Dumping Syndrome Medication

  • Author: Alan BR Thomson, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 26, 2010
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Next

Hypoglycemic agents

Class Summary

Shown to be helpful for late dumping.

Acarbose (Precose, Prandase)

 

Lowers blood sugar by delaying GI absorption of carbohydrates. Decreases postprandial hyperglycemia.

Previous
Next

Antisecretory agents

Class Summary

These agents may improve morbidity.

Octreotide (Somatostatin)

 

Acts primarily on somatostatin receptor subtypes II and V. Inhibits GH secretion and has a multitude of other endocrine and nonendocrine effects, including inhibition of glucagon, VIP, and GI peptides.

Previous
 
Contributor Information and Disclosures
Author

Alan BR Thomson, MD  Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association, American College of Gastroenterology, American Gastroenterological Association, Canadian Association of Gastroenterology, Canadian Medical Association, College of Physicians and Surgeons of Alberta, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Sukhdeep Padda, MD  Assistant Professor, Department of Internal Medicine, Section of Gastroenterology, University of Arizona Health Sciences Center

Sukhdeep Padda, MD is a member of the following medical societies: American College of Gastroenterology

Disclosure: Nothing to disclose.

Francisco Ramirez, MD, FACG  Chief, Section of Gastroenterology, Carl T Hayden VA Medical Center; Associate Professor, Department of Medicine, University of Arizona

Francisco Ramirez, MD, FACG is a member of the following medical societies: American College of Gastroenterology

Disclosure: Nothing to disclose.

Thomas Aguirre, MD  Gastroenterology Fellow, Department of Internal Medicine, University of Arizona

Thomas Aguirre, MD is a member of the following medical societies: American College of Gastroenterology and American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Vivek V Gumaste, MD  Associate Professor of Medicine, Mt Sinai School of Medicine; Adjunct Clinical Assistant, Mt Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center

Vivek V Gumaste, MD is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

BS Anand, MD  Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References
  1. Borrelli D, Borrelli A, Presenti L, Bergamini C, Basili G. [Surgical approach of the functional post-partial gastrectomy syndromes] [Italian]. Ann Ital Chir. Jan-Feb 2007;78(1):3-10. [Medline].

  2. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. Oct 2005;20(5):517-25. [Medline].

  3. Ishikawa K, Arita T, Ninomiya S, et al. Outcome of segmental gastrectomy versus distal gastrectomy for early gastric cancer. World J Surg. Nov 2007;31(11):2204-7. [Medline].

  4. Braghetto I, Papapietro K, Csendes A, et al. Nonesophageal side-effects after antireflux surgery plus acid-suppression duodenal diversion surgery in patients with long-segment Barrett's esophagus*. Dis Esophagus. 2005;18(3):140-5. [Medline].

  5. Rivera I, Ochoa-Martinez CI, Hermosillo-Sandoval JM, et al [Spanish]. [Dumping syndrome in patients submitted to gastric resection]. Cir Cir. Nov-Dec 2007;75(6):429-34. [Medline].

  6. Thalhammer M, Cuk A, Palitzsch KD. [Postalimentary hypoglycaemia in post-gastrectomy late dumping syndrome] [German]. Dtsch Med Wochenschr. Feb 25 2005;130(8):393-6. [Medline].

  7. Azpiroz F, Malagelada JR. Gastric tone measured by an electronic barostat in health and postsurgical gastroparesis. Gastroenterology. Apr 1987;92(4):934-43. [Medline].

  8. Hertz AF. IV. The Cause and Treatment of Certain Unfavorable After-effects of Gastro-enterostomy. Ann Surg. Oct 1913;58(4):466-72. [Medline].

  9. Spiller R. Role of motility in chronic diarrhoea. Neurogastroenterol Motil. Dec 2006;18(12):1045-55. [Medline].

  10. Morioka J, Miyachi M, Niwa M, et al. Gastric emptying for liquids and solids after distal gastrectomy with Billroth-I reconstruction. Hepatogastroenterology. May-Jun 2008;55(84):1136-9. [Medline].

  11. Kalser MH, Cohen R. Correlation of jejunal transfer of water and electrolytes with blood volume in postgastrectomy patients: response to hypertonic glucose meal. Ann Surg. Nov 1966;164(5):821-9. [Medline].

  12. Hinshaw DB, Joergerson EJ, Davis HA. Peripheral blood flow and blood volume studies in the dumping syndrome. Arch Surg. 1957;74:686.

  13. Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. Dec 2007;92(12):4678-85. [Medline].

  14. Yamamoto H, Mori T, Tsuchihashi H, et al. A possible role of GLP-1 in the pathophysiology of early dumping syndrome. Dig Dis Sci. Dec 2005;50(12):2263-7. [Medline].

  15. Akimov VP, Dvaladze LG, Shengelia TD, Veselov IuE. [A new view on pathogenesis of dumping-syndrome] [Russian]. Vestn Khir Im I I Grek. 2008;167(6):22-5. [Medline].

  16. Deitel M. The change in the dumping syndrome concept. Obes Surg. Dec 2008;18(12):1622-4. [Medline].

  17. Holdsworth CD, Turner D, McIntyre N. Pathophysiology of post-gastrectomy hypoglycaemia. Br Med J. Nov 1 1969;4(5678):257-9. [Medline].

  18. Virji A, Murr MM. Caring for patients after bariatric surgery. Am Fam Physician. Apr 15 2006;73(8):1403-8. [Medline].

  19. Penning C, Vecht J, Masclee AA. Efficacy of depot long-acting release octreotide therapy in severe dumping syndrome. Aliment Pharmacol Ther. Nov 15 2005;22(10):963-9. [Medline].

  20. Geer RJ, Richards WO, O'Dorisio TM, Woltering EO, Williams S, Rice D, et al. Efficacy of octreotide acetate in treatment of severe postgastrectomy dumping syndrome. Ann Surg. Dec 1990;212(6):678-87. [Medline].

  21. Didden P, Penning C, Masclee AA. Octreotide therapy in dumping syndrome: Analysis of long-term results. Aliment Pharmacol Ther. Nov 1 2006;24(9):1367-75. [Medline].

  22. Moreira RO, Moreira RB, Machado NA, Gonçalves TB, Coutinho WF. Post-prandial hypoglycemia after bariatric surgery: pharmacological treatment with verapamil and acarbose. Obes Surg. Dec 2008;18(12):1618-21. [Medline].

  23. Zhang J, Chen JD. Systematic review: applications and future of gastric electrical stimulation. Aliment Pharmacol Ther. Oct 1 2006;24(7):991-1002. [Medline].

  24. Wei HB, Wei B, Zheng ZH, et al. Comparative study on three types of alimentary reconstruction after total gastrectomy. J Gastrointest Surg. Aug 2008;12(8):1376-82. [Medline].

  25. Nunobe S, Sasako M, Saka M, et al. Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer. 2007;10(3):167-72. [Medline].

  26. Nakane Y, Michiura T, Sakuramoto K, et al. [Evaluation of the preserved function of the remnant stomach in pylorus preserving-gastrectomy by gastric emptying scintigraphy] [Japanese]. Gan To Kagaku Ryoho. Jan 2007;34(1):25-8. [Medline].

  27. Porter HW, Claman ZB. A preliminary report on the advantage of small stoma in partial gastrectomy for ulcer. Ann Surg. 1954;129:417.

  28. Woodward ER, Desser PL, Gasster M. Surgical treatment of postgastrectomy dumping syndrome. West J Surg. 1955;63:567.

  29. Koruth NM, Krukowski ZH, Matheson NA. Pyloric reconstruction. Br J Surg. Oct 1985;72(10):808-10. [Medline].

  30. Cheadle WG, Baker PR, Cuschieri A. Pyloric reconstruction for severe vasomotor dumping after vagotomy and pyloroplasty. Ann Surg. Nov 1985;202(5):568-72. [Medline].

  31. Henley FA. Experiences with jejunal interposition for correction of postgastrectomy syndromes. In: Harkins HN, Nyhus LM, eds. Surgery of the Stomach and Duodenum. Boston, Mass: Little Brown and Company; 1969:777.

  32. Sawyers JL, Herrington JL Jr. Superiority of antiperistaltic jejunal segments in management of severe dumping syndrome. Ann Surg. Sep 1973;178(3):311-21. [Medline].

  33. Vogel SB, Hocking MP, Woodward ER. Clinical and radionuclide evaluation of Roux-Y diversion for postgastrectomy dumping. Am J Surg. Jan 1988;155(1):57-62. [Medline].

  34. Meier JJ, Butler AE, Galasso R, Butler PC. Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased beta-cell turnover. Diabetes Care. Jul 2006;29(7):1554-9. [Medline]. [Full Text].

  35. Kellogg TA, Bantle JP, Leslie DB, et al. Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. Jul-Aug 2008;4(4):492-9. [Medline].

  36. Rubio MA, Moreno C. [Nutritional implications of bariatric surgery on the gastrointestinal tract] [Spanish]. Nutr Hosp. May 2007;22 Suppl 2:124-34. [Medline].

  37. Smith L, Smithers M, Prins J, O'Moore-Sullivan T. Acute and long-term effect of alpha-glucosidase inhibitor on dumping syndrome in a patient after a vagotomy and pyloric surgery. ANZ J Surg. Dec 2005;75(12):1124-6. [Medline].

  38. Yamada M, Ohrui T, Asada M, et al. Acarbose attenuates hypoglycemia from dumping syndrome in an elderly man with gastrectomy. J Am Geriatr Soc. Feb 2005;53(2):358-9. [Medline].

  39. Abbott WE, Krieger H, Levey S. Technical surgical factors which enhance or minimize postgastrectomy abnormalities. Ann Surg. 1958;148:567.

  40. Abell TL, Minocha A. Gastrointestinal complications of bariatric surgery: diagnosis and therapy. Am J Med Sci. Apr 2006;331(4):214-8. [Medline].

  41. Andreasen JJ, Orskov C, Holst JJ. Secretion of glucagon-like peptide-1 and reactive hypoglycemia after partial gastrectomy. Digestion. 1994;55(4):221-8. [Medline].

  42. Blackburn AM, Christofides ND, Ghatei MA, Sarson DL, Ebeid FH, Ralphs DN, et al. Elevation of plasma neurotensin in the dumping syndrome. Clin Sci (Lond). Oct 1980;59(4):237-43. [Medline].

  43. Bloom SR, Royston CM, Thomson JP. Enteroglucagon release in the dumping syndrome. Lancet. Oct 14 1972;2(7781):789-91. [Medline].

  44. Burkhalter E. Incidence of gastrectomy in United States army hospitals worldwide from 1975 to 1985. Am J Gastroenterol. Nov 1988;83(11):1231-4. [Medline].

  45. Carvajal SH, Mulvihill SJ. Postgastrectomy syndromes: dumping and diarrhea. Gastroenterol Clin North Am. Jun 1994;23(2):261-79. [Medline].

  46. Cranley B, Kelly KA, Go VL, McNichols LA. Enhancing the anti-dumping effect of Roux gastrojejunostomy with intestinal pacing. Ann Surg. Oct 1983;198(4):516-24. [Medline].

  47. Didden P, Penning C, Masclee AA. Octreotide therapy in dumping syndrome: Analysis of long-term results. Aliment Pharmacol Ther. Nov 1 2006;24(9):1367-75. [Medline].

  48. Duthie HL, Irvine WT, Kerr JW. Cardiovascular changes in post-gastrectomy syndrome. Br J Surg. 1959;46:350.

  49. Eisenberg MM, Woodward ER, Carson TJ, Dragstedt LR. Vagotomy and drainage procedure for duodenal ulcer: the results of ten years' experience. Ann Surg. Sep 1969;170(3):317-28. [Medline].

  50. Gonzalez-Sanchez JA, Corujo-Vazquez O, Sahai-Hernandez M. Bariatric surgery patients: reasons to visit emergency department after surgery. Bol Asoc Med P R. Oct-Dec 2007;99(4):279-83. [Medline].

  51. Gray JL, Debas HT, Mulvihill SJ. Control of dumping symptoms by somatostatin analogue in patients after gastric surgery. Arch Surg. Oct 1991;126(10):1231-5; discussion 1235-6. [Medline].

  52. Gustavsson S, Kelly KA, Melton LJ 3rd, Zinsmeister AR. Trends in peptic ulcer surgery. A population-based study in Rochester, Minnesota, 1956-1985. Gastroenterology. Mar 1988;94(3):688-94. [Medline].

  53. Hasler WL, Soudah HC, Owyang C. Mechanisms by which octreotide ameliorates symptoms in the dumping syndrome. J Pharmacol Exp Ther. Jun 1996;277(3):1359-65. [Medline].

  54. Hockings MP, Vogel SB. Woodward's postgastrectomy syndromes. Philadelphia, Pa: WB Saunders; 1991:195.

  55. Hoffmann J, Jensen HE, Christiansen J, Olesen A, Loud FB, Hauch O. Prospective controlled vagotomy trial for duodenal ulcer. Results after 11-15 years. Ann Surg. Jan 1989;209(1):40-5. [Medline].

  56. Holst JJ. Glucagonlike peptide 1: a newly discovered gastrointestinal hormone. Gastroenterology. Dec 1994;107(6):1848-55. [Medline].

  57. Hopman WP, Wolberink RG, Lamers CB, Van Tongeren JH. Treatment of the dumping syndrome with the somatostatin analogue SMS 201-995. Ann Surg. Feb 1988;207(2):155-9. [Medline].

  58. Johnson LP, Jesseph JE. Evidence of a humoral etiology of the dumping syndrome. Surg Forum. 1961;12:316.

  59. Johnston D, Blackett RL. A new look at selective vagotomies. Am J Surg. Nov 1988;156(5):416-27. [Medline].

  60. Karamanolis G, Tack J. Nutrition and motility disorders. Best Pract Res Clin Gastroenterol. 2006;20(3):485-505. [Medline].

  61. Khoshoo V, Reifen RM, Gold BD, Sherman PM, Pencharz PB. Nutritional manipulation in the management of dumping syndrome. Arch Dis Child. Dec 1991;66(12):1447-8. [Medline].

  62. Krieger H, Levey S. Technical surgical factors which enhance or minimize postgastrectomy abnormalities. Ann Surg. 1958;148:567.

  63. Lamers CB, Bijlstra AM, Harris AG. Octreotide, a long-acting somatostatin analog, in the management of postoperative dumping syndrome. An update. Dig Dis Sci. Feb 1993;38(2):359-64. [Medline].

  64. Lawaetz O, Blackburn AM, Bloom SR, Aritas Y, Ralphs DN. Gut hormone profile and gastric emptying in the dumping syndrome. A hypothesis concerning the pathogenesis. Scand J Gastroenterol. Jan 1983;18(1):73-80. [Medline].

  65. Layer P, Holst JJ, Grandt D, Goebell H. Ileal release of glucagon-like peptide-1 (GLP-1). Association with inhibition of gastric acid secretion in humans. Dig Dis Sci. May 1995;40(5):1074-82. [Medline].

  66. LeQuesne LP, Hobsley M, Hand BH. The dumping syndrome I. Factors responsible for the symptoms. Br Med J. 1960;1:141.

  67. Lygidakis NJ. A new method for the surgical treatment of the dumping syndrome. Ann R Coll Surg Engl. Nov 1981;63(6):411-4. [Medline].

  68. Machella TE. The mechanism of postgastrectomy dumping. Surg. 1949;130:145.

  69. Mackie CR, Jenkins SA, Hartley MN. Treatment of severe postvagotomy/postgastrectomy symptoms with the somatostatin analogue octreotide. Br J Surg. Nov 1991;78(11):1338-43. [Medline].

  70. Meyer JH, Thompson JB, Cohen MB. Motility of the stomach and the gastroduodenal junction. In: Johnson LR, ed. The Physiology of the Gastrointestinal Tract. 2nd ed. New York, NY: Raven Press; 1987:625-9.

  71. Meyer JH, Thomson JB, Cohen MB, Shadchehr A, Mandiola SA. Sieving of solid food by the canine stomach and sieving after gastric surgery. Gastroenterology. Apr 1979;76(4):804-13. [Medline].

  72. Miholic J, Reilmann L, Meyer HJ, Körber H, Kotzerke J, Hecker H. Extracellular space, blood volume, and the early dumping syndrome after total gastrectomy. Gastroenterology. Oct 1990;99(4):923-9. [Medline].

  73. Mix CL. Dumping following gastrojejunostomy. Surg Clin North Am. 1922;2:617.

  74. Norryd C, Dencker H, Lunderquist A, Olin T, Tylén U. Superior mesenteric blood flow during experimentally induced dumping in man. Acta Chir Scand. 1975;141(3):187-96. [Medline].

  75. Overton RC, Jordon GLJ, DeBakey ME. The postgastrectomy syndrome: studies of pathogenesis. Ann Surg. 1957;145:471.

  76. Paimela H, Tuompo PK, Perakyl T, Saario I, Hockerstedt K, Kivilaakso E. Peptic ulcer surgery during the H2-receptor antagonist era: a population-based epidemiological study of ulcer surgery in Helsinki from 1972 to 1987. Br J Surg. Jan 1991;78(1):28-31. [Medline].

  77. Pedersen JH, Beck H, Shokouh-Amiri M, Fischer A. Effect of neurotensin in the dumping syndrome. Scand J Gastroenterol. May 1986;21(4):478-82. [Medline].

  78. Penning C, Vecht J, Masclee AA. Efficacy of depot long-acting release octreotide therapy in severe dumping syndrome. Aliment Pharmacol Ther. Nov 15 2005;22(10):963-9. [Medline].

  79. Perman E. The so-called dumping syndrome after gastrectomy. Acta Med Scan. 1947;128 (suppl 196):361.

  80. Ralphs DN, Thomson JP, Haynes S, Lawson-Smith C, Hobsley M, Le Quesne LP. The relationship between the rate of gastric emptying and the dumping syndrome. Br J Surg. Sep 1978;65(9):637-41. [Medline].

  81. Roberts KE, Randall HT, Farr HW. Cardiovascular and blood volume alterations resulting from intrajejunal administration of hypertonic solutions to gastrectomized patients: The relationship of these changes to the dumping syndrome. Ann Surg. 1954;140:631.

  82. Sagor GR, Bryant MG, Ghatei MA, Kirk RM, Bloom SR. Release of vasoactive intestinal peptide in the dumping syndrome. Br Med J (Clin Res Ed). Feb 14 1981;282(6263):507-10. [Medline].

  83. Sawyers JL. Management of postgastrectomy syndromes. Am J Surg. Jan 1990;159(1):8-14. [Medline].

  84. Sigstad H. A clinical diagnostic index in the diagnosis of the dumping syndrome. Changes in plasma volume and blood sugar after a test meal. Acta Med Scand. Dec 1970;188(6):479-86. [Medline].

  85. Snook JA, Wells AD, Prytherch DR, Evans DH, Bloom SR, Colin-Jones DG. Studies on the pathogenesis of the early dumping syndrome induced by intraduodenal instillation of hypertonic glucose. Gut. Dec 1989;30(12):1716-20. [Medline].

  86. Tack J. Gastric motor disorders. Best Pract Res Clin Gastroenterol. 2007;21(4):633-44. [Medline].

  87. Tulassay Z, Tulassay T, Gupta R, Cierny G. Long acting somatostatin analogue in dumping syndrome. Br J Surg. Dec 1989;76(12):1294-5. [Medline].

  88. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. Oct 2005;20(5):517-25. [Medline].

  89. van der Kleij FG, Vecht J, Lamers CB, Masclee AA. Diagnostic value of dumping provocation in patients after gastric surgery. Scand J Gastroenterol. Dec 1996;31(12):1162-6. [Medline].

  90. Vetch J, Lambers RJ. Octreotide influences small intestinal motility and transit time in fasting and fed states. Gastro. 1994;106:A583.

  91. Visick AH. A study of the failures after gastrectomy. Ann R Coll Surg Engl. 1948;3:266.

  92. Wick JY. Coming to a facility near you: the bariatric surgery patient. Consult Pharm. Nov 2006;21(11):874-76, 878-80, 882, 885-6. [Medline].

  93. Wong PY, Talamo RC, Babior BM, Raymond GG, Colman RW. Kallikrein-kinin system in postgastrectomy dumping syndrome. Ann Intern Med. May 1974;80(5):577-81. [Medline].

  94. Z'graggen K, Guweidhi A, Steffen R, et al. Severe recurrent hypoglycemia after gastric bypass surgery. Obes Surg. Aug 2008;18(8):981-8. [Medline].

  95. Zeitlin IJ, Smith AN. 5-hydroxyindoles and kinins in the carcinoid and dumping syndromes. Lancet. Nov 5 1966;2(7471):986-91. [Medline].

Previous
Next
 
Pathophysiology of dumping syndrome.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.