TY - JOUR
T1 - Dumping Syndrome
T2 - Pragmatic Treatment Options and Experimental Approaches for Improving Clinical Outcomes
AU - Masclee, Gwen M. C.
AU - Masclee, Ad A. M.
N1 - Funding Information: Professor Ad AM Masclee reports grants from the Dutch Cancer Society and Pentax GMBH outside the submitted work. The authors report no other conflicts of interest in this work. Publisher Copyright: © 2023 Masclee and Masclee.
PY - 2023
Y1 - 2023
N2 - 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. Dumping syndrome consists of early and late dumping symptoms and can be diagnosed using clinical parameters with the help of the Sigstad’s score, questionnaires or by provocative testing. The prevalence of dumping syndrome varies depending on the employed definition of dumping syndrome. Overall, dumping syndrome is more frequent nowadays due to increasing numbers of upper gastrointestinal and bariatric surgeries being performed. 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.
AB - 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. Dumping syndrome consists of early and late dumping symptoms and can be diagnosed using clinical parameters with the help of the Sigstad’s score, questionnaires or by provocative testing. The prevalence of dumping syndrome varies depending on the employed definition of dumping syndrome. Overall, dumping syndrome is more frequent nowadays due to increasing numbers of upper gastrointestinal and bariatric surgeries being performed. 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.
KW - bariatric surgery
KW - dumping syndrome
KW - early and late dumping
KW - octreotide
KW - somatostatin analogues
KW - upper gastrointestinal surgery
UR - http://www.scopus.com/inward/record.url?scp=85176544864&partnerID=8YFLogxK
U2 - https://doi.org/10.2147/CEG.S392265
DO - https://doi.org/10.2147/CEG.S392265
M3 - Review article
C2 - 37954129
SN - 1178-7023
VL - 16
SP - 197
EP - 211
JO - Clinical and Experimental Gastroenterology
JF - Clinical and Experimental Gastroenterology
ER -