Τίτλος:
International consensus on the diagnosis and management of dumping syndrome
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Dumping syndrome is a common but underdiagnosed complication of gastric and oesophageal surgery. We initiated a Delphi consensus process with international multidisciplinary experts. We defined the scope, proposed statements and searched electronic databases to survey the literature. Eighteen experts participated in the literature summary and voting process evaluating 62 statements. We evaluated the quality of evidence using grading of recommendations assessment, development and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 33 of 62 statements, including the definition and symptom profile of dumping syndrome and its effect on quality of life. The panel agreed on the pathophysiological relevance of rapid passage of nutrients to the small bowel, on the role of decreased gastric volume capacity and release of glucagon-like peptide 1. Symptom recognition is crucial, and the modified oral glucose tolerance test, but not gastric emptying testing, is useful for diagnosis. An increase in haematocrit >3% or in pulse rate >10 bpm 30 min after the start of the glucose intake are diagnostic of early dumping syndrome, and a nadir hypoglycaemia level <50 mg/dl is diagnostic of late dumping syndrome. Dietary adjustment is the agreed first treatment step; acarbose is effective for late dumping syndrome symptoms and somatostatin analogues are preferred for patients who do not respond to diet adjustments and acarbose. © 2020, The Author(s).
Συγγραφείς:
Scarpellini, E.
Arts, J.
Karamanolis, G.
Laurenius, A.
Siquini, W.
Suzuki, H.
Ukleja, A.
Van Beek, A.
Vanuytsel, T.
Bor, S.
Ceppa, E.
Di Lorenzo, C.
Emous, M.
Hammer, H.
Hellström, P.
Laville, M.
Lundell, L.
Masclee, A.
Ritz, P.
Tack, J.
Περιοδικό:
Nature Reviews Endocrinology
Εκδότης:
Lithuanian Nature Research Centre
Λέξεις-κλειδιά:
glucagon like peptide 1; somatostatin; acarbose; gastrointestinal hormone, Delphi study; diagnostic test; dietary intake; dumping syndrome; evidence based medicine; gastric volume capacity; glucose intake; hematocrit; human; hypoglycemia; medical literature; nutrient; oral glucose tolerance test; pathophysiology; patient care; priority journal; pulse rate; quality control; quality of life; Review; small intestine; stomach emptying; stomach parameters; adverse event; bariatric surgery; body weight loss; consensus; diet therapy; dumping syndrome; esophagus; gastrectomy; glucose blood level; meal; metabolism; pathology; postoperative complication; practice guideline; stomach; surgery, Acarbose; Bariatric Surgery; Blood Glucose; Consensus; Diet Therapy; Dumping Syndrome; Esophagus; Evidence-Based Medicine; Gastrectomy; Gastric Emptying; Gastrointestinal Hormones; Humans; Meals; Postoperative Complications; Practice Guidelines as Topic; Quality of Life; Stomach; Weight Loss
DOI:
10.1038/s41574-020-0357-5
