Therapeutic value of octreotide for patients with severe dumping syndrome--a review of randomised controlled trials.

Approximately 10%–50% of patients develop some manifestations of the dumping syndrome after gastric surgery. Among them, 5%–10% have clinically significant symptoms, and 1%–2% are debilitated by them. Early dumping, typically starting 10–30 minutes after a meal, usually involves both vasomotor and gastrointestinal complaints such as sweating, palpitation, weakness and faintness, abdominal bloating, cramping, and profound diarrhoea. Late dumping, often occurring 2–3 hours postprandially, involves mainly vascular complaints characterised by perspiration, palpitation, mental confusion, and sometimes syncope. It is estimated that, among all aVected patients, 75% have early dumping symptoms. The symptoms of early dumping probably result from rapid emptying of hyperosmolar chyme into the small bowel leading to a large fluid shift from the intravascular space into the intestinal lumen, with consequent rapid small bowel distension and an increase in both the amplitude and frequency of bowel contractions. Late dumping is a consequence of reactive hypoglycaemia resulting from an exaggerated insulin and glucagon-like peptide-1 release. The diagnosis of late dumping syndrome can be often confirmed through frequent blood sampling after a provocation test using 75 g of orally administrated glucose. The management of the dumping syndrome can be achieved in most cases by dietary modification and adjustment of lifestyle, in particular reduction of carbohydrate intake. However, in approximately 3%–5% of patients, severe symptoms of dumping can continue despite dietary changes. This results in marked weight loss, fear of eating and outdoor activities, or even an inability to maintain full time employment. For the past decade it has been suggested that octreotide (Sandostatin SMS 210–995; Novartis Pharmaceuticals, East Hanover, NJ, USA), an analogue of somatostatin, can alleviate dumping by slowing gastric emptying, inhibiting insulin release, decreasing enteric peptide secretion, increasing intestinal absorption of water and sodium, slowing monosaccharide absorption, increasing gut transit time, and preventing haemodynamic changes. In particular, octreotide has been demonstrated to be eVective in patients refractory to standard therapy. 4