title: Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management.
abstract: Dumping syndrome, a common complication of esophageal, gastric or bariatric surgery, includes early and late dumping symptoms. Early dumping occurs within 1 h after eating, when rapid emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and release of gastrointestinal hormones, resulting in gastrointestinal and vasomotor symptoms. Late dumping occurs 1-3 h after carbohydrate ingestion, caused by an incretin-driven hyperinsulinemic response resulting in hypoglycemia. Clinical recommendations are needed for the diagnosis and management of dumping syndrome.
  
  
  
  A systematic literature review was performed through February 2016. Evidence-based medicine was used to develop diagnostic and management strategies for dumping syndrome.
  
  
  
  Dumping syndrome should be suspected based on concurrent presentation of multiple suggestive symptoms after upper abdominal surgery. Suspected dumping syndrome can be confirmed using symptom-based questionnaires, glycemia measurements and oral glucose tolerance tests. First-line management of dumping syndrome involves dietary modification, as well as acarbose treatment for persistent hypoglycemia. If these approaches are unsuccessful, somatostatin analogues should be considered in patients with dumping syndrome and impaired quality of life. Surgical re-intervention or continuous enteral feeding may be necessary for treatment-refractory dumping syndrome, but outcomes are variable.
  
  
  
  Implementation of these diagnostic and treatment recommendations may improve dumping syndrome management.
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: A P
authors.initials: AP
authors.lastname: van Beek
authors.affiliation: Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Emous
authors.affiliation: European Center for Nutrition and Health (CENS), University of Lyon, 1 Civil Hospices of Lyon, Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Laville
authors.affiliation: Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Tack
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects*; D004032:Diet; D004377:Dumping Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires
keywords: dumping syndrome; hyperinsulinemic hypoglycemia; pasireotide; somatostatin analogue