Dumping Syndrome

Definition/diagnostic criteria Dumping syndrome, a complication of oesophageal, gastric or bariatric surgery, presents as a constellation of vasomotor and gastrointestinal symptoms. It is classified into early and late forms based on the timing of symptoms postprandially. Early dumping occurs within 30 minutes and involves gastrointestinal and vasomotor symptoms, while late dumping, occurring 1 to 3 hours postprandially, primarily leads to hypoglycaemia. Diagnosis is largely clinical, supported by patients’ history of surgery and symptomatology.

Epidemiology The prevalence of dumping syndrome in the UK varies, influenced by the type of gastric surgery performed. It is estimated to affect 15-20% of patients post-gastrectomy. With the increasing prevalence of bariatric surgery for obesity, the incidence of dumping syndrome is anticipated to rise.

Diagnosis
Clinical features: Early dumping syndrome manifests as abdominal pain, bloating, diarrhoea, nausea, vomiting, palpitations, tachycardia and dizziness. Late dumping is characterised by hypoglycaemia symptoms, such as weakness, sweating, hunger, tremors, confusion and occasionally syncope.

Investigations: Diagnosis is usually clinical. Blood glucose testing revealing hypoglycaemia may be helpful in confirmation of late dumping syndrome.

Treatment Management involves dietary modifications, such as small, frequent meals, avoiding simple sugars, increasing fibre and protein intake, and separating fluid from solid food intake.

Pharmacological treatment is considered when dietary adjustments are insufficient. Acarbose, a glucosidase inhibitor, is beneficial in late dumping by slowing carbohydrate absorption. Octreotide, a somatostatin analogue, may be used for severe cases, particularly for those unresponsive to dietary measures and acarbose. It should be noted that these medications are not specifically licensed for dumping syndrome in the UK but are used off-label.

Prognosis The prognosis of dumping syndrome is generally favourable with lifestyle and dietary modifications. Most patients achieve symptom control through these means. A smaller proportion requiring pharmacological intervention also respond well, although long-term reliance on medication like octreotide is rare. Surgical revision is considered in refractory cases but is relatively uncommon. Long-term outcomes are generally positive, with a significant improvement in quality of life following successful management.