Pathophysiology, diagnosis and management of postoperative dumping syndrome

The signs and symptoms of dumping syndrome, a well-established complication of gastric and esophageal surgery, result from rapid gastric emptying and the delivery of large particles of poorly digested food to the small bowel. These symptoms, which can be classed as early or late, their pathophysiological basis, and the treatment options available to patients with dumping syndrome are outlined in this article. 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. Key Points Dumping syndrome is a common complication of esophageal and gastric (including bariatric) surgery Symptoms include early (gastrointestinal and vasomotor) and late (hypoglycemia) symptoms Diagnosis is based on a suggestive symptom pattern in patients with the appropriate surgical history; a modified oral glucose tolerance test might help to establish the diagnosis Initial therapy should focus on dietary measures; acarbose can be added to these measures in patients with hypoglycemia In patients who have not responded to initial therapy, (slow-release) somatostatin analogs are the treatment of choice In patients with treatment-refractory dumping syndrome, surgical reinterventions