Late Dumping Research Articles

6567 Novel Indication of GLP-1 Receptor Agonists Beyond Weight Loss: Addressing Post-Gastric Bypass Late Dumping Syndrome

Abstract Disclosure: G. Arevalo: None. S. Gra Menendez: None. D. Soliman: None. R.J. Galindo: Consulting Fee; Self; Novo Nordisk, Eli Lilly & Company, Sanofi, Bayer, Inc., Boehringer Ingelheim, Pfizer, Inc., Abbott Laboratories. Grant Recipient; Self; National Institute of Diabetes and Digestive and Kidney Diseases (2P30DK111024), National Institute of Diabetes and Digestive and Kidney Diseases (K23DK123384). Other; Self; Novo Nordisk, Eli Lilly & Company, Dexcom. Background: Late dumping syndrome, characterized by postprandial hyperinsulinemic hypoglycemia (PHH), represents a complex clinical challenge in post-bariatric patients. GLP-1 receptor agonists are being explored as an effective therapeutic option. Clinical Case: A 47-year-old overweight (BMI of 29.86 kg/m²) woman, with a medical history of scleroderma and esophageal dysmotility, underwent a gastric sleeve gastrectomy later requiring conversion to Roux-en-Y gastric bypass to improve esophageal motility. Eleven months post-bypass, she began experiencing recurrent episodes of hypoglycemia (venous glucose 49-70 mg/dL, n >70 mg/dL) accompanied by sweating, palpitations, drowsiness, and weakness. Initial tests were consistent with postprandial hyperinsulinemic hypoglycemia: serum insulin (13.5 µIU/mL, n < 3 µIU/mL), and c-peptide (4.1 ng/mL, n < 0.6 ng/mL). The Sigstad score and the Arts dumping severity score were positive for late dumping syndrome with a score of 26 and 14, respectively. During glucagon administration, the patient's blood glucose level increased by up to 50 mg/dL within 10 minutes of administration. Both sulfonylurea screening and insulin antibody tests were negative. Real-time CGM measurements showed patterns of postprandial hyperglycemic peaks, up to 160-180 mg/dL (n <140 mg/dL), approximately 30 to 60 min after meals, followed by rapidly declining glucose (1-2 hours later), resulting in hypoglycemic events as low as 49 mg/dL. Initial management with dietary changes and pharmacological treatment was unsuccessful due to poor medication tolerability of acarbose and diazoxide, and low adherence to the prescribed diet due to her esophageal dysmotility. The CGM patterns and symptom presentation raised suspicion that late dumping syndrome was triggered by rapid hyperglycemic responses after oral ingestions of typical meals, resulting in the desynchronization of hormonal responses (insulin and GLP-1), and post-prandial hypoglycemia. Hence, the consideration for a GLP-1 receptor agonist emerged. A weekly subcutaneous injection of a long-acting GLP-1 receptor agonist, semaglutide 0.25 mg exhibited marked improvement in her glycemic profile: fewer episodes of postprandial hyperglycemia, and the subsequent descents in blood glucose were less pronounced. The patient demonstrated a favorable response with no severe hypoglycemic episodes reported during a follow-up period of three months. Conclusion: This is the first case to demonstrate semaglutide's efficacy as a standalone treatment for PHH in post-bariatric patients. In this case, semaglutide effectively controlled glycemia and improved the patient's quality of life, presenting a promising therapeutic option for such complex cases. Presentation: 6/1/2024

OGC P54 Catastrophic dumping after gastrectomy in a patient with absent pituitary treated with octreotide – case report

Abstract Background Gastrectomy results in a profound change in appetite, satiety and response to food. Most people will adapt and manage to maintain adequate enteral nutrition, however severe symptoms can hamper quality of life. Early dumping, defined as noxious symptoms occurring within an hour of food, arises due to a combination of vastly increased satiety gut hormone secretion and fluid shifts. Late dumping (reactive hypoglycaemia) occurs due to enhanced post-prandial incretin hormone secretion. We present a case of severe dumping in a patient with absent pituitary treated with the global counter-regulatory hormone octreotide. Methods A 71-year-old patient with absent pituitary underwent total gastrectomy and oesophago-jejunal anastomosis for a greater curve gastric adenocarcinoma. Post-operatively, the patient developed an overall aversion to eating along with significant nausea and vomiting, diarrhoea, abdominal fullness, and tachycardia. Anti-emetics including droperidol, metoclopramide, and haloperidol yielded limited response. NJ feeding also triggered symptoms and was stopped. Parenteral nutrition was the principal source of diet. A trial of a somatostatin analogue, octreotide, resulted in significant improvement of patient symptoms. A dose increase and then conversion to monthly lanreotide was tolerated well resulting in complete resolution of symptoms and no side effects. Results The pituitary gland and hypothalamus are central to regulating appetite and satiety through complex signalling pathways. Hormone signals, including GLP-1, GIP, PYY and ghrelin act on central circuits within the hypothalamus to modulate intake, gastric emptying, and satiety. With an absent pituitary, these hormonal signalling pathways including somatostatin are disrupted. Octreotide therapy likely works through a combination of central suppression of gut hormone signalling as well as peripheral reduction in gut hormone secretion. Conclusions Dumping syndrome is a multifactorial, quality of life limiting consequence of upper GI resection. In patients with altered central appetite control circuitry the symptoms may be so severe as to prevent any enteral intake, including via NJ tube. Interestingly, considering this an endocrinology problem and acting to suppress all hormonal signalling with octreotide had immediate and enduring success in the presented case. This may represent a route for management of patients with significant dumping symptoms and nutritional compromise after gastrectomy or oesophagectomy.

Dumping syndrome after bariatric surgery: prevalence, pathophysiology and role in weight reduction - a systematic review.

Dumping syndrome is a frequent and wellknown adverse event after bariatric surgery and covers a dynamic spectrum of early and late dumping. Accelerated gastric emptying is generally considered to be the cause of gastrointestinal and vasomotor complaints. However, there is much uncertainty regarding the exact pathophysiology of dumping. It has been speculated that the syndrome is a desired consequence of bariatric surgery and contributes to more efficient weight loss, but supporting data are scarce. A systematic search was conducted in PubMed in July-August 2021. The prevalence of dumping after the most frequently performed bariatric procedures was analyzed, as well as underlying pathophysiology and its role in weight reduction. Roux-en-Y gastric bypass (RYGB) is associated with the highest postoperative prevalence of dumping. The fast transit induces neurohumoral changes which contribute to an imbalance between postprandial glucose and insulin levels, resulting in hypoglycemia which is the hallmark of late dumping. Early dumping can, when received in a positive way, become a tool to maintain a strict dietary pattern, but no significant relationship to the degree of weight loss has been shown. However, late dumping is detrimental and promotes overall higher caloric intake. Dumping syndrome is common after bariatric surgery, especially after RYGB. The pathophysiology is complex and ambiguous. Currently available data do not support dumping as a necessary condition to induce weight loss after bariatric surgery.

Dumping Syndrome in Children: A Narrative Review.

Dumping syndrome (DS) is a typical side effect of stomach surgery, which includes cancer, non-cancer esophageal and gastric surgery, and bariatric surgery. It is marked by the fast evacuation of undigested food from the stomach into the small intestine, which causes a variety of symptoms. Early dumping symptoms include gastrointestinal symptoms such as stomach discomfort, diarrhea, and nausea, as well as vasomotor symptoms such as drowsiness and face flushing, and occur within the first hour following a meal. Late dumping symptoms appear one to three hours after a meal and are related to reactive hypoglycemia, resulting in hypoglycemia, sweating, palpitations, and confusion. Early dumping pathophysiology involves abnormalities in stomach structure and function, which result in rapid transit of stomach contents to the duodenum, insufficient digestion, and fluid transfers from the vascular compartment to the intestine. Late dumping occurs as a result of hyperinsulinemia caused by the fast passage of undigested foods to the gut. Symptom-based questionnaires and diagnostic testing such as plasma glucose measurement and stomach emptying studies can be used to confirm a diagnosis of DS. The primary approach to managing DS is dietary modifications, including eating smaller, more frequent meals and avoiding high glycemic index carbohydrates. Dietary supplements and medications may be used to slow down gastric emptying or control blood glucose levels. Pharmacological options include alpha-glycosidase inhibitors, somatostatin analogs, glucagon-like peptide-1 analogs, and sodium-glucose cotransporter inhibitors. In severe cases, refractory to conservative measures, surgical interventions may be considered. DS can arise in children following gastric surgery for obesity or corrective surgery for congenital abnormalities. It is frequently misdiagnosed and can have serious implications, such as hypoglycemia-related cognition deficits. Screening and early identification using glucose tolerance testing and continuous glucose monitoring (CGM) are critical in at-risk youngsters. Children's treatment techniques are similar to those used in adults, with dietary changes and medication therapies serving as the cornerstone of care. Overall, DS is a complex condition that requires a multidisciplinary approach to diagnosis and management. Further research is needed to improve understanding of its pathophysiology and optimize treatment strategies, particularly in children. This review aims to provide a well-rounded informative summary of the most recent literature on the under-recognized clinical and scientific aspects of DS among the children age group. It incorporates the quality of life, pathophysiology, diagnosis, prevalence, and treatment.

Late dumping syndrome preceded by Coxsackievirus B4 infection and cholecystectomy

A 44-year-old female patient presented with weight loss, diarrhea and intermittent episodes of left upper quadrant (LUQ) pain lasting for 3years, accompanied by acute episodes of focal LUQ pain, dizziness, tachycardia, borborygmi and bloating, occurring approximately 60min after meals. The patient developed chronic acalculous cholecystitis and transient exocrine pancreatic insufficiency after infection with Coxsackievirus B4 (CVB4), which resolved following laparoscopic cholecystectomy 2years before the current presentation. Although imaging and functional investigation studies were unremarkable, a gastric transit study revealed rapid clearance of radiolabeled food, and the patient's symptomatology and gastrointestinal studies supported the diagnosis of late dumping syndrome. The patient's symptoms significantly improved with adherence to recommended dietary changes, including an increase in protein intake, abstinence from simple carbohydrates and avoidance of simultaneous consumption of beverages with food, following consultation with a dietitian.

Clinical Relevance of Proximal Gastrectomy With Double-flap Esophagogastrostomy Reconstruction With Glycemic Profile and Postgastrectomy Syndromes.

The glycemic profile of patients who have undergone proximal gastrectomy (PG) using a continuous glucose monitoring (CGM) device has not been investigated. We aimed to investigate the association between postgastrectomy syndrome and the glycemic profile of patients who underwent PG and its impact on postoperative body weight loss and nutritional status. We retrospectively investigated 65 patients with CGM post-surgery. Postoperative glycemic profiles were recorded using a CGM device. To evaluate postgastrectomy syndromes and quality of life (QOL), the Postgastrectomy Syndrome Assessment Scale 37-item questionnaire was employed. The dynamics of albumin and hemoglobin levels were investigated at 1 and 6 months postoperatively. The time below the range (percentage of glucose reading <70 mg/dl) in patients who underwent PG with double-flap (DF) esophagogastrostomy reconstruction was significantly shorter than in those who underwent total gastrectomy (TG). Late dumping scores tended to be better in patients after PG with DF than in those after TG. The body weight loss rate of patients who underwent PG with DF was similar to those who underwent TG. The albumin level at 6 months recovered to the preoperative level in patients who underwent PG with DF, but not in those who underwent TG. Hemoglobin levels at 1 and 6 months postoperatively were significantly higher in patients who underwent PG with DF than in those who underwent TG. Proximal gastrectomy with double-flap esophagogastrostomy reconstruction did not improve QOL or body weight loss, as expected, however, suppressed hypoglycemia, late dumping syndrome, and deterioration in nutritional status.

A case of insulinoma confused with dumping syndrome after total gastrectomy

We present the case of a 70-year-old female patient with persistent hypoglycemia after total gastrectomy due to gastrointestinal stromal tumors. She was thought to have late dumping syndrome but was diagnosed with insulinoma after further examination. Dumping syndrome is mainly seen after stomach or esophageal surgery. It is divided into early dumping and late dumping syndrome. Late dumping syndrome is initially manifested by an exaggerated insulin response and reactive hypoglycemia after glucagon-like peptide-1 release. Diagnosis is based on clinical findings. Treatment mainly consists of reducing carbohydrate intake and not ingesting solid and liquid foods together. In cases where diet alone is not sufficient, acarbose, an α-glucosidase inhibitor that slows the digestion of carbohydrates, may be beneficial for late dumping. Octreotide can be used in resistant cases. However, the diagnosis of insulinoma, which leads to a similar clinical presentation in resistant dumping cases, should be kept in mind. Our patient who showed clinical signs of dumping syndrome after gastrectomy, and treatment-resistant hypoglycemia was diagnosed with insulinoma on the basis of further investigations. The patient’s symptoms resolved after surgery for insulinoma.

Persistent Postgastrectomy Hypoglycemia Unawareness in Patients With Gastric Cancer Unveiled by a Prospective Study.

Late dumping syndrome is a common postgastrectomy complication characterized by reactive hypoglycemia. This study aimed to explore the glycemic trend in patients who underwent gastrectomy for gastric cancer and clarify its changes over time in association with postgastrectomy symptoms. Changes over time in glycemic trend in association with postgastrectomy symptoms have not been evaluated. We conducted a prospective study of 71 patients who underwent curative gastrectomy for gastric cancer between November 2017 and April 2020. The patients underwent continuous glucose monitoring twice-at 1- and 12-month postgastrectomy-and were assessed using the Post-Gastrectomy Syndrome Assessment Scale 37-item questionnaire (PGSAS-37) at 1-, 6-, and 12-month postgastrectomy. Our results revealed that hypoglycemia (<70 mg/dL), especially nocturnal hypoglycemia (00:00-06:00), frequently occurred even at 12-month postgastrectomy. Hypoglycemia improved in total gastrectomy patients but remained unchanged in distal gastrectomy patients, which was still high in both groups at 12-month postgastrectomy. Glycemic variability (SD of the glycemic trend) was exacerbated in both gastrectomy groups. However, the PGSAS-37 symptom scores remained unchanged, and the living status and quality of life tended to improve. Hypoglycemia unawareness, including postprandial hypoglycemia without symptoms and nocturnal hypoglycemia, was evident even 12-month postgastrectomy. Persistent postgastrectomy hypoglycemia unawareness, including late dumping syndrome without symptoms and nocturnal hypoglycemia, should be recognized as an important issue in postgastrectomy syndrome. Therefore, meticulous long-term evaluation for glycemic trends and care of patients is required.

Postoperative dumping-syndrome with relevant impairment ofglucose homeostasis - relief by continuous glucose monitoring and individual therapy with GLP-1 receptor agonists

Dumping syndromes are a common side effect after partial or total gastric resection. The symptoms may be diverse, with vasomotoric reactions, collapse tendencies and digestive disorders (early dumping) as well as blood sugar derailment as a result of too fast absorption of glucose (late dumping).Entrenched therapy concepts, including personalized nutritional concepts and the use of medication as octreotide or diazoxide, will not always lead to the desired results. It is then, that individual therapy concepts have to be found to restore the patient's quality of life, as shown in this case study.

Dumping Syndrome and Postbariatric Hypoglycemia: Supporting Evidence for a Common Etiology.

Dumping syndrome (DS) and postbariatric hypoglycemia (PBH) are frequent complications of bariatric surgery. Previously known as "early and late dumping," these complications have been separated due to differences in their onset and behaviors. To investigate a potentially common etiology of DS and PBH using an analysis of a mixed meal test (MMT) study. A large teaching hospital in the Netherlands. From all patients who underwent bariatric surgery in 2008-2011, a random selection completed an MMT (n = 47). Patients scored complaints related to DS and PBH with a standardized questionnaire at several time intervals. The groups were divided into patients with (DS+; n = 22) and without (DS-; n = 25) an increase in DS symptoms after the start of the MMT. Glucose and gut hormone levels were compared. Hypoglycemia was defined as a blood glucose level below 3.3 mmol/L. The DS+ group had lower blood glucose values compared to the DS- group, which reached significance at 90 and 120 minutes (P < .05). For the DS+ group, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and satiety were higher at various time intervals (P < .05) compared to the DS- group. No differences were found for insulin and hunger score. GLP-1 and PYY were correlated with symptoms of DS. Patients with DS complaints had lower postprandial glucose values. GLP-1 and PYY values were elevated in the DS+ group early and late during the test. These hormones also correlated with DS. These findings support the hypothesis of a common etiology of DS and PBH and a role of GLP-1 and PYY in both complications.

Management of Late Dumping Syndrome Induced Hypoglycemia With GLP-1R Agonist

Background: Late dumping syndrome is a prominent post-bariatric surgery side effect. Glucose-dependenthyperinsulinemia, induced by elevated gastric inhibitory polypeptide (GIP) and glucagon-likepeptide-1 (GLP-1) levels, leading to 2–3 hours post-prandial hypoglycemia. In literature, several managements are available: dietary changes, glucosidase inhibitor, andsomatostatin analogues. In case of failure of those strategies, partial or total pancreatectomy isindicated. Recently, management using GLP-1R agonists showed promising effect inmanagement of late dumping syndrome induced post-prandial hypoglycemia. (1)AimThe aim of this study was to investigate the effect of using GLP-1R agonists w/o low glycemicindex diet for treating dumping syndromes induced post-prandial hypoglycemia in post bariatricsurgery patients. Methods: A sample of 27 cases (25 females, 2 males) mean age 44.64, SD 10.2 of post-bariatric surgerywere managed using GLP-1R w/o low-glycemic index diet after being diagnosed with the latedumping syndrome induced post-prandial hypoglycemia for duration 1–3 years post-surgery. The27 were sent a survey of 13 questions related to their experience pre-and post-management plan. Results: Out of the 27 patients, 15 responded to the survey. The results showed 100% of the participantsdeveloped episodes of severe symptomatic late dumping syndrome with hypoglycemiasymptoms diagnosed after one and half years of their symptoms. 87% of them experiencedhypoglycemia post meals 2–3 hours.70 % of the participants got hypoglycemia more than 5episodes per week (less than 4.0 mmol/l) which was confirmed by blood glucose monitoring. After starting treatment with GLP-1R agonists with or without low-glycemic index diet, 87% ofthe participants reported that the hypoglycemia episodes were reduced. Out of those 87%participants 46% did not get any hypoglycemia episode and 54% of them experienced 1–2 timeshypoglycemia episodes. Conclusion: The results of the survey showed the successful reduction or prevention of late dumpinghypoglycemia episodes frequency post-bariatric surgery by GLP 1R agonist with or without lowglycemicindex diet.

Reply to: Late dumping syndrome or postprandial reactive hypoglycaemic syndrome after bariatric surgery

Reply to: Late dumping syndrome or postprandial reactive hypoglycaemic syndrome after bariatric surgery

1109 – Endoscopic Management of Late Dumping Syndrome: International Series and Proposed Management Strategy

1109 – Endoscopic Management of Late Dumping Syndrome: International Series and Proposed Management Strategy

Tailored One Anastomosis Gastric Bypass: 3-Year Outcomes of 94 Patients.

One anastomosis gastric bypass (OAGB) claims its place among bariatric operations, proving itself a safe and effective procedure. This is a retrospective analysis of prospectively collected data regarding 94 patients who underwent surgery in a single surgical unit. Tailoring of the biliopancreatic limb length decided upon preoperative BMI was applied. Patients' excess weight loss and resolution of comorbidities were evaluated. Data on patients' nutritional status is also presented. Mean BMI reduction at 36months postoperatively was 21.7 ± 6.3kg/m2. Mean excess weight loss (%EWL) was 83.6%, 91.8%, and 92.5% at 12, 24, and 36months postoperatively, respectively. When controlling for preoperative BMI, a 36-month %EWL of 89.1% for the 2-m subgroup, a 95.3% for the 2.5-m subgroup, and a 104.7% for the 3-m subgroup were found. Operation's success, defined as %EWL greater than 50%, was 97.9% 36months postoperatively. All patients suffering from hypertension, diabetes, and dyslipidemia achieved full remission. Furthermore, the percentage of patients with obstructive sleep apnea and gastroesophageal reflux disease, achieving full remission was 91.7% and 86.7%, respectively. An incidence of 5.3% new onset regurgitation was noted. Iron deficiency presented in 26 (27.7%) patients postoperatively, vitamin B12 deficiency in 13 (13.8%), folic acid deficiency in 18 (19.1%), and mild hypoalbuminemia in 7 (7.4%). Major early postoperative complications (Clavien-Dindo grade ≥ 3) were reported in 1.7% of our patients. One (1.1%) patient developed marginal ulcer and two (2.2) patients had late dumping. OAGB is a safe and efficient technique; however, careful selection of patients and postoperative surveillance with respect to weight regain and nutritional deficiencies are mandatory for optimal results.

Hypoglycemic Convulsive Seizure Due to Late Dumping Syndrome

Hypoglycemic Convulsive Seizure Due to Late Dumping Syndrome

Post-Fundoplication Late Dumping Syndrome in an Adult Diagnosed by Provocative Modified Oral Glucose Tolerance Test

Fundoplication has been routinely performed to alleviate refractory GERD. Post-fundoplication dumping syndrome is a rare complication in adult patients with a few reported in the literature. We present a case of post-fundoplication dumping syndrome in an adult patient that was diagnosed and subtyped by properly recorded modified oral glucose tolerance test (OGTT). A 71-year-old woman with a history of refractory GERD and 3 cm hiatal hernia was treated with lap paraesophageal hernia repair and Toupet fundoplication. Reflux was completed resolved; however, at 2 month, she developed abdominal bloating, nauseas, palpitation, dizziness and weakness that occurred every 3-5 days within 30-60 min postprandium that followed by 2-4 hours of excess diarrhea, burping and flatulence. Furthermore, she developed hair loss, cracked fingernails and acholic stools. Upper GI series, barium swallow, ultrasound of abdomen, HIDA scan and colon biopsies were negative. For a year, patient was treat for IBS with dicyclomine, loperamide, amitriptyline and FODMAP diet without any symptom relief. Further work ups including endoscopy, CT abdomen, timed barium esophagram, celiac and stool studies, hydrogen breath test, C-peptide, VIP, 5-HIAA and gastrin were negative. Dumping syndrome was finally diagnosed after rapid gastric emptying was confirmed on gastric scintigraphy (Figure 1 and 2). To further confirm and subtype, we performed 50g OGTT that revealed BP 122/85 and HR 71 before ingestion, BP 123/79 and HR 76 during ingestion, and BP 107/72 and HR 68 after ingestion. 2 hours blood glucose level of 37 mg/dL supported late type. She reported improvement after starting on small, frequent meals with high fiber and high glycemic index, and avoidance of high carbohydrate and simple sugars. We present a patient with rare post-fundoplication late dumping syndrome confirmed by OGTT. Patient did not meet early type criteria which is HR increase by 10 or more per minute or hematocrit increase of 3% in the first 30 min. Hypoglycemia < 60 mg/dL after 2-3 hours of ingestion suggested late type. Clear etiology is unknown but possible mechanisms are vagal damage and/or disruption of gastric motility. Diagnosis was delayed due to the shared symptomatology with IBS and unfamiliar association with fundoplication in adult population. This study highlights utilization of low cost and accessible OGTT which may reduce delayed diagnosis of dumping syndrome in post-fundoplication patients.2654_A Figure 1. Gastric scintigraphy showing very rapid gastric emptying with 7.6% retention at 60 minutes.2654_B Figure 2. Percent emptying trend over 240 minutes.

Safety and efficacy of pasireotide in dumping syndrome—results from a phase 2, multicentre study

Dumping syndrome is a prevalent complication of oesophageal and gastric surgery characterised by early (postprandial tachycardia) and late (hypoglycaemia) postprandial symptoms. To evaluate efficacy and safety of the somatostatin analogue, pasireotide in patients with dumping syndrome after bariatric or upper gastrointestinal cancer surgery. A single-arm, open-label, multicentre, intrapatient dose-escalation, phase 2 study with 4 phases: screening, 3-month SC (subcutaneous), 3-month IM (intramuscular) and 6-month optional extension IM phase. Primary endpoint was the proportion of patients without hypoglycaemia (plasma glucose <3.3mmol/L [60 mg/dL] during an oral glucose tolerance test, OGTT) at the end of 3-month SC phase. A ≥50% response rate was considered clinically relevant. Forty-three patients with late dumping were enrolled; 33 completed the 3-month SC phase and 23 completed the 12-month study. The proportion of patients without hypoglycaemia at month 3 (primary endpoint) was 60.5% (26 of 43; 95% confidence interval, 44.4%-75.0%). Improvement in quality of life was observed during SC phase, which was maintained in the IM phase. The proportion of patients with a rise in pulse rate of ≥10beats/min during OGTT reduced from baseline (60.5%) to month 3 (18.6%) and month 12 (27.3%). Overall (month 0-12), the most frequent (>20% of patients) adverse events were headache (34.9%); diarrhoea, hypoglycaemia (27.9% each); fatigue, nausea (23.3% each); and abdominal pain (20.9%). These results suggest that pasireotide is a promising option in patients with dumping syndrome after bariatric or upper gastrointestinal cancer surgery.

Long-term self-reported symptom prevalence of early and late dumping in a patient population after sleeve gastrectomy, primary, and revisional gastric bypass surgery

BackgroundEarly and late dumping are side effects of bariatric surgery. Almost no data are available on the prevalence of dumping after different surgical procedures. ObjectivesComparison of the relative risks of dumping in a large population of patients having undergone primary Roux-en-Y gastric bypass (pRYGB), sleeve gastrectomy (SG), or revisional RYGB (rRYGB; after removal of band). SettingBariatric center of a teaching hospital. MethodsIn this descriptive cohort study, all patients who underwent a pRYGB (n = 615), SG (n = 157), or rRYGB (n = 274) between 2008 and 2011 were approached by mail and asked to complete and return a questionnaire of general and disease-specific questions related to dumping syndrome. Relative risks (RR) were calculated (mean with 95% confidence intervals) by comparing the prevalence of high suspicion for early and late dumping between different surgical procedure groups and primary gastric bypass surgery. ResultsThe questionnaire was completed and returned by 593 (57%) of 1046 patients. Fewer patients with SG were at high suspicion of early dumping than after pRYGB (RR [95% confidence interval] .46 [.22–.99], P = .049). No differences for early dumping were seen between rRYGB and pRYGB (RR 1.21 [.77–1.91], P = .40). More patients were at high suspicion for late dumping after rRYGB compared with after pRYGB (RR 1.78 [1.09–2.90] P = .021). No differences for late dumping were seen between SG and pRYGB (RR .59 [.22–1.61], P =.30). ConclusionFewer complaints of early dumping are reported after SG, while patients report more complaints of late dumping after rRYGB compared with pRYGB.

Pasireotide and octreotide in the treatment of severe late dumping syndrome

Key Clinical MessageHypoglycemia due to late dumping is a significant problem postoesophagectomy but may not always be diagnosed sufficiently early. It can be difficult to treat and may severely compromise quality of life. The combination of diazoxide and octreotide or more probably pasireotide may transform the patient's life and should be considered in all problematic cases.

Late dumping syndrome in pregnant women after ROUX-EN-Y gastric bypass (RYGB) surgery

Late dumping syndrome in pregnant women after ROUX-EN-Y gastric bypass (RYGB) surgery