THE DUMPING SYNDROME - CURRENT INSIGHTS INTO PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENT

The dumping syndrome is encountered in approximately 10% of patients a fter gastric surgery. A postprandial peripheral and splanchnic vasodil atation and ensuing relative hypovolaemia are pivotal in the pathophys iology of early systemic symptoms. Late dumping symptoms are a consequ ence of a reactive hypoglycaemia, which results from an exaggerated in sulin and glucagon-like peptide-1 release. The diagnosis of dumping sy ndrome can reliably be made with the aid of a provocation test using 5 0 g glucose orally. Most patients with dumping can be treated with adv ice on diet and lifestyle. Octreotide effectively controls the signs a nd symptoms of dumping in patients refractory to standard therapy. It acts through its inhibitory effects on insulin and gut hormone release , a delay of intestinal transit time and inhibition of food-induced ci rculatory changes. Its long-term use is somewhat limited by side effec ts, particularly diarrhoea and steatorrhoea.