Nutritional approach to dumping syndrome.

BACKGROUND: Dumping syndrome is defined by the occurrence of 'dumping-like' symptoms after surgery of the upper GI tract, triggered by food reaching the small bowel too rapidly or in too high quantity. There are two different subsets of symptoms and signs, classified as early and late dumping, respectively. Nutritional approach is recommended with different levels of evidence across the managing flow-chart of the syndrome.

METHODS: We performed a narrative review of literature evidence on the nutritional approach to dumping syndrome. In detail, we made a search on main medical databases for publications using the following keywords, their acronyms and their associations (e.g., "and "): "Dumping syndrome"," Treatment", "Nutrition", "Dietary supplements", "Food viscosity", "Artificial Nutrition".

RESULTS: Dietary adjustment remains the initial step in the management of dumping syndrome and can be maintained throughout the patients' natural history. In detail, in patients with late dumping, rapidly absorbable carbohydrates and lactose must be avoided. In case of insufficient response to diet alone, dietary supplements increasing food viscosity have successfully been used. Similarly, corn starch has shown efficacy for children suffering from dumping symptoms. Increased amount of dietary soluble fibers increases intestinal transit time, delays glucose absorption, and improves patients' symptoms. In refractory patients, continuous enteral nutrition via a nasogastric tube or a feeding jejunostomy has been used, especially for late dumping hypoglycemia.

CONCLUSIONS: some data from literature supports the use of nutritional schemes and agents enhancing food viscosity for dumping symptoms management. In refractory cases, enteral nutrition can be attempted. Larger RCTs are needed to confirm these observations.