I. Samuk et al., DUMPING SYNDROME FOLLOWING NISSEN FUNDOPLICATION, DIAGNOSIS, AND TREATMENT, Journal of pediatric gastroenterology and nutrition, 23(3), 1996, pp. 235-240
We evaluated the prevalence, diagnosis, and treatment of dumping syndr
ome (DS) following Nissen fundoplication in 50 consecutive infants and
children who underwent the operation for gastroesophageal reflux. Exa
mination included a preoperative dietary assessment with emphasis on s
pecific postprandial clinical symptoms and technetium scintigraphy to
evaluate gastric emptying. In the immediate postoperative period, post
prandial glucose levels were examined in all patients with symptoms cl
inically suggestive of DS. In the late postoperative period (6 months
to 5.5 years), all patients with more than one specific clinical sympt
om of DS were further evaluated by glucose tolerance test (GTT), HbA(1
)C levels, and gastric technetium scintigraphy. DS was diagnosed in 15
patients (30%). Five patients had immediate severe DS (SDS), and 10 i
n the late postoperative course had latent postoperative DS (LDS). In
all patients with DS, preoperative and postoperative gastric emptying
scan T 1/2 did not show any statistical significance. High levels of H
bA(1)C ranging from 7.9 to 9% (mean, 8.25 +/- 0.5) were found in only
three patients. Treatment included parenteral nutrition in one patient
. All the others were successfully managed with nutritional manipulati
on alone, using a combination of lactose-free formula and fat emulsion
. In patients whose postprandial symptoms persisted, pectin 5-15 g/day
divided into six doses was added to the diet. Following 6 months of d
ietary treatment, the postprandial normoglycomic response was restored
. Eleven patients experienced complete resolution of symptoms (78.5%),
and three patients (21.4%) showed significant clinical improvement. T
his study indicates that DS is a common complication following Nissen
fundoplication. The GTT is the most reliable examination for establish
ing the diagnosis. Treatment is simple and effective. The technetium g
astric emptying scan and HbA(1)C level do not play a significant role
in the diagnosis.