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Diagnosis and Treatment of Dumping Syndrome After Gastric Bypass for Morbid Obesity

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Bariatric Endoscopy

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Abstract

Dumping syndrome (DS) refers to a group of gastrointestinal and vasomotor symptoms that occur after the ingestion of a meal. The large number of patients undergoing bariatric surgery has dramatically increased the prevalence of DS. Uncontrolled severe dumping can result in sitophobia and weight loss, leading to malnutrition. In many patients, effective control of symptoms can be achieved with dietary and lifestyle modifications. If this approach is unsatisfactory, medical therapy is the following step, and in some cases surgery might be considered. Diagnosis and management of dumping syndrome is detailed in this chapter.

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References

  1. Buchwald H. The dumping syndrome and its treatment. A review and presentation of cases. Am J Surg. 1968;116(1):81–8.

    Article  PubMed  CAS  Google Scholar 

  2. Denixheau D. Les suites medicales eloignees de la gastroenterostomie au corns de l’ulc&re de l’estomac et de ses complications. T/&se de Paris;1907.

    Google Scholar 

  3. Jonas S. Gber die nach Gastroenterostomie auftretenden Beschwerded und das rediologische Vorhalten des anastomierten Magens. ArchVerdauungskr. 1908;14.

    Google Scholar 

  4. Hertz AF. Cause and treatment of certain unfavorable after effects of gastroenterostomy. Ann Surg. 1913; 58:466–72.

    Article  PubMed  CAS  Google Scholar 

  5. Wyllys E, Andrews E, Mix CL. Dumping stomach and other results of gastrojejunostomy: operative cure by disconnecting old stoma. Surg Clin Chic. 1920; 4:879–92.

    Google Scholar 

  6. Gilger MA, et al. Outcomes of surgical fundoplication in children. Clin Gastroenterol Hepatol. 2004;2(11): 978–84.

    Article  PubMed  Google Scholar 

  7. Mallory GN, Macgregor AM, Rand CS. The influence of dumping on weight loss after gastric restrictive surgery for morbid obesity. Obes Surg. 1996;6(6):474–8.

    Article  PubMed  Google Scholar 

  8. Zaloga GP, Chernow B. Postprandial hypoglycemia after Nissen fundoplication for reflux esophagitis. Gastroenterology. 1983;84(4):840–2.

    PubMed  CAS  Google Scholar 

  9. Tack J, et al. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009;6(10):583–90.

    Article  PubMed  Google Scholar 

  10. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19(12):1605–11.

    Article  PubMed  Google Scholar 

  11. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005;20(5):517–25.

    Article  PubMed  Google Scholar 

  12. Hejazi RA, Patil H, McCallum RW. Dumping syndrome: establishing criteria for diagnosis and identifying new etiologies. Dig Dis Sci. 2010;55(1):117–23.

    Article  PubMed  Google Scholar 

  13. Deitel M. The change in the dumping syndrome concept. Obes Surg. 2008;18(12):1622–4.

    Article  PubMed  Google Scholar 

  14. Johnson LP, et al. Serotonin antagonists in experimental and clinical “dumping”. Ann Surg. 1962;156:537–49.

    Article  PubMed  CAS  Google Scholar 

  15. Johnson LP, Sloop RD, Jesseph JE. Etiologic significance of the early symptomatic phase in the dumping syndrome. Ann Surg. 1962;156:173–9.

    Article  PubMed  CAS  Google Scholar 

  16. Tack J. Gastric motor disorders. Best Pract Res Clin Gastroenterol. 2007;21(4):633–44.

    Article  PubMed  CAS  Google Scholar 

  17. Gebhard B, et al. Postprandial GLP-1, norepinephrine, and reactive hypoglycemia in dumping syndrome. Dig Dis Sci. 2001;46(9):1915–23.

    Article  PubMed  CAS  Google Scholar 

  18. Mason EE. Gastric emptying controls type 2 diabetes mellitus. Obes Surg. 2007;17(7):853–5.

    Article  PubMed  Google Scholar 

  19. Bantle JP, et al. Hyperinsulinemic hypoglycemia developing late after gastric bypass. Obes Surg. 2007;17(5):592–4.

    Article  PubMed  Google Scholar 

  20. Deitel M. Surgery for diabetes at lower BMI: some caution. Obes Surg. 2008;18(10):1211–4.

    Article  PubMed  Google Scholar 

  21. Service GJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353(3):249–54.

    Article  PubMed  CAS  Google Scholar 

  22. Clancy TE, Moore Jr FD, Zinner MJ. Post-gastric bypass hyperinsulinism with nesidioblastosis: subtotal or total pancreatectomy may be needed to prevent recurrent hypoglycemia. J Gastrointest Surg. 2006;10(8):1116–9.

    Article  PubMed  Google Scholar 

  23. Markmann FJ, Yeh H, Naji A, et al. Transplantation of abdominal organs. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston textbook of surgery. 18th ed. Philadelphia, PA: Saunders Elsevier; 2008.

    Google Scholar 

  24. Eagon JC, Miedema BW, Kelly KA. Postgastrectomy syndromes. Surg Clin North Am. 1992;72(2):445–65.

    PubMed  CAS  Google Scholar 

  25. van der Kleij FG, et al. Diagnostic value of dumping provocation in patients after gastric surgery. Scand J Gastroenterol. 1996;31(12):1162–6.

    Article  PubMed  Google Scholar 

  26. Abell TL, et al. Cyclic vomiting syndrome in adults. Neurogastroenterol Motil. 2008;20(4):269–84.

    Article  PubMed  CAS  Google Scholar 

  27. Camilleri M, et al. Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology. 1998;115(3):747–62.

    Article  PubMed  CAS  Google Scholar 

  28. Hasegawa T, et al. Long-term effect of alpha-glucosidase inhibitor on late dumping syndrome. J Gastroenterol Hepatol. 1998;13(12):1201–6.

    PubMed  CAS  Google Scholar 

  29. van Berge Henegouwen MI, et al. The effect of octreotide on gastric emptying at a dosage used to prevent complications after pancreatic surgery: a randomised, placebo controlled study in volunteers. Gut. 1997;41(6):758–62.

    Article  PubMed  Google Scholar 

  30. Foxx-Orenstein A, et al. Effect of a somatostatin analogue on gastric motor and sensory functions in healthy humans. Gut. 2003;52(11):1555–61.

    Article  PubMed  CAS  Google Scholar 

  31. Geer RJ, et al. Efficacy of octreotide acetate in treatment of severe postgastrectomy dumping syndrome. Ann Surg. 1990;212(6):678–87.

    Article  PubMed  CAS  Google Scholar 

  32. Fuessl HS, et al. Effect of a long-acting somatostatin analogue (SMS 201–995) on postprandial gastric emptying of 99mTc-tin colloid and mouth-to-caecum transit time in man. Digestion. 1987;36(2):101–7.

    Article  PubMed  CAS  Google Scholar 

  33. Hopman WP, et al. Treatment of the dumping syndrome with the somatostatin analogue SMS 201–995. Ann Surg. 1988;207(2):155–9.

    Article  PubMed  CAS  Google Scholar 

  34. Arts J, et al. Efficacy of the long-acting repeatable formulation of the somatostatin analogue octreotide in postoperative dumping. Clin Gastroenterol Hepatol. 2009;7(4):432–7.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  36. Ewins DL, et al. Assessment of gall bladder dynamics, cholecystokinin release and the development of gallstones during octreotide therapy for acromegaly. Q J Med. 1992;83(300):295–306.

    PubMed  CAS  Google Scholar 

  37. Patti ME, et al. Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia. Diabetologia. 2005;48(11):2236–40.

    Article  PubMed  CAS  Google Scholar 

  38. Woodward ER, Desser PL, Gasster M. Surgical treatment of the postgastrectomy dumping syndrome. West J Surg Obstet Gynecol. 1955;63(9):567–73.

    PubMed  CAS  Google Scholar 

  39. Sawyers JL, Herrington Jr JL. Superiority of antiperistaltic jejunal segments in management of severe dumping syndrome. Ann Surg. 1973;178(3):311–21.

    Article  PubMed  CAS  Google Scholar 

  40. Koruth NM, Krukowski ZH, Matheson NA. Pyloric reconstruction. Br J Surg. 1985;72(10):808–10.

    Article  PubMed  CAS  Google Scholar 

  41. Ramus NI, Williamson RC, Jonhston D. The use of jejunal interposition for intractable symptoms complicating peptic ulcer surgery. Br J Surg. 1982;69(5):265–8.

    Article  PubMed  CAS  Google Scholar 

  42. Thomson A, Padda S, Ramirez F, Aguirre T. Dumping syndrome. Medscape; June 10, 2008. http://www.emedicine.com/med/topic589.htm Accessed 28 Nov 2012.

  43. Keshishian A, et al. Duodenal switch is a safe operation for patients who have failed other bariatric operations. Obes Surg. 2004;14(9):1187–92.

    Article  PubMed  Google Scholar 

  44. Loss AB, Souza AAP, Pitombo CA, Milcent M, Madureira FAV. Analysis of the dumping syndrome on morbid obese patients submitted to Roux en Y gastric bypass. Rev Col Bras Cir. 2009;36(5):413–9.

    Google Scholar 

  45. Zagury L, et al. Insulinoma misdiagnosed as dumping syndrome after bariatric surgery. Obes Surg. 2004; 14(1):120–3.

    Article  PubMed  Google Scholar 

  46. Goncalves CG, Rubino F, Brethauer SA, Schauer PR. Physiology and metabolism in obesity surgery: Roux-en- Y gastric bypass. In: Pitombo C, Jones Jr KB, Higa KD, Pareja JC, editors. Obesity surgery—principles and practice. 1st ed. New York: Mc Graw Hill; 2007.

    Google Scholar 

  47. Marema R. Laparoscopic gastric bypass: evaluation, safety, and efficacy of the banded gastric bypass. In: Pitombo C, Jones Jr KB, Higa KD, Pareja JC, editors. Obesity surgery—principles and practice. 1st ed. New York: Mc Graw Hill; 2007.

    Google Scholar 

  48. Schauer P. Physiology and metabolism in obesity surgery: Roux-en- Y gastric bypass. In: Pitombo C, Jones Jr KB, Higa KD, Pareja JC, editors. Obesity surgery—principles and practice. 1st ed. New York: Mc Graw Hill; 2007.

    Google Scholar 

  49. Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab. 2004;89(6):2608–15.

    Article  PubMed  CAS  Google Scholar 

  50. Moreira RO, et al. Post-prandial hypoglycemia after bariatric surgery: pharmacological treatment with verapamil and acarbose. Obes Surg. 2008;18(12): 1618–21.

    Article  PubMed  Google Scholar 

  51. Service FJ, et al. Noninsulinoma pancreatogenous hypoglycemia: a novel syndrome of hyperinsulinemic hypoglycemia in adults independent of mutations in Kir6.2 and SUR1 genes. J Clin Endocrinol Metab. 1999;84(5):1582–9.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Bariatric Surgery, Cleveland Clinic Florida, Weston, FL, 33331, USA

    Haidy G. Rivero M.D., Abraham Abdemur M.D. & Raul J. Rosenthal M.D.

Authors
  1. Haidy G. Rivero M.D.
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  2. Abraham Abdemur M.D.
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  3. Raul J. Rosenthal M.D.
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Corresponding author

Correspondence to Raul J. Rosenthal M.D. .

Editor information

Editors and Affiliations

  1. Harvard Medical School, Division of Gastroenterology,, Brigham and Women's Hospital, 75 Francis St, ASB2, Boston, 02115, Massachusetts, USA

    Christopher C. Thompson

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Rivero, H.G., Abdemur, A., Rosenthal, R.J. (2013). Diagnosis and Treatment of Dumping Syndrome After Gastric Bypass for Morbid Obesity. In: Thompson, C. (eds) Bariatric Endoscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1710-2_16

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  • DOI: https://doi.org/10.1007/978-1-4419-1710-2_16

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  • Print ISBN: 978-1-4419-1709-6

  • Online ISBN: 978-1-4419-1710-2

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