Gastric dumping syndrome medical therapy: Difference between revisions
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{{Gastric dumping syndrome}} | {{Gastric dumping syndrome}} | ||
{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
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==Medical Therapy== | ==Medical Therapy== | ||
Medical [[therapy]] for [[Gastric dumping syndrome|dumping syndrome]] includes [[Diet (nutrition)|diet]] and [[Medication|drug therapy]].<ref>{{cite journal|doi=10.1111/obr.12467/}}</ref> | Medical [[therapy]] for [[Gastric dumping syndrome|dumping syndrome]] includes [[Diet (nutrition)|diet]] and [[Medication|drug therapy]].<ref>{{cite journal|doi=10.1111/obr.12467/}}</ref> | ||
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{| class="wikitable" | {| class="wikitable" | ||
!Level of evidence | !Level of evidence | ||
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|Little or no systematic empirical evidence | |Little or no systematic empirical evidence | ||
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=== Diet === | === Diet === | ||
'''Dietary Modifications (Level III; Grade B)''' | '''Dietary Modifications (Level III; Grade B)''' | ||
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* Lying [[supine]] for 30 minutes after a meal | * Lying [[supine]] for 30 minutes after a meal | ||
* [[Glycemic index]] education of foods is important | * [[Glycemic index]] education of foods is important | ||
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==== | ===='''Dietary Foods''' ==== | ||
The following is a table that illustrates the types of food to take and avoid in the case of [[Gastric dumping syndrome|dumping syndrome]]. | The following is a table that illustrates the types of food to take and avoid in the case of [[Gastric dumping syndrome|dumping syndrome]]. | ||
{| class="wikitable" style="margin: 1em auto 1em auto" | {| class="wikitable" style="margin: 1em auto 1em auto" | ||
| Line 172: | Line 170: | ||
* Sugar alcohols such as [[sorbitol]], [[xylitol]], and [[mannitol]] | * Sugar alcohols such as [[sorbitol]], [[xylitol]], and [[mannitol]] | ||
|} | |} | ||
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'''Dietary Supplements (Level III; Grade C)''' | '''Dietary Supplements (Level III; Grade C)''' | ||
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* [[Glucomannan]] improves [[glucose]] tolerance but isn't as effective | * [[Glucomannan]] improves [[glucose]] tolerance but isn't as effective | ||
* The increased fiber in the supplements leads to [[gas]] and [[bloating]]. This decreases tolerability and in turn reduces [[Compliance (medicine)|compliance]]. | * The increased fiber in the supplements leads to [[gas]] and [[bloating]]. This decreases tolerability and in turn reduces [[Compliance (medicine)|compliance]]. | ||
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'''Drug Therapy''' | '''Drug Therapy''' | ||
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* Last resort drug | * Last resort drug | ||
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'''Somatostatin analogues''' | '''Somatostatin analogues''' | ||
* [[Pasireotide]] has a higher [[Chemical affinity|affinity]] than [[Octreotide]] and is more effective but it does not reduce [[Gastric dumping syndrome|dumping syndrome]] [[Symptom|symptoms]] as well as [[Octreotide]]. | * [[Pasireotide]] has a higher [[Chemical affinity|affinity]] than [[Octreotide]] and is more effective but it does not reduce [[Gastric dumping syndrome|dumping syndrome]] [[Symptom|symptoms]] as well as [[Octreotide]]. | ||
* Even though it has been safe and effective no results of its clinical trials have been published to date. | * Even though it has been safe and effective no results of its clinical trials have been published to date. | ||
{| class="wikitable" | {| class="wikitable" | ||
!Drug | !Drug | ||
| Line 293: | Line 294: | ||
|Reduced [[Hypoglycemia|hypoglycemic]] [[Symptom|symptoms]] | |Reduced [[Hypoglycemia|hypoglycemic]] [[Symptom|symptoms]] | ||
|} | |} | ||
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'''Effects of Surgery on Medications''' | '''Effects of Surgery on Medications''' | ||
* After RYGB [[surgery]], [[bioavailability]] is decreased in [[:Category:Drugs|drugs]] such as (eg, [[amoxicillin]], [[azithromycin]], [[Cyclosporine|cyclosporine A]], [[levothyroxine]], [[nitrofurantoin]], [[Mycophenolate sodium|mycophenolic acid]], [[phenytoin]], [[phenobarbital]], [[sirolimus]], [[tacrolimus]], [[tamoxifen]]). Surgeries that decrease the [[stomach]] size may increase [[toxicity]] of [[Non-steroidal anti-inflammatory drug|nonsteroidal anti-inflammatory drugs]], [[Salicylic acid|salicylates]], oral [[Bisphosphonate|bisphosphonates]], and oral [[iron]] tablet formulations. Any procedure that causes dumping; increases [[Gastrointestinal tract|gut]] transit time and may decease [[:Category:Drugs|drug]] [[absorption]]. | * After RYGB [[surgery]], [[bioavailability]] is decreased in [[:Category:Drugs|drugs]] such as (eg, [[amoxicillin]], [[azithromycin]], [[Cyclosporine|cyclosporine A]], [[levothyroxine]], [[nitrofurantoin]], [[Mycophenolate sodium|mycophenolic acid]], [[phenytoin]], [[phenobarbital]], [[sirolimus]], [[tacrolimus]], [[tamoxifen]]). Surgeries that decrease the [[stomach]] size may increase [[toxicity]] of [[Non-steroidal anti-inflammatory drug|nonsteroidal anti-inflammatory drugs]], [[Salicylic acid|salicylates]], oral [[Bisphosphonate|bisphosphonates]], and oral [[iron]] tablet formulations. Any procedure that causes dumping; increases [[Gastrointestinal tract|gut]] transit time and may decease [[:Category:Drugs|drug]] [[absorption]]. | ||
<br><br> | |||
==References== | |||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 18:38, 12 December 2017
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Gastric dumping syndrome Microchapters |
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Differentiating Gastric dumping syndrome from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Gastric dumping syndrome medical therapy On the Web |
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American Roentgen Ray Society Images of Gastric dumping syndrome medical therapy |
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Risk calculators and risk factors for Gastric dumping syndrome medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The main therapy for the management of dumping syndrome includes diet and pharmacological intervention.
Medical Therapy
Medical therapy for dumping syndrome includes diet and drug therapy.[1]
| Level of evidence | Type of evidence |
|---|---|
| I | Evidence from meta-analysis of multiple, well-designed, controlled studies (randomized trials with low false-positive and low false-negative errors) |
| II | Evidence from at least 1 well-designed, quasi-experimental study (randomized trials with high false-positive and high false-negative errors) |
| III | Evidence from well-designed, quasi-experimental studies (nonrandomized, controlled, single-group, pre–post, cohort and time or matched case–control series) |
| IV | Evidence from well-designed, non-experimental studies (comparative and correlational descriptive and case studies) |
| V | Evidence from case reports |
| Grade of recommendation | Level of evidence |
| A | Level I evidence or consistent findings from multiple studies (level II, III or IV) |
| B | Level II, III or IV evidence with generally consistent findings |
| C | Level II, III or IV evidence with inconsistent findings |
| D | Little or no systematic empirical evidence |
Diet
Dietary Modifications (Level III; Grade B)
- Decrease carbohydrate intake
- Avoid simple sugars like soda, candy sweets, and cookies
- Fluid restriction
- Wait at least 30 minutes after a meal before drinking
- Increase protein intake
- Increase fat intake
- Increase fiber intake
- Dairy and dairy product restriction
- Shorter meals
- Eat slowly
- Chew properly
- Lying supine for 30 minutes after a meal
- Glycemic index education of foods is important
Dietary Foods
The following is a table that illustrates the types of food to take and avoid in the case of dumping syndrome.
| Breads, Cereals, Rice and Pasta | Foods To Choose | Foods to Avoid |
|---|---|---|
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| Fruits | Foods to Choose | Foods To Avoid |
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| Milk and Dairy Products | Foods To Choose | Foods to Avoid |
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| Meats, Poultry, Fish, Dry Beans, Peas, Eggs and Cheese | Foods to Choose | Foods to Avoid |
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| Vegetables | Foods to Choose | Foods to Avoid |
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| Fats, Condiments and Beverages | Foods to Choose | Foods to Avoid |
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| |
| Snacks, Sweets, and Desserts | Foods to Choose | Foods to Avoid |
|
Dietary Supplements (Level III; Grade C)
The following work similarly to each other. These supplements increase viscosity which in turn decreases gastric emptying and causes a delay in glucose absorption.
- Delay glucose absorption:
- 15 grams of Guar gum or Pectin is effective.
- Glucomannan improves glucose tolerance but isn't as effective
- The increased fiber in the supplements leads to gas and bloating. This decreases tolerability and in turn reduces compliance.
Drug Therapy
The two main stays for pharmacological intervention are Acarbose (Glucobay, Precose, Prandase) and 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) |
| Dose |
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| Effect |
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| Additional information |
|
Somatostatin analogues
- Pasireotide has a higher affinity than Octreotide and is more effective but it does not reduce dumping syndrome symptoms as well as Octreotide.
- Even though it has been safe and effective no results of its clinical trials have been published to date.
| Drug | Dose | Effect |
|---|---|---|
| Tolbutamide[2] | 0.25-0.75 g, TID | Subjective improvement |
| Propranolol[3] | 10 mg, QID | Reduced early dumping |
| Cyproheptadine[4] | 4-8 mg, TID | Preventing vasomotor symptoms |
| Methysergide maleate[5] | 4-8 mg, TID | Reduced vasomotor symptoms |
| Verapamil[6] | 120-240 mg, QD | Reduced vasomotor symptoms |
| Acarbose[7] | 50-100 mg, TID | Reduced late dumping |
| Octreotide[8] | 25-100 mcg, TID | Reduced vasomotor symptoms |
| Pantoprazole (PPI)[9] | Subjective improvement | |
| Cholestyramine[10] | Subjective improvement | |
| Diazoxide[11] | 75-260 mg, QD | Subjective improvement |
| Nifedipine[12] | 30 mg, QD | Reduced hypoglycemic symptoms |
| Exendin 9-39[13] | 7500 pmol/kg prime | Reduced hypoglycemic symptoms |
Effects of Surgery on Medications
- After RYGB surgery, bioavailability is decreased in drugs such as (eg, amoxicillin, azithromycin, cyclosporine A, levothyroxine, nitrofurantoin, mycophenolic acid, phenytoin, phenobarbital, sirolimus, tacrolimus, tamoxifen). Surgeries that decrease the stomach size may increase toxicity of nonsteroidal anti-inflammatory drugs, salicylates, oral bisphosphonates, and oral iron tablet formulations. Any procedure that causes dumping; increases gut transit time and may decease drug absorption.
References
- ↑ . doi:10.1111/obr.12467/. Missing or empty
|title=(help) - ↑ Sigstad H (1969). "Effect of tolbutamide on the dumping syndrome". Scand. J. Gastroenterol. 4 (3): 227–31. PMID 5346670.
- ↑ Niv Y (1988). "The early dumping syndrome and propranolol". Ann. Intern. Med. 108 (6): 910–1. PMID 3369789.
- ↑ Leichter SB, Permutt MA (1975). "Effect of adrenergic agents on postgastrectomy hypoglycemia". Diabetes. 24 (11): 1005–10. PMID 1183731.
- ↑ Bernard PF, Baschet C, Le Henand F, Bouderlique JR, Lortat-Jacob JL (1970). "[Treatment of 65 cases of dumping syndrome with methysergide in recently gastrectomized patients]". Presse Med (in French). 78 (12): 549–50. PMID 5439191.
- ↑ Tabibian N (1990). "Successful treatment of refractory post-vagotomy syndrome with verapamil (Calan SR)". Am. J. Gastroenterol. 85 (3): 328–9. PMID 2309689.
- ↑ Hasegawa T, Yoneda M, Nakamura K, Ohnishi K, Harada H, Kyouda T, Yoshida Y, Makino I (1998). "Long-term effect of alpha-glucosidase inhibitor on late dumping syndrome". J. Gastroenterol. Hepatol. 13 (12): 1201–6. PMID 9918426.
- ↑ Vecht J, Masclee AA, Lamers CB (1997). "The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment". Scand. J. Gastroenterol. Suppl. 223: 21–7. PMID 9200302.
- ↑ Sanaka M, Yamamoto T, Kuyama Y (2010). "Effects of proton pump inhibitors on gastric emptying: a systematic review". Dig. Dis. Sci. 55 (9): 2431–40. doi:10.1007/s10620-009-1076-x. PMID 20012198.
- ↑ Barkun AN, Love J, Gould M, Pluta H, Steinhart H (2013). "Bile acid malabsorption in chronic diarrhea: pathophysiology and treatment". Can. J. Gastroenterol. 27 (11): 653–9. PMC 3816948. PMID 24199211.
- ↑ Vilarrasa N, Goday A, Rubio MA, Caixàs A, Pellitero S, Ciudin A, Calañas A, Botella JI, Bretón I, Morales MJ, Díaz-Fernández MJ, García-Luna PP, Lecube A (2016). "Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry". Obes Facts. 9 (1): 41–51. doi:10.1159/000442764. PMC 5644871. PMID 26901345.
- ↑ Guseva N, Phillips D, Mordes JP (2010). "Successful treatment of persistent hyperinsulinemic hypoglycemia with nifedipine in an adult patient". Endocr Pract. 16 (1): 107–11. doi:10.4158/EP09110.CRR. PMC 3979460. PMID 19625246.
- ↑ Salehi M, Gastaldelli A, D'Alessio DA (2014). "Blockade of glucagon-like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass". Gastroenterology. 146 (3): 669–680.e2. doi:10.1053/j.gastro.2013.11.044. PMC 3943944. PMID 24315990.