Aetiological Factors and Therapeutic Approach to the Dumping Syndrome.

to describe the postprandial symptom-complex seen in patients after gastric surgery. The symptoms are of gastro-intestinal and vasomotor origin with variable predominance. They develop within 30 minutes of eating and are particularly severe after the ingestion of carbohydrates. Therapy has largely been limited to dietary and fluid restrictions and postprandial recumbency. The reported incidence of this complication varies from 0.3% (Herrington et al., 1961) to 75% (Muir, 1949). The continuing evolution of gastric surgery has made study comparisons difficult; however, the size of the gastric reservoir, the size and location of the stoma, and the individual patient's susceptibility have emerged as significant aetiological factors. A new concept of therapy was recently presented (Buse et al., 1957 ; Le Quesne et al., 1960). These authors proposed that the essential factor in the production of the dumping reaction was a defect in carbohydrate metabolism resulting in inadequate handling of a glucose load, a lag type glucose-tolerance curve, and a resultant decrease in plasma volume, usually greater than 10%, which in turn produced the dumping symptoms. They supported this hypothesis by demonstrating that insulin administered before a glucose meal markedly decreased the blood-volume change and the dumping reaction. The therapeutic implications of this were noted, and the present study was evolved to substantiate the therapeutic benefit of insulin, explore the therapeutic efficacy of an oral hypoglycaemic agent, and investigate the relationship of insulin and carbohydrate metabolism in the dumping reaction.