Table 5.
Recommendations from the Delphi consensus on dumping syndrome
| Recommendations | Based on statements | Grading level |
|---|---|---|
| Dumping syndrome is a complication of oesophageal or gastric surgery that can comprise both early and late dumping syndrome symptoms | 1–6 | Grade B |
| Early dumping syndrome is the typical and most frequent manifestation of dumping syndrome and can occur in isolation or in association with late symptoms | 4–6 | Grades A and B |
| Dumping syndrome affects quality of life and can be associated with weight loss | 7 and 8 | Grade B |
| Symptoms of early dumping syndrome are driven by rapid delivery of nutrients to the small bowel, which triggers release of several gastrointestinal hormones, including vasoactive agents, incretins and glucose modulators | 9–13 | Grade B |
| Hypoglycaemia is the main symptom of late dumping syndrome, and is driven by a hyperinsulinaemic response and GLP1 release | 14 and 15 | Grades A and B |
| Dumping syndrome can contribute to weight loss after bariatric surgery | 16 and 17 | Grade B |
| Dumping syndrome should be suspected based on the clinical history, but currently available dumping questionnaires have no proven diagnostic value | 19–26 | Grades B and C |
| Spontaneous hypoglycaemia below 2.8 mmol/l (50 mg/dl) is suggestive of late dumping syndrome | 27 | Grade B |
| A modified oral glucose tolerance test is a useful diagnostic test for dumping syndrome. The test is considered positive for early dumping syndrome in case of an early (30 min) increase in haematocrit >3% or in pulse rate >10 bpm. The test is considered positive for late dumping syndrome in case of late (60–180 min after ingestion) hypoglycaemia (<50 mg/dl) | 33–39 | Grades B and C |
| The value of continuous glucose monitoring for diagnosing dumping syndrome has not been established | 30 and 31 | Grade C |
| Mixed meal tests are not considered superior to the modified glucose tolerance test, and gastric emptying tests have no established value in diagnosing dumping syndrome | 40–42 | Grades B and C |
| Dietary intervention, with elimination of rapidly absorbable carbohydrates, is the first-line treatment approach for dumping syndrome. Patients are also advised to consume high fibre and protein-rich foods, eaten slowly and chewed well | 43–47 | Grades B and C |
| Agents that increase meal viscosity have no established value in the management of dumping syndrome | 48 | Grade B |
| Acarbose is effective for the treatment of dumping syndrome symptoms, especially symptoms of late dumping syndrome | 50 and 51 | Grade B |
| Diazoxide has no established value for the treatment of dumping syndrome | 52 | Grade C |
| Somatostatin analogues are effective for the treatment of dumping syndrome. The short-acting analogues have greater efficacy but require multiple injections | 53–56 | Grade B |
| Continuous enteral or gastric feeding has no established value for the treatment of dumping syndrome | 57 and 58 | Grade C |
| Surgical interventions (or re-interventions) for dumping syndrome have uncertain outcomes and the optimal procedure is not established | 59–62 | Grades B and C |
GLP1, glucagon-like peptide 1.