title: Octreotide improves early dumping syndrome potentially through incretins: a case report.
abstract: Dumping syndrome, or rapid gastric emptying, is a frequent complication after gastric surgery. In this case, the patient was a 47-year-old woman who 10 years previously had undergone distal gastrectomy with Billroth I reconstruction for early-stage gastric cancer. She presented with symptoms of weakness, headache, palpitation, sweating, dizziness and significant fatigue between one and two hours after a meal. Because a 75 g oral glucose tolerance test (75 g-OGTT) induced both acute postprandial tachycardia (within 1 hour) and postprandial hypoglycemia, we diagnosed this patient with early and late dumping syndrome. Dietary measures and acarbose improved symptoms of late dumping syndrome but did not prevent the symptoms of early dumping syndrome such as postprandial tachycardia, weakness, headache, palpitation, and dizziness. We therefore used the somatostatin analogue octreotide, which has been reported as an effective therapy for early dumping syndrome. Octreotide prevented the symptoms of early dumping syndrome, especially postprandial tachycardia, but caused postprandial hyperglycemia. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were completely suppressed during the 75 g-OGTT following subcutaneous injection of octreotide. No change was observed in vasoactive intestinal polypeptide (VIP), which is the gastrointestinal peptide hormone generally responsible for early dumping syndrome, suggesting possible contribution of incretins in early dumping syndrome of this patient.
authors.affiliation: Department of Medicine, Division of Endocrinology and Metabolism, Shiga University of Medical Science, Otsu 520-2192, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sato
authors.forename: Katsutaro
authors.initials: K
authors.lastname: Morino
authors.forename: Natsuko
authors.initials: N
authors.lastname: Ohashi
authors.forename: Emi
authors.initials: E
authors.lastname: Ueda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ikeda
authors.forename: Hideka
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ugi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Shinichi
authors.initials: S
authors.lastname: Araki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maegawa
mesh_terms: D004377:Dumping Syndrome / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D054795:Incretins / Q000097:blood / Q000502:physiology*; D008875:Middle Aged; D015282:Octreotide / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D005765:Gastrointestinal Agents; D054795:Incretins; D015282:Octreotide