Abstract
Gastric surgery has long been known to be a cause of dumping syndrome (DS). However, the increasing incidence of gastric bypass surgery, as well as reports of DS unrelated to previous gastric surgeries, has increased the importance of understanding DS in recent years. DS is due to the gastrointestinal response to voluminous and hyperosmolar chyme that is rapidly expelled from the stomach into the small intestine. This response involves neural and hormonal mechanisms. This review encompasses the symptoms, diagnosis, and treatment approaches of DS and also focuses on the current research status of the pathophysiology of DS.
Similar content being viewed by others
References
Pinatel LF. Peptic ulcer: late complications of the surgical treatment. Rev Gastroenterol Peru. 1995;15:273–281.
Tack J, Arts J, Caenepeel P, et al. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009;6:583–590.
Behrns KE, Sarr MG. The early postprandial dumping syndrome: prevention and treatment. Adv Surg. 1994;27:233–255.
Eagon JC, Miedema BW, Kelly KA. Postgastrectomy syndromes. Surg Clin North Am. 1992;72:445–465.
Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9:159–191.
Berg, et al. Dumping syndrome, updated perspectives on etiologies and diagnosis. Pract Gastroenterol. 2014;38:30–38.
Plavšić I, Hauser G, Tkalčić M, Pletikosić S, Salkić N, Diagnosis of irritable bowel syndrome: role of potential biomarkers. Gastroenterol Res Pract. 2015; 490183. Epub. 6/11/2015.
van der Kleij F, Vecht J, Lamers C, et al. Diagnostic value of dumping provocation in patients after gastric surgery. Scand J Gastroenterol. 1996;31:1162–1166.
Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol. 2000;95:1456–1462.
Gulsrud PO, Taylor IL, Watts HD, et al. How gastric emptying of carbohydrate affects glucose tolerance and symptoms after truncal vagotomy with pyloroplasty. Gastroenterology. 1980;78:1463–1471.
Aldoori MI, Qamar MI, Read AE, et al. Increased flow in the superior mesenteric artery in dumping syndrome. Br J Surg. 1985;72:389–390.
Lipsitz LA, Ryan SM, Parker JA, et al. Hemodynamic and autonomic nervous system responses to mixed meal ingestion in healthy young and old subjects and dysautonomic patients with postprandial hypotension. Circulation. 1993;87:391–400.
Jansen RW, Penterman BJ, van Lier HJ, et al. Blood pressure reduction after oral glucose loading and its relation to age, blood pressure and insulin. Am J Cardiol. 1987;60:1087–1091.
Heseltine D, Potter JF, Hartley G, et al. Blood pressure, heart rate and neuroendocrine responses to a high carbohydrate and a high fat meal in healthy young subjects. Clin Sci (Lond). 1990;79:517–522.
Fagius J, Berne C. Increase in muscle nerve sympathetic activity in humans after food intake. Clin Sci (Lond). 1994;86:159–167.
LeQuesne LP, Hobsley M, Hand BH. The Dumping Syndrome- 1. Factors responsible for symptoms. Br Med J. 1960;1:141.
Zhao XT, Wang L, Lin HC. Slowing of intestinal transit by fat depends on naloxone-blockable efferent, opioid pathway. Am J Physiol Gastrointest. 2000;278:G866–G870.
Sarr MG, Foley MK, Winters RC, et al. Role of extrinsic innervation in carbohydrate-induced ileal modulation of pancreatic secretion and upper gut function. Pancreas. 1997;14:166–173.
Fu-Cheng X, Anini Y, Chariot J, et al. Peptide YY release after intraduodenal, intraileal, and intracolonic administration of nutrients in rats. Pflugers Arch. 1995;431:66–75.
Pedersen JH, Beck H, Shokouh-amiri M, et al. Effect of neurotensin in the dumping syndrome. Scand J Gastroenterol. 1986;21:478–482.
Lawaetz O, Blackburn AM, Bloom SR, et al. Gut hormone profile and gastric emptying in the dumping syndrome: a hypothesis concerning the pathogenesis. Scand J Gastroenterol. 1983;18:73–80.
Sagor GR, Bryant MG, Ghatei MA, et al. Release of vasoactive intestinal peptide in the dumping syndrome. BMJ (Clin Res Ed). 1981;282:507–510.
Fahrenkrug J, Haglund U, Jodal M, et al. Nervous release of vasoactive intestinal polypeptide in the gastrointestinal tract of cats: possible physiological implications. J Physiol. 1978;284:291–305.
Gebhard B, Holst JJ, Biegelmayer C, et al. Postprandial GLP-1, norepinephrine, and reactive hypoglycemia in dumping syndrome. Dig Dis Sci. 2001;46:1915–1923.
Schirra J, Goke B. The physiological role of GLP-1 in human: incretin, ileal brake or more. Regul Pept. 2005;128:109–115.
Yamamoto H, Kishi T, Lee CE, et al. Glucagon-like peptide-1-responsive catecholamine neurons in the area postrema link peripheral glucagon-like peptide-1 with central autonomic control sites. J Neurosci. 2003;1:2939–2946.
Yamamoto H, Mori T, Tsuchihashi H, et al. A possible role of GLP-1 in the pathophysiology of early dumping syndrome. Dig Dis Sci. 2005;50:2263–2267.
Lin HC, Neevel C, Chen PS, Suh G, Chen JH. Slowing of intestinal transit by fat or peptide YY depends on beta-adrenergic pathway. Am J Physiol Gastrointest. 2003;285:G1310–G1316.
Berg P, Hall M, Sarosiek I, et al. Understanding the etiologies, clinical spectrum, and diagnostic challenge of dumping syndrome. Gastroenterology. 2013;144:S-734.
Kitagawa Y, Dempsey DT. Stomach. In: Brunicardi FC, Andersen DK, Timothy RB, et al., eds. Schwartz’s Principles of Surgery. 10th ed. United States of America: McGraw Hill Education; 2015:1062.
Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005;20:517–525.
Mallory GN, Macgregor AM, Rand CS. The influence on dumping on weight loss after gastric restrictive surgery for morbid obesity. Obes Surg. 1996;6:474–478.
Abell TL, Minocha A. Gastrointestinal complications of bariatric surgery: diagnosis and therapy. Am J Med Sci. 2006;331:214–218.
Lugo-Vicente H. Dumping syndrome. Pediatric Surgery Update. 2000;14:1.
Schauer PR, Bruce S. The surgical management of obesity. In: Brunicardi FC, Andersen DK, Timothy RB, et al., eds. Schwartz’s principles of surgery. 10th ed. United States of America: McGraw Hill Education; 2015:1121.
Hejazi RA, Patil H, McCallum RW. Dumping syndrome: establishing criteria for diagnosis and identifying new etiologies. Dig Dis Sci. 2010;55:117–123.
Didden P, Penning C, Masclee AAM. Octreotide therapy in dumping syndrome: analysis of long-term results. Aliment Pharmacol Ther. 2006;24:1367–1375.
Leeds AR, Ralphs DN, Ebied F, et al. Pectin in the dumping syndrome: reduction of symptoms and plasma volume changes. Lancet. 1981;1:1075–1078.
De Cunto A, Barbi E, Minen F, et al. Safety and efficacy of high-dose acarbose treatment for dumping syndrome. J Pediatr Gastroenterol Nutr. 2011;53:113–114.
Hasegawa T, Yoneda M, Nakamura K, et al. Long-term effect of alpha-glycosidase inhibitor on late dumping syndrome. J Gastroenterol Hepatol. 1998;13:1201–1206.
Parrish CR. The clinician’s guide to short bowel syndrome. Pract Gastroenterol. 2005;29:67.
Thondam SK, Nair S, Wile D, Gill GV. Diazoxide for the treatment of hypoglycaemic dumping syndrome. QJM. 2013;106:855–858. doi:10.1093/qjmed/hcr234.
Spanakis E, Gragnoli. Successful medical management of status post-Roux-en-Y-gastric-bypass hyperinsulinemic hypoglycemia. Obes Surg. 2009;19:1333–1334.
Li-Ling J, Irving M. Therapeutic value of octreotide for patients with severe dumping syndrome—a review of randomised controlled trials. Postgrad Med J. 2001;77:441–442.
Hasler WL, Soudah HC, Owyang C. Mechanisms by which octreotide ameliorates symptoms in the dumping syndrome. J Pharmacol Exp Ther. 1996;277:1359–1365.
Vecht J, Lamers CB, Masclee AA. Long-term results of octreotide-therapy in severe dumping syndrome. Clin Endocrinol (Oxf). 1999;51:619–624.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None to declare.
Rights and permissions
About this article
Cite this article
Berg, P., McCallum, R. Dumping Syndrome: A Review of the Current Concepts of Pathophysiology, Diagnosis, and Treatment. Dig Dis Sci 61, 11–18 (2016). https://doi.org/10.1007/s10620-015-3839-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-015-3839-x