with sugar, honey, jams, and jellies. Choose high-fiber foods when possible. These include whole wheat breads and cereals, whole wheat pasta, fresh fruits, and vegetables. Choose foods high in soluble fiber. This includes apples, oats, beets, brussel sprouts, carrots, spinach, and beans. Try adding a serving of fat to meals and snacks such as butter, margarine, gravy, vegetable oils, and salad dressings. Fats slow stomach emptying and may help prevent dumping syndrome. Some people find that avoiding very hot or very cold foods can be helpful. Chew foods well and eat slowly. Try to relax while eating. Lying down right after eating may lessen symptoms.

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