Review Question - QID 103030

Dumping syndrome is a complication of both gastric bypass and sleeve gastrectomy. Early symptoms are divided into GI complaints (abdominal pain, diarrhea, borborygmi, bloating, and nausea) and vasomotor complaints (flushing, palpitation, perspiration, tachycardia, hypotension, and even syncope) and late symptoms include hypoglycemia, perspiration, hunger, fatigue, and syncope.

Diagnosis is based on clinical assessment and a modified oral glucose tolerance test. Barium fluoroscopy and radionuclide scintigraphy are also used to see if there is premature emptying of the stomach.

Patients are advised to eat more frequently with smaller portions and to avoid drinking during meals. Intake of carbohydrates should be reduced. Acarbose is administered to patients who fail dietary management.

Virji and Murr explain dumping syndrome as a complication of bariatric surgery. They stress the importance of dietary compliance to avoid symptoms and suggest that they last 1-2 hours after eating sweet or foods or those with lots of simple carbohydrates.

Rohof et al. explain how build up of carbohydrate in the jejunum can lead to sudden increases in insulin release via glucagon-like peptide (GLP-1). This causes hypoglycemia and the aforementioned symptom cluster.

Illustration A charts the causal progression of symptoms.

Incorrect answers:
Answer 1: Increasing dietary fiber is unlikely to help this patient.
Answer 3: Carbohydrate intake should be decreased, not increased.
Answer 4: The patient’s symptoms are not related to gastric reflux. His omeprazole dosage should not be increased.
Answer 5: Loperamide may help with the patient’s diarrhea, but is unlikely to relieve his other GI symptoms.