van Beek A P, Emous M, Laville M, Tack J
Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
Obes Rev. 2017 Jan;18(1):68-85. doi: 10.1111/obr.12467. Epub 2016 Oct 17.
Dumping syndrome, a common complication of esophageal, gastric or bariatric surgery, includes early and late dumping symptoms. Early dumping occurs within 1 h after eating, when rapid emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and release of gastrointestinal hormones, resulting in gastrointestinal and vasomotor symptoms. Late dumping occurs 1-3 h after carbohydrate ingestion, caused by an incretin-driven hyperinsulinemic response resulting in hypoglycemia. Clinical recommendations are needed for the diagnosis and management of dumping syndrome.
A systematic literature review was performed through February 2016. Evidence-based medicine was used to develop diagnostic and management strategies for dumping syndrome.
Dumping syndrome should be suspected based on concurrent presentation of multiple suggestive symptoms after upper abdominal surgery. Suspected dumping syndrome can be confirmed using symptom-based questionnaires, glycemia measurements and oral glucose tolerance tests. First-line management of dumping syndrome involves dietary modification, as well as acarbose treatment for persistent hypoglycemia. If these approaches are unsuccessful, somatostatin analogues should be considered in patients with dumping syndrome and impaired quality of life. Surgical re-intervention or continuous enteral feeding may be necessary for treatment-refractory dumping syndrome, but outcomes are variable.
Implementation of these diagnostic and treatment recommendations may improve dumping syndrome management.
倾倒综合征是食管、胃或减肥手术后的常见并发症，包括早期和晚期倾倒症状。早期倾倒发生在进食后1小时内，此时食物快速排空至小肠会引发液体迅速转移至肠腔并释放胃肠激素，从而导致胃肠道和血管舒缩症状。晚期倾倒发生在摄入碳水化合物后1 - 3小时，由肠促胰岛素驱动的高胰岛素反应导致低血糖引起。需要针对倾倒综合征的诊断和管理提出临床建议。
截至2016年2月进行了系统的文献综述。采用循证医学制定倾倒综合征的诊断和管理策略。
基于上腹部手术后同时出现多种提示性症状应怀疑倾倒综合征。可疑的倾倒综合征可通过基于症状的问卷、血糖测量和口服葡萄糖耐量试验来确诊。倾倒综合征的一线管理包括饮食调整，以及对持续性低血糖采用阿卡波糖治疗。如果这些方法无效，对于生活质量受损的倾倒综合征患者应考虑使用生长抑素类似物。对于治疗难治性倾倒综合征可能需要手术再次干预或持续肠内喂养，但结果不一。
实施这些诊断和治疗建议可能会改善倾倒综合征的管理。
