Gastric dumping syndrome medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Medical Therapy
- Dumping syndrome is largely avoidable by avoiding certain foods which are likely to cause it, therefore having a balanced diet is important. Treatment includes changes in eating habits and medication. People who have gastric dumping syndrome need to eat several small meals a day that are low in carbohydrates, especially omitting simple sugars (candy, desserts, ice cream), and should drink liquids between meals, not with them.
- People with severe cases take medicine such as cholestyramine or proton pump inhibitors (such as pantoprazole) to slow their digestion.
- Treatment – Most patients with dumping can be treated conservatively with dietary changes (frequent small meals that are high in fiber and protein and low in carbohydrates, separation of liquid from solid during meals) [9,10]. Symptoms tend to resolve in most patients as they learn to avoid foods that aggravate the problem (eg, simple sugar).
Octreotide may also help in severe cases of dumping but is rarely required [8]. A study of 30 patients with dumping treated with either subcutaneous octreotide, administered three times a day, or its long-acting formulation (Octreotide LAR), which is given monthly, reported that both significantly reduced dumping symptoms and improved quality of life [12]. Patients preferred monthly treatment. The rare patient with intractable dumping symptoms who fails dietary and medical therapy may require reoperation [9,10]. In patients who had a distal gastrectomy, conversion from a loop gastrojejunostomy to a Roux-en-Y reconstruction is the procedure of choice. This operation slows gastric emptying by impairing motility of the Roux loop. Thus, gastric remnant of no more than 25 percent should be left to avoid postoperative Roux stasis syndrome (see 'Roux stasis syndrome' below). In patients who had a prior loop gastrojejunostomy without gastrectomy, simple takedown of the gastrojejunostomy usually resolves dumping syndrome, provided that normal antropyloric and duodenal functions are maintained.