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Cited by 288Bariatric Surgery and OutcomesGastrointestinal motility and disordersGastrointestinal Bleeding Diagnosis and Treatment

Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management

Open access
van Beek, A. P., Emous, M., Laville, M., Tack, J.·2017·Obesity Reviews
DOI 10.1111/obr.12467
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Abstract

BACKGROUND: 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. METHODS: A systematic literature review was performed through February 2016. Evidence-based medicine was used to develop diagnostic and management strategies for dumping syndrome. RESULTS: 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. CONCLUSIONS: Implementation of these diagnostic and treatment recommendations may improve dumping syndrome management.

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes dumping syndrome after esophageal, gastric, or bariatric surgery, covering early and late pathophysiology, diagnosis, and management. It recommends symptom-based confirmation and stepwise therapy from dietary modification to acarbose, somatostatin analogues, and, for refractory cases, surgical or enteral approaches.

Key findings

  • Dumping syndrome occurs in approximately 20% after vagotomy with pyloroplasty, up to 40% after Roux-en-Y gastric bypass or sleeve gastrectomy, and up to 50% after esophagectomy; isolated late dumping affects up to 25%. Early dumping occurs within 1 h after eating, while late dumping occurs 1–3 h after carbohydrate ingestion.
  • Diagnosis should be suspected from multiple suggestive symptoms after upper abdominal surgery and confirmed with symptom questionnaires (e.g., Sigstad index >7 suggests dumping, <4 suggests other diagnoses), glycemia measurements, and provocative tests. OGTT is positive for early dumping if 30-min haematocrit rises >3% or pulse rises >10 beats/min; late dumping is positive if hypoglycemia occurs 60–180 min post-ingestion.
  • First-line management is dietary modification (level III/B), with acarbose for persistent hypoglycemia (III/B); if unsuccessful, somatostatin analogues are recommended for patients with impaired quality of life (II/A). Surgical re-intervention or continuous enteral feeding may be needed for refractory dumping, but outcomes are variable.
  • In surgical re-intervention series, approximately 24% had gastric bypass reversal, approximately 9% had gastric pouch restriction, and approximately 67% had pancreatic resection; symptom resolution was generally higher after reversal or pouch restriction than after pancreatic resection.

Methods

  • Systematic PubMed literature search through February 2016 using terms including “dumping syndrome” combined with symptoms, pathophysiology, management, diet, pectin, guar gum, glucomannan, acarbose, somatostatin analogue, octreotide, lanreotide, pasireotide, diazoxide, nifedipine, GLP-1 receptor antagonist, surgery, and continuous enteral feeding; reference lists were also reviewed, yielding approximately 160 potentially relevant citations after filters.
  • Evidence-based medicine was used to develop diagnostic and management strategies, with consensus recommendations developed by an interdisciplinary team (endocrinologist, gastroenterologist, nutritionist, and bariatric surgeon). Diagnostic approaches were not systematically reviewed but are briefly described.

Limitations

  • The paper states that pathophysiological mechanisms are incompletely understood, few recent mechanistic studies exist, and much current knowledge is based on older literature. It also states diagnostic limitations: OGTT has low diagnostic accuracy and no firmly established normative values; mixed-meal tolerance testing needs further validation; gastric emptying studies have low sensitivity and specificity; Sigstad’s score has not been established in bariatric or upper GI cancer surgery patients; and Arts’ questionnaire was never formally validated.
  • The paper states treatment evidence is limited: most studies included relatively few patients and were not adequately controlled; effectiveness of some approaches is not clearly established; surgical re-intervention studies were small, highly selected, had short mean follow-up, and used inconsistent methodology; continuous enteral feeding evidence is based on individual case reports; and no medications are approved for dumping syndrome.
  • Evident from the text: the recommendations rely heavily on low-level evidence and expert consensus, and the diagnostic review was not systematic.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/obr.12467

Cites

131 of 131 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

46 of 178 cited sources checked · 17 supported · 2 flagged · accuracy not yet measured

  • Findingcitation

    Pancreatic resection, the most commonly reported procedure, was performed in approximately 67% of patients.

    “Pancreatic resection, the most commonly reported procedure, was performed in approximately 67% of patients (66,103,105,107,114,116-123).”
    Quote in the paperNot a substantial claim4 of 10 sources checked
    • cites [66] source

      The Results (Surgical Treatment) report partial pancreatectomy in 3 patients, while redo surgery was the first surgical option for 4 patients. Thus pancreatic resection accounted for 3 of the 7 surgical cases (about 43%), not approximately 67%, and was not the most common approach in this registry. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [103] source

      The Patient 1–3 sections report pancreatic resections in all three patients described. The paper does not report that resection was the most commonly performed procedure or that it was performed in approximately 67% of patients across the cases cited. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [105] source

      The Results (page not provided) report 75 patients who underwent pancreatic resection for noninsulinoma pancreatogenous hypoglycemia. The paper studies resection patients rather than comparing procedures across a broader patient group, so it does not establish that resection was the most commonly reported procedure or was performed in approximately 67% of patients. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [107] source
    • cites [114] source
    • cites [116] source
    • cites [117] source
    • cites [118] source
    • cites [119] source

      The Tissue section (page unavailable) reports that all 36 selected patients with nesidioblastosis underwent partial pancreatectomy, so the paper documents pancreatic resection. It does not report that resection was the most commonly performed procedure or that approximately 67% of patients underwent it; the surgical history was a selection criterion for this cohort. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [120] source
  • Premisecitation

    Dumping syndrome is a common complication of esophageal, gastric or bariatric surgery.

    “Dumping syndrome, a common complication of esophageal, gastric or bariatric surgery, includes early and late dumping symptoms.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [4] source

      The Functional Outcome passage (page not supplied) reports postprandial dumping symptoms in 53 of 107 long-term survivors after esophageal resection, supporting that dumping is common in this group. The cited passages do not establish how common it is after gastric or bariatric surgery. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [5] source
  • Premisecitation

    Several concurrent phenomena contribute to the development of early dumping symptoms.

    “Several concurrent phenomena contribute to the development of early dumping symptoms (3,(22)(23)(24)(25).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [22] source
    • cites [23] source

      In the “V &P patients” section (page unavailable), the paper suggests that rapid gastric emptying may underlie dumping syndrome and reports post-meal diarrhea and symptomatic dumping. It does not establish that several concurrent phenomena contribute to early dumping symptoms; its discussion of multiple mechanisms concerns postoperative malabsorption, not dumping symptoms. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
  • Premisecitation

    Weight loss after Roux-en-Y gastric bypass was not dependent on the presence of dumping symptoms.

    “However, although it has previously been suggested that dumping symptoms might be essential for weight loss after bariatric surgery, a prospective series demonstrated that weight loss after Roux-en-Y gastric bypass was not dependent on the presence of dumping symptoms, and other studies suggest that some patients with dumping syndrome may exhibit weight gain (5,17,18).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [5] source
    • cites [17]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [18] source

      The Results (Subjects characteristics, Table 1; page unavailable) report similar total weight loss in two gastric-bypass groups, despite more frequent dumping symptoms in one group. But the Methods (Subjects; page unavailable) show that participants were grouped by hypoglycemia history, not dumping status. The paper therefore offers indirect support, not a prospective demonstration that weight loss was independent of dumping symptoms. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    The pathophysiology of late dumping is largely attributable to the development of hyperinsulinemic or reactive hypoglycemia.

    “In contrast to the multiple pathophysiologic factors involved in early dumping syndrome, the pathophysiology of late dumping is largely attributable to the development of hyperinsulinemic or reactive hypoglycemia (3,(22)(23)(24)(25).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [22] source
    • cites [23] source

      The V&P patients section mentions dumping syndrome in connection with rapid gastric emptying, and the Discussion addresses gastric emptying and digestive secretions. Neither addresses late dumping or attributes it to hyperinsulinemic or reactive hypoglycemia (searched: late dumping, insulin, glucose, hypoglycemia). (LLM, conf=0.72)

      Experimental — accuracy not yet measured
  • May combine two claims. 63
  • Classified as probably not a substantial claim. 54
  • The quote only partly states this claim. 6

  • May combine two claims.

    Premisecitation

    Anecdotal evidence suggests that off-label diazoxide administered at doses ranging from 100 mg to 150 mg three times daily may be effective in the treatment of late dumping symptoms, but no effect on early symptoms is expected because of its mode of action.

    “Anecdotal evidence suggests that off-label diazoxide administered at doses ranging from 100 mg to 150 mg three times daily may be effective in the treatment of late dumping symptoms, but no effect on early symptoms is expected because of its mode of action (103).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [103] source

      Split into 2 atoms — 0 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • Rests on an assumption: Diazoxide is a potassium channel activator that inhibits calcium-induced insulin release.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A Swedish nationwide cohort study of 5,040 post-gastric bypass patients demonstrated that approximately 1% were hospitalized for hypoglycemia and/or related disorders at a median of 2.7 years after surgery.

    “Furthermore, a Swedish nationwide cohort study of 5,040 post-gastric bypass patients demonstrated that approximately 1% were hospitalized for hypoglycemia and/or related disorders at a median of 2.7 years after surgery (19).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [19] source

      The Results report 5,040 gastric bypass patients and a median of 2.7 years from surgery to inpatient care for hypoglycaemia. Table 2 reports percentages for each diagnosis separately: 0.18% for hypoglycaemia and up to 0.99% for related conditions. It does not establish that approximately 1% were hospitalized for hypoglycaemia and/or related disorders combined, or that the 2.7-year median applies to all those disorders. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Dumping syndrome has been reported to occur in approximately 20% of patients who undergo vagotomy with pyloroplasty, in up to 40% of patients after Roux-en-Y gastric bypass or sleeve gastrectomy, and in up to 50% of patients who undergo esophagectomy.

    “Dumping syndrome has been reported to occur in approximately 20% of patients who undergo vagotomy with pyloroplasty, in up to 40% of patients after Roux-en-Y gastric bypass or sleeve gastrectomy, and in up to 50% of patients who undergo esophagectomy (3)(4)(5)(6)(7).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [4] source
    • cites [5] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Patients were also at increased risk for confusion, syncope, epilepsy and seizures after gastric bypass surgery.

    “Patients were also at increased risk for confusion, syncope, epilepsy and seizures after gastric bypass surgery (19).”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    An increased GLP-1 response has been reported in patients after gastric surgery, and a positive correlation has been observed between increasing GLP-1 levels and insulin release.

    “An increased GLP-1 response has been reported in patients after gastric surgery, and a positive correlation has been observed between increasing GLP-1 levels and insulin release (29).”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An insulinoma, which is extremely rare, should be considered if fasting hypoglycemia occurs (i.e. not provoked by a meal).

    “In contrast, an insulinoma, which is extremely rare, should be considered if fasting hypoglycemia occurs (i.e.not provoked by a meal) (41,42).”
    Quote in the paperNot a substantial claim2 of 2 sources checked

  • May combine two claims.

    Premisecitation

    A number of short-term studies involving the ingestion of up to 15 g of guar gum or pectin with each meal have demonstrated the efficacy of these dietary supplements in slowing gastric emptying, reducing GI hormone release, improving hyperglycemia and controlling dumping symptoms.

    “A number of short-term studies involving the ingestion of up to 15 g of guar gum or pectin with each meal have demonstrated the efficacy of these dietary supplements in slowing gastric emptying, reducing GI hormone release, improving hyperglycemia and controlling dumping symptoms (Table 2) (48)(49)(50)(51)(52)(53)(54)(55)(56)(57).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [48] source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [49] source
    • cites [50] source

  • May combine two claims.

    Premisecitation

    This survey used a very low cutoff for dumping complaints (VAS score >10 mm), and a single item on the questionnaire was sufficient to label patients as symptomatic for late dumping.

    “This survey used a very low cutoff for dumping complaints (VAS score >10 mm), and a single item on the questionnaire was sufficient to label patients as symptomatic for late dumping (32).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [32] source

      The available Abstract passage says patients were classified as symptomatic or symptom-free using visual analogue scale ratings, but it gives neither a >10 mm cutoff nor the number of questionnaire items required for a late-dumping classification. Searches for “10 mm” and for a single late-dumping symptom found no passage addressing those details in our copy. (LLM, conf=0.69)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Various surgical re-interventions have been used, including gastric tube placement, gastric bypass reversal with or without concomitant sleeve resection and gastric pouch restriction.

    “Various surgical re-interventions have been used, including gastric tube placement, gastric bypass reversal with or without concomitant sleeve resection and gastric pouch restriction (Table 5) (66,103,105-123).”
    Quote in the paperNot a substantial claim6 of 10 sources checked
    • cites [66] source

      The Results (Surgical Treatment; page not provided) describe gastric bypass reversal and gastric pouch restriction, and the Discussion mentions nutrition through a gastrostomy tube. The paper does not describe bypass reversal with concomitant sleeve resection; the resection it reports was of a Roux limb, not the stomach. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [103] source

      The Patient 1 section reports that a gastric bypass was taken down, supporting bypass reversal as one surgical re-intervention. The passages do not report gastric tube placement, reversal with sleeve resection, or gastric pouch restriction; Patient 2 says reversal and gastrectomy were considered but not possible. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [105] source

      The Results (page not provided) report feeding-tube placement and gastric-bypass revision as additional operations; the Discussion describes gastric re-restriction procedures. The paper does not specify that the feeding tube was gastric or describe bypass reversal with or without sleeve resection. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [106] source

      The Results describe G-tube placement, and the surgical-technique section describes bypass reversal both with and without sleeve gastrectomy. The passages do not describe gastric pouch restriction as a re-intervention, so this source supports only part of the list. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [107] source
    • cites [108] source
    • cites [109] source

      The Case Report and Discussion describe gastrostomy tube placement, gastric bypass reversal, and gastric pouch reduction. The Discussion also describes modified sleeve gastrectomy as a revision of bypass, but does not say it was performed concomitantly with reversal. No page numbers are available in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [110] source
    • cites [111] source
    • cites [112] source

      The Abstract (p. 1) reports a surgical revision for intractable dumping syndrome after Roux-en-Y gastric bypass: conversion to loop duodenojejunal bypass with sleeve gastrectomy. Our copy does not describe gastric tube placement, bypass reversal with or without sleeve resection, or gastric pouch restriction as the listed alternatives. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Fewer than half of patients (48%) were deemed to have achieved a highly or moderately successful surgical outcome, and 25% experienced no apparent benefit.

    “Fewer than half of patients (48%) were deemed to have achieved a highly or moderately successful surgical outcome, and 25% experienced no apparent benefit (105).”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    Somatostatin analogues target various steps in the pathophysiology of dumping syndrome, including delaying gastric emptying, delaying transit through the small intestine, inhibiting the release of GI hormones, inhibiting insulin secretion and inhibiting postprandial vasodilation.

    “Somatostatin analogues target various steps in the pathophysiology of dumping syndrome, including delaying gastric emptying, delaying transit through the small intestine, inhibiting the release of GI hormones, inhibiting insulin secretion and inhibiting postprandial vasodilation (15,(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [15] source
    • cites [67] source

      The Discussion (page unavailable) reports that octreotide reduces postprandial gastric and small-bowel motility and cites prior findings of slower gastric emptying and longer oro-cecal transit time. It also discusses inhibition of gastrointestinal hormones and insulin and reduced postprandial splanchnic blood flow, but some mechanisms are speculative. The study concerns patients with gastroparesis, not dumping syndrome, and does not establish that these effects target dumping syndrome’s pathophysiology. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [68] source

  • May combine two claims.

    Premisecitation

    Both short-acting and long-acting formulations of somatostatin analogues have demonstrated efficacy by slowing gastric emptying, improving hypoglycemia and reducing early and late dumping symptoms.

    “Both short-acting and long-acting formulations of somatostatin analogues have demonstrated efficacy by slowing gastric emptying, improving hypoglycemia and reducing early and late dumping symptoms (Table 4) (15,66,(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [15] source
    • cites [66] source

      The Results (Therapy Strategies: Pharmacological Treatment; page not provided) report that octreotide reduced or resolved hypoglycemic episodes in some patients. The paper does not establish efficacy for both short- and long-acting formulations, attribute slowed gastric emptying specifically to somatostatin analogues, or report reduced early and late dumping symptoms; the Discussion distinguishes dumping syndrome from the condition studied. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites [80] source

  • May combine two claims.

    Premisecitation

    Several small studies demonstrated that acarbose improved glucose tolerance, reduced GI hormone release, reduced the incidence of hypoglycemia and improved symptoms in patients with dumping syndrome.

    “Several small studies demonstrated that acarbose improved glucose tolerance, reduced GI hormone release, reduced the incidence of hypoglycemia and improved symptoms in patients with dumping syndrome (Table 3) (8,34,53,58-66).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [8] source
    • cites [34] source
    • cites [53] source

      The Results (page not supplied) show that acarbose attenuated the glucose curve, raised the glucose nadir, and reduced hypoglycaemic symptoms from eight patients on placebo to two. The paper does not establish a reduced incidence of hypoglycaemia as distinct from symptoms, and it did not measure GI hormone release; plasma insulin peaks were not significantly reduced by acarbose alone. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Approximately 24% of patients who underwent surgical re-intervention because of refractory severe post-Roux-en-Y gastric bypass hypoglycemia received a gastric bypass reversal and approximately 9% had gastric pouch restriction.

    “As shown in Table 5, approximately 24% of patients who underwent surgical re-intervention because of refractory severe post-Roux-en-Y gastric bypass hypoglycemia received a gastric bypass reversal (66,103,106-113) and approximately 9% had gastric pouch restriction (66,114,115).”
    Quote in the paperNot a substantial claim6 of 10 sources checked
    • cites [66] source

      The Results (Surgical Treatment; page not available) report gastric bypass reversal in three patients and gastric pouch restriction in one patient after RYGB. The paper supports the inclusion of those procedures in the citing authors’ Table 5, but it does not establish the table’s aggregate figures of approximately 24% and 9%. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [103] source

      Patient 1 reports a gastric bypass take-down after severe hypoglycaemia, so the paper supports an example of reversal. It does not report gastric pouch restriction or the approximately 24% and 9% rates; its Introduction describes a three-patient case series, not the pooled group underlying those percentages. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [106] source
    • cites [107] source
    • cites [108] source
    • cites [109] source
    • cites [110] source
    • cites [111] source
    • cites [112] source

      The Abstract (p. 1) describes two patients who underwent conversion to loop duodenojejunal bypass with sleeve gastrectomy for intractable dumping syndrome. Searches for gastric bypass reversal, gastric pouch restriction, and the stated percentages found no passage reporting the 24% or 9% figures. The case reports do not establish those proportions among patients undergoing surgical re-intervention. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [113] source

      The Abstract (p. 1) describes one patient who underwent conversion to a modified duodenal switch for intractable dumping syndrome. Our copy gives no patient totals or percentages for bypass reversal or gastric pouch restriction; searches for those procedures and the claimed 24% and 9% found no supporting passage. (LLM, conf=0.77)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    The authors of this publication also restored glucose homeostasis via the placement of a gastric tube in the remnant stomach of a patient who had undergone gastric bypass surgery.

    “The authors of this publication also restored glucose homeostasis via the placement of a gastric tube in the remnant stomach of a patient who had undergone gastric bypass surgery (Dr.van Beek, unpublished observation).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dr.van Beek, unpublished observation

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingnone given

    Complications of surgical re-intervention included recurrent symptoms, diabetes and weight gain.

    “Complications of surgical re-intervention included recurrent symptoms, diabetes and weight gain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    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.

    “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.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] source
    • cites [2] source

  • May combine two claims.

    Premisecitation

    Late dumping occurs 1-3 h after carbohydrate ingestion, caused by an incretin-driven hyperinsulinemic response resulting in hypoglycemia.

    “Late dumping occurs 1-3 h after carbohydrate ingestion, caused by an incretin-driven hyperinsulinemic response resulting in hypoglycemia.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] source
    • cites [2] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Early dumping syndrome occurs within the first hour after a meal.

    “Early dumping syndrome occurs within the first hour after a meal.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Symptoms can also be emotionally distressing, leading to anxiety and apprehension.

    “Symptoms can also be emotionally distressing, leading to anxiety and apprehension.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Dumping syndrome has also been reported to occur after Nissen fundoplication in children and in adults.

    “Dumping syndrome has also been reported to occur after Nissen fundoplication in children and in adults (8,9).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8] source
    • cites [9]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Approximately 12% had persistent dumping symptoms 1 to 2 years after surgery, especially postprandial fatigue necessitating lying down; 7% had persistent nausea and 6% had persistent fainting.

    “Approximately, 12% had persistent dumping symptoms 1 to 2 years after surgery, especially postprandial fatigue necessitating lying down; 7% had persistent nausea and 6% had persistent fainting (14).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] source

  • May combine two claims.

    Premisecitation

    Enhanced release of these GI hormones may induce discoordinated GI motility and inhibit secretion, as well as elicit hemodynamic effects.

    “Enhanced release of these GI hormones may induce discoordinated GI motility and inhibit secretion, as well as elicit hemodynamic effects; for example, neurotensin and vasoactive intestinal polypeptide induce splanchnic vasodilation that results in hypotension and systemic hemoconcentration (27).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Patients with severe dumping syndrome may experience weight loss of up to 30% of their preoperative weight.

    “Patients with severe dumping syndrome may experience weight loss of up to 30% of their preoperative weight (16).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] source

  • May combine two claims.

    Premisenone given

    The prevalence of early and late dumping symptoms depends on the type and extent of surgery, as well as the definition of dumping syndrome used by study investigators.

    “The prevalence of early and late dumping symptoms depends on the type and extent of surgery, as well as the definition of dumping syndrome used by study investigators.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Early dumping syndrome is the most frequent type of dumping syndrome and may occur in isolation or in association with late symptoms.

    “Early dumping syndrome is the most frequent type of dumping syndrome and may occur in isolation or in association with late symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Alterations in gastric anatomy or interference with its intrinsic innervation disturb gastric emptying mechanisms and allow a substantial amount of undigested food to reach the small intestine too rapidly.

    “Alterations in gastric anatomy or interference with its intrinsic innervation disturb gastric emptying mechanisms and allow a substantial amount of undigested food to reach the small intestine too rapidly (1,2).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] source
    • cites [2] source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Early dumping symptoms may have resolved in some patients before late dumping symptoms present.

    “Furthermore, early dumping symptoms may have resolved in some patients before late dumping symptoms present.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Among 129 patients who underwent gastric bypass surgery, 12% reported severe fatigue after eating (half were so tired that they needed to lie down), 7% reported severe nausea and 6% severe fainting.

    “Among 129 patients who underwent gastric bypass surgery, 12% reported severe fatigue after eating (half were so tired that they needed to lie down), 7% reported severe nausea and 6% severe fainting (14).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] source

  • May combine two claims.

    Premisecitation

    Late dumping usually occurs 1 to 3 h after a meal and is a result of an incretin-driven hyperinsulinemic response after carbohydrate ingestion.

    “In contrast, late dumping usually occurs 1 to 3 h after a meal and is a result of an incretin-driven hyperinsulinemic response after carbohydrate ingestion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Dumping syndrome is not a single disease entity but consists of a constellation of symptoms that can be categorized as early dumping or late dumping symptoms.

    “Dumping syndrome is not a single disease entity but, instead, consists of a constellation of symptoms that can be categorized as early dumping or late dumping symptoms (1,2).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] source
    • cites [2] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Early dumping is characterized by gastrointestinal symptoms such as abdominal pain, bloating, borborygmi, nausea, and diarrhoea, and vasomotor symptoms such as fatigue, desire to lie down after meals, flushing, palpitations, perspiration, tachycardia, hypotension, and, rarely, syncope.

    “Early dumping is characterized by gastrointestinal (GI) symptoms such as abdominal pain, bloating, borborygmi, nausea, and diarrhoea, and vasomotor symptoms such as fatigue, desire to lie down after meals, flushing, palpitations, perspiration, tachycardia, hypotension, and, rarely, syncope (1,2).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] source
    • cites [2] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Bariatric surgery results in major alterations to the anatomy and function of the GI tract.

    “Bariatric surgery results in major alterations to the anatomy and function of the GI tract (11).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Hyperosmolar nutrients in the small bowel presumably cause a shift of fluid from the intravascular compartment (i.e. plasma) to the intestinal lumen, resulting in a reduction in plasma volume, tachycardia, and, rarely, syncope.

    “Hyperosmolar nutrients in the small bowel presumably cause a shift of fluid from the intravascular compartment (i.e.plasma) to the intestinal lumen, resulting in a reduction in plasma volume, tachycardia, and, rarely, syncope.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    Movement of fluid into the small bowel may also cause distention and contribute to cramp-like contractions, bloating and diarrhoea.

    “Movement of fluid into the small bowel may also cause distention and contribute to cramp-like contractions, bloating and diarrhoea.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Relatively few recent studies have been devoted to elucidating the mechanisms involved in early and late dumping syndromes, and much of our current knowledge is based on older literature.

    “Relatively few recent studies have been devoted to elucidating the mechanisms involved in early and late dumping syndromes, and much of our current knowledge is based on older literature (21).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] source

  • May combine two claims.

    Interpretationnone given

    Dumping syndrome cannot always be discretely separated into early and late dumping symptoms but is an entire disease spectrum whereby patients can develop early dumping, late dumping or both.

    “Moreover, dumping syndrome cannot always be discretely separated into early and late dumping symptoms but, instead, is an entire disease spectrum whereby patients can develop early dumping, late dumping or both.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Gastric surgery reduces gastric volume or removes the barrier function of the pylorus, resulting in the rapid delivery of a substantial amount of undigested solid food to the small intestine, thereby bypassing the larger part of the stomach.

    “Gastric surgery reduces gastric volume or removes the barrier function of the pylorus, resulting in the rapid delivery of a substantial amount of undigested solid food to the small intestine, thereby bypassing the larger part of the stomach (Fig. 1) (1).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] source

  • May combine two claims.

    Premisecitation

    Dietary supplements that increase the viscosity of food (e.g. guar gum, pectin and glucomannan) slow the rate of gastric emptying and delay glucose absorption.

    “Dietary supplements that increase the viscosity of food (e.g.guar gum, pectin and glucomannan) slow the rate of gastric emptying and delay glucose absorption.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Arts' dumping questionnaire was designed to differentiate between early and late dumping symptoms.

    “Sigstad's score was developed to separate patients with or without postoperative dumping syndrome in the era of peptic ulcer surgery (17), while Arts' dumping questionnaire was designed to differentiate between early and late dumping symptoms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Two GI hormones are believed to play a pivotal role in the incretin effect: glucose-dependent insulinotropic polypeptide or gastric inhibitory polypeptide and GLP-1.

    “Two GI hormones are believed to play a pivotal role in the incretin effect: glucosedependent insulinotropic polypeptide or gastric inhibitory polypeptide and GLP-1.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The primary focus of the Sigstad's scoring system is to identify early dumping by diagnosing signs and symptoms such as a high pulse rate or increased haematocrit indicative of hypovolemia.

    “The primary focus of the Sigstad's scoring system is to identify early dumping by diagnosing signs and symptoms such as a high pulse rate or increased haematocrit indicative of hypovolemia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The mixed-meal tolerance test is considered positive for late dumping syndrome in patients who develop hypoglycemia between 60 and 180 min after meal ingestion.

    “The mixed-meal tolerance test is considered positive for late dumping syndrome in patients who develop hypoglycemia between 60 and 180 min after meal ingestion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Diagnoses of symptomatic gallstone disease can be confirmed with an ultrasound showing gallbladder stones and blood testing confirming liver function abnormalities after colic.

    “Diagnoses can be confirmed with an ultrasound showing gallbladder stones and blood testing confirming liver function abnormalities after colic.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Symptoms of cramp-like contractions, bloating and diarrhoea in patients with a history of upper GI surgery may also occur as a consequence of complications such as stenosis, fistula formation, adhesions and ischemia.

    “Symptoms of cramp-like contractions, bloating and diarrhoea in patients with a history of upper GI surgery may also occur as a consequence of complications such as stenosis, fistula formation, adhesions and ischemia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A single study reported that glucomannan significantly improved glucose tolerance but had no effect on glucose absorption in children with dumping syndrome who underwent various types of gastric surgery.

    “A single study reported that glucomannan significantly improved glucose tolerance but had no effect on glucose absorption in children with dumping syndrome who underwent various types of gastric surgery (57).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Symptomatic gallstone disease is characterized by colicky pain attacks, with an urge to move, nausea, and, often, vomiting. Pain generally lasts for at least 1 h.

    “Symptomatic gallstone disease is characterized by colicky pain attacks, with an urge to move, nausea, and, often, vomiting.Pain generally lasts for at least 1 h.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Some clinicians consider plasma glucose concentrations <2.8 mmol/L (50 mg/dL) to be indicative of post-gastric bypass hypoglycemia, whereas others regard levels <3.3 mmol/L (60 mg/dL) diagnostic of hypoglycemia.

    “To date, no definitive guidance regarding cutoff values for plasma glucose has been established, but some clinicians consider plasma glucose concentrations <2.8 mmol/L (50 mg/dL) to be indicative of post-gastric bypass hypoglycemia, whereas others regard levels <3.3 mmol/L (60 mg/dL) diagnostic of hypoglycemia (33).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] source

  • May combine two claims.

    Premisecitation

    A diagnostic index >7 is suggestive of dumping syndrome whereas a score <4 suggests that other diagnoses should be considered.

    “A diagnostic index >7 is suggestive of dumping syndrome whereas a score <4 suggests that other diagnoses should be considered.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] source

  • May combine two claims.

    Premisecitation

    Dietary modification is the initial approach used to manage dumping syndrome and is usually beneficial for a majority of patients.

    “Dietary modification is the initial approach used to manage dumping syndrome and is usually beneficial for a majority of patients (3,10,16,43-47).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [10] source
    • cites [16] source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Internal herniation generally results in pain, sometimes colic pain, a sensation of fullness quickly after meals, sometimes ileus and vomiting and no vegetative symptoms.

    “Internal herniation generally results in pain, sometimes colic pain, a sensation of fullness quickly after meals, sometimes ileus and vomiting and no vegetative symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Because there is currently no optimal approach for the diagnosis of dumping syndrome, provocative testing is still commonly used in some countries to diagnose hypoglycemia in the safety of a medical testing facility.

    “Because there is currently no optimal approach for the diagnosis of dumping syndrome, (20) provocative testing is still commonly used in some countries to diagnose hypoglycemia in the safety of a medical testing facility.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Postprandial syncope may be similar to loss of consciousness, and the two conditions may be difficult to differentiate, especially in elderly patients.

    “Finally, postprandial syncope may be similar to loss of consciousness, and the two conditions may be difficult to differentiate, especially in elderly patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Symptoms of stenosis or anastomoses are similar to symptoms of marginal ulcer accompanied by dysphagia, and the diagnosis can be confirmed via gastroscopy or a barium or gastrografin swallow.

    “Symptoms of stenosis or anastomoses are similar to symptoms of marginal ulcer accompanied by dysphagia, and the diagnosis can be confirmed via gastroscopy or a barium or gastrografin swallow.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    In the case of hypoglycemia resulting from exogenous insulin injection, C-peptide levels are inappropriately low at the time of hyperinsulinemic hypoglycemia.

    “In the case of hypoglycemia resulting from exogenous insulin injection, C-peptide levels are inappropriately low at the time of hyperinsulinemic hypoglycemia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    A diagnosis of internal herniation can be confirmed via computed tomography or diagnostic laparoscopy.

    “A diagnosis of internal herniation can be confirmed via computed tomography or diagnostic laparoscopy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The OGTT is considered positive for early dumping based on the presence of an early (30 min) increase in haematocrit >3% or an increase in pulse rate >10 beats/min after 30 min, the latter being regarded as the most sensitive indicator of early dumping syndrome.

    “The OGTT is considered positive for early dumping based on the presence of an early (30 min) increase in haematocrit >3% or an increase in pulse rate >10 beats/min after 30 min, the latter being regarded as the most sensitive indicator of early dumping syndrome (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    The main characteristics of obstipation are a feeling of fullness, pain and defecation only once in 3 days.

    “The main characteristics of obstipation are a feeling of fullness, pain and defecation only once in 3 days.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Gastric emptying studies generally have low sensitivity and specificity, probably because the process of rapid gastric emptying occurs soon after ingestion, a phase that is not adequately assessed in most studies.

    “However, gastric emptying studies generally have low sensitivity and specificity, probably because the process of rapid gastric emptying occurs soon after ingestion, a phase that is not adequately assessed in most studies.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [15] source
    • cites [37] source

  • May combine two claims.

    Premisecitation

    Rapid delivery of undigested carbohydrates to the small intestine results in high glucose concentrations that induce a hyperinsulinemic response, resulting in subsequent hypoglycemia and related late dumping symptoms.

    “Rapid delivery of undigested carbohydrates to the small intestine results in high glucose concentrations that induce a hyperinsulinemic response, resulting in subsequent hypoglycemia and related late dumping symptoms (28).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] source

  • May combine two claims.

    Premisecitation

    The diagnostic accuracy of the OGTT is low and normative values have not been firmly established.

    “Therefore, the diagnostic accuracy of this test is low and normative values have not been firmly established (20).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    A marginal ulcer or gastritis is generally characterized by pain during meals, acid reflux, and nausea, and the diagnosis can be confirmed via gastroscopy.

    “A marginal ulcer or gastritis is generally characterized by pain during meals, acid reflux, and nausea, and the diagnosis can be confirmed via gastroscopy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Test results are positive for late dumping based on the development of late (60-180 min postingestion) hypoglycemia.

    “Test results are positive for late dumping based on the development of late (60-180 min postingestion) hypoglycemia (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] source

  • May combine two claims.

    Premisenone given

    The diagnostic value of a single glucose measurement is low, but its clinical value increases when evaluated in conjunction with late dumping symptoms.

    “Although the diagnostic value of a single glucose measurement is low, its clinical value increases when evaluated in conjunction with late dumping symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Some studies demonstrate improved specificity of the mixed meal tolerance test in asymptomatic patients; however, normative values have not been established for healthy individuals.

    “Some studies demonstrate improved specificity of this test in asymptomatic patients; however, normative values have not been established for healthy individuals (20).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] source

  • May combine two claims.

    Premisecitation

    There is an association between hypoglycemia after Roux-en-Y gastric bypass and nesidioblastosis that may result in serious and refractory neuroglycopenic symptoms, which respond to pancreatic resection and re-re section.

    “A special consideration is the association between hypoglycemia after Roux-en-Y gastric bypass and nesidioblastosis that may result in serious and refractory neuroglycopenic symptoms, which respond to pancreatic resection and re-re section (124).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [124] source

  • May combine two claims.

    Premisecitation

    Patients with dumping syndrome who receive long-term somatostatin analogue therapy experience a weight gain of approximately 1% despite generally mild steatorrhea.

    “Despite the occurrence of steatorrhea, which is generally mild, patients with dumping syndrome who receive long-term somatostatin analogue therapy experience a weight gain of approximately 1% (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The search results were manually reviewed to eliminate commentaries and correspondence/letters related to the clinical study publications.

    “The search results were manually reviewed to eliminate commentaries and correspondence/letters related to the clinical study publications.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Both subcutaneous and LAR pasireotide were well tolerated, and no new safety signals were identified.

    “Both subcutaneous and LAR pasireotide were well tolerated, and no new safety signals were identified (101).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [101]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    Because dietary supplements are high in fibre, some patients may experience gas and bloating.

    “Because dietary supplements are high in fibre, some patients may experience gas and bloating.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Acarbose is an α-glycosidase hydrolase inhibitor that slows carbohydrate digestion in the small intestine, thus blunting postprandial hyperglycemia and subsequent hypoglycemia.

    “Acarbose is an α-glycosidase hydrolase inhibitor that slows carbohydrate digestion in the small intestine, thus blunting postprandial hyperglycemia and subsequent hypoglycemia.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    The use of acarbose as a treatment approach for dumping syndrome is limited by the fact that it affects only late dumping symptoms and may result in side effects related to carbohydrate maldigestion, such as bloating, flatulence and diarrhoea.

    “However, the use of acarbose as a treatment approach for dumping syndrome is limited by the fact that it affects only late dumping symptoms and may result in side effects related to carbohydrate maldigestion, such as bloating, flatulence and diarrhoea.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    The palatability and tolerability of many dietary supplements are poor.

    “However, the palatability and tolerability of many dietary supplements are poor.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    In general, surgical reintervention procedures are largely ineffective, and some procedures (e.g. pancreatectomy) are rarely performed because of lack of effectiveness and high morbidity.

    “In general, surgical reintervention procedures are largely ineffective, and some procedures (e.g.pancreatectomy) are rarely performed because of lack of effectiveness and high morbidity.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    A systematic review of diagnostic approaches for dumping syndrome was not performed, but the most widely used approaches are described briefly.

    “A systematic review of diagnostic approaches for dumping syndrome was not performed, but the most widely used approaches are described briefly herein.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Pasireotide suppressed the increase in pulse rate and late hypoglycemia, and delayed gastric emptying.

    “A pilot study also demonstrated that pasireotide suppressed the increase in pulse rate and late hypoglycemia, and delayed gastric emptying (90).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [90] source

  • May combine two claims.

    Premisecitation

    Pasireotide did not demonstrate a significant improvement in dumping symptoms, and approximately 20% of patients in the pilot study discontinued treatment because of GI events.

    “However, pasireotide did not demonstrate a significant improvement in dumping symptoms, and approximately 20% of patients in the pilot study discontinued treatment because of GI events (90).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [90] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Pasireotide is a multireceptor-targeted somatostatin analogue with high affinity for 4 of the 5 somatostatin receptor subtypes, including sst2 and sst5.

    “Pasireotide is a multireceptor-targeted somatostatin analogue with high affinity for 4 of the 5 somatostatin receptor subtypes, including sst2 and sst5.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [98] source
    • cites [99] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Consensus recommendations were developed by an interdisciplinary team (endocrinologist, gastroenterologist, nutritionist and bariatric surgeon) to provide uniform practical guidance.

    “Each of the selected publications was reviewed for management approaches for dumping syndrome, and consensus recommendations were developed by an interdisciplinary team (endocrinologist, gastroenterologist, nutritionist and bariatric surgeon) to provide uniform practical guidance to the different specialists involved in the management of dumping syndrome.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Dietary recommendations to delay fluid intake until at least 30 min after meals means that consumption of viscous, gel-forming dietary supplements with dry food may pose a choking hazard and cause bowel obstruction as a result of a delay in the transit of food through the GI tract.

    “Furthermore, dietary recommendations to delay fluid intake until at least 30 min after meals means that consumption of viscous, gel-forming dietary supplements with dry food may pose a choking hazard and cause bowel obstruction as a result of a delay in the transit of food through the GI tract.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Pasireotide inhibited GLP-1 and insulin release more effectively than octreotide, resulting in improved control of postprandial hyperinsulinemic hypoglycemia after a gastric bypass.

    “A recent case report demonstrated that pasireotide inhibited GLP-1 and insulin release more effectively than octreotide, resulting in improved control of postprandial hyperinsulinemic hypoglycemia after a gastric bypass (100).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [100] source

  • May combine two claims.

    Premisecitation

    Pasireotide effectively controlled postprandial hypoglycemia and improved changes in pulse rate and haematocrit in patients with dumping syndrome.

    “Pasireotide effectively controlled postprandial hypoglycemia and improved changes in pulse rate and haematocrit in patients with dumping syndrome.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [101]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Premisecitation

    In a retrospective analysis of 2 patients, symptoms resolved after distal pancreatectomy.

    “Symptoms resolved after distal pancreatectomy”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barbour et al. (118)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Premisecitation

    In a multicenter, retrospective, systematic case series of 1 patient, resection of the 'candy cane' roux limb left the patient symptom-free 1 year after the procedure.

    “Patient was symptom-free 1 year after procedure”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Vilarrasa et al. (66)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In a retrospective analysis of 3 patients, 1 patient developed portal vein thrombus and seroma.

    “1 patient developed portal vein thrombus and seroma”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Carter et al. (110)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Premisecitation

    In a case report of 2 patients, after 6 months, the Sigstad's score decreased to 2 points after laparoscopic conversion to loop duodenojejunal bypass with sleeve gastrectomy.

    “After 6 months, the Sigstad's score decreased to 2 points”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Huang et al. (112)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a case report of 1 patient, laparoscopic conversion to modified duodenal switch resulted in no reported complications.

    “No complications were reported”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Huang et al. (113)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    No medications are currently approved for the management of dumping syndrome, and most of the currently available treatments have considerable limitations, including failure to target early symptoms and poor tolerability.

    “No medications are currently approved for the management of dumping syndrome, and most of the currently available treatments have considerable limitations, including failure to target early symptoms and poor tolerability.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The most common adverse events associated with somatostatin analogues are diarrhoea, nausea, steatorrhea, gallstone formation and pain at the injection site.
    • Rests on an assumption: Somatostatin analogues have not received regulatory approval for the treatment of dumping syndrome.

  • May combine two claims.

    Study design and conductnone given

    Most surgical reintervention studies were relatively small and presumably included highly selected patients, mean follow-up was short, and the methodology used to evaluate hypoglycemia was not consistent.

    “Most surgical reintervention studies were relatively small and presumably included highly selected patients, mean follow-up was short, and the methodology used to evaluate hypoglycemia was not consistent.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a case report of 2 patients, laparoscopic conversion to loop duodenojejunal bypass with sleeve gastrectomy resulted in no reported complications.

    “No complications were reported”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Huang et al. (112)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a case report of 1 patient, laparoscopic conversion to modified duodenal switch resolved dumping symptoms.

    “Dumping symptoms resolved”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Huang et al. (113)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    The outcomes of surgical re-intervention or continuous gastric/enteral feeding are poorly studied and tend to be more variable.

    “Surgical re-intervention or continuous gastric/enteral feeding may need to be considered in some patients with treatment-refractory dumping syndrome, but the outcomes of these approaches are poorly studied and tend to be more variable.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Premisecitation

    In a case report of 2 patients, subtotal pancreatectomy was successful.

    “Subtotal pancreatectomy successful”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Clancy et al. (116)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a case report of 1 patient, laparoscopic adjustable banding for pouch dilatation produced subjective improvement in symptoms.

    “Subjective improvement in symptoms”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites de Heide et al. (115)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • The quote only partly states this claim.

    Premisecitation

    In a case report of 2 patients, laparoscopic conversion to loop duodenojejunal bypass with sleeve gastrectomy resolved dumping symptoms.

    “Dumping symptoms resolved”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Huang et al. (112)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a case series of 3 patients, 1 patient had no hypoglycemic episodes.

    “1 patient had no hypoglycemic episodes”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Patti et al. (103)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a case series of 5 patients, laparoscopic conversion to sleeve gastrectomy resulted in no reported complications.

    “No complications were reported”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lakdawala et al. (111)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims. The quote only partly states this claim.

    Premisecitation

    In a case series of 3 patients, distal pancreatectomy and Fobi ring around the gastric pouch (n=2) or distal pancreatectomy (50%-60%) and removal of pouch band (n=1) resulted in no new hypoglycemic episodes.

    “No new hypoglycemic episodes”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Z'graggen et al. (114)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Anecdotal evidence suggests that continuous enteral feeding may be beneficial in avoiding dumping symptoms after meal ingestion; however, this approach is invasive and may impair quality of life.

    “Anecdotal evidence suggests that continuous enteral feeding may be beneficial in avoiding dumping symptoms after meal ingestion; however, this approach is invasive and may impair quality of life (1,126).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] source
    • cites [126] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a case report of 1 patient, distal pancreatectomy left the patient symptom-free for >10 months.

    “Symptom-free for >10 months”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Alvarez et al. (117)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a retrospective analysis of 3 patients, sleeve gastrectomy resolved hypoglycemia.

    “Dumping symptoms and hypoglycemia resolved”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Carter et al. (110)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

101 of 101

  • The paper relies on this without support.

    Clinical recommendations are needed for the diagnosis and management of dumping syndrome.

    “Clinical recommendations are needed for the diagnosis and management of dumping syndrome.”

  • The paper relies on this without support.

    The large number of patients undergoing bariatric surgery makes it important to educate clinicians about how to recognize and manage dumping syndrome.

    “Because of the large number of patients undergoing bariatric surgery, it is important to educate clinicians about how to recognize and manage dumping syndrome.”

  • The paper relies on this without support.

    The effectiveness of some treatment approaches for dumping syndrome has not been clearly established because most studies included relatively few patients and were not adequately controlled.

    “The effectiveness of some of these approaches has not been clearly established as most studies included relatively few patients and were not adequately controlled.”

  • The paper relies on this without support.

    The most common adverse events associated with somatostatin analogues are diarrhoea, nausea, steatorrhea, gallstone formation and pain at the injection site.

    “The most common adverse events associated with somatostatin analogues are diarrhoea, nausea, steatorrhea, gallstone formation and pain at the injection site.”

  • The paper relies on this without support.

    Somatostatin analogues have not received regulatory approval for the treatment of dumping syndrome.

    “Somatostatin analogues have not received regulatory approval for the treatment of dumping syndrome.”

  • The paper relies on this without support.

    Despite the availability of several effective therapeutic options, some patients will continue to experience treatment-refractory dumping syndrome.

    “Despite the availability of several effective therapeutic options, some patients will continue to experience treatmentrefractory dumping syndrome.”

  • The paper relies on this without support.

    Most patients with postprandial hypoglycemia after Roux-en-Y gastric bypass respond to dietary modification and pharmacologic intervention.

    “Most patients with postprandial hypoglycemia after Roux-en-Y gastric bypass respond to dietary modification and pharmacologic intervention.”

  • The paper relies on this without support.

    A subset of patients with severe post-Roux-en-Y gastric bypass hypoglycemia may respond inadequately to dietary modification and pharmacologic intervention.

    “However, a subset of patients with severe post-Roux-en-Y gastric bypass hypoglycemia may respond inadequately, and surgical re-intervention may be considered.”

  • The paper relies on this without support.

    Patients with dumping syndrome may experience symptomatic improvement over time.

    “Conservative management approaches should be pursued before attempting surgical re-intervention as patients with dumping syndrome may experience symptomatic improvement over time.”

  • The paper relies on this without support.

    Dumping syndrome is a well-known but under-recognized complication of esophageal and gastric surgery and is becoming increasingly prevalent with the rising incidence of bariatric surgery.

    “Dumping syndrome is a well-known but under-recognized complication of esophageal and gastric surgery and is becoming increasingly prevalent with the rising incidence of bariatric surgery.”

  • The paper relies on this without support.

    Severe dumping syndrome can result in disabling symptoms that impair quality of life.

    “Severe dumping syndrome, in particular, can result in disabling symptoms that impair quality of life.”

  • The paper relies on this without support.

    Diazoxide is a potassium channel activator that inhibits calcium-induced insulin release.

    “Diazoxide is a potassium channel activator that inhibits calcium-induced insulin release.”

  • The paper relies on this without support.

    Nifedipine is a calcium channel blocking agent.

    “Nifedipine, a calcium channel blocking agent, successfully controlled persistent hyperinsulinemic hypoglycemia in a case report of an adult patient with dumping syndrome that occurred after gastric bypass surgery (104).”
13 of 13

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Same surgical-outcome study is summarized as 48% and approximately 40% successful

    Minor

    The text and Table 5 give different proportions for moderate or high surgical success in the same cited study (105): 48% versus approximately 40%.

1 of 1

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Authors
van Beek, A. P., Emous, M., Laville, M., & Tack, J.
Affiliations
  • Department of Endocrinology, University of Groningen University Medical Center Groningen Groningen The Netherlands
  • Medisch Centrum Leeuwarden (NL)
  • Hospices Civils de Lyon (FR)
  • Universitair Ziekenhuis Leuven (BE)
ORCID
Venue
Obesity Reviews
Publisher
Wiley
Published
2016-10-17
Volume
18
Issue
1
Pages
68-85
ISSN
  • 1467-7881 (ISSN-L)
  • 1467-789X
DOI
10.1111/obr.12467
OpenAlex
W2538890734
Semantic Scholar
4534719973a1688cb3190187bfd04315e789765f
Cited by
288
References
131
Citations by year
2026: 24 · 2025: 27 · 2024: 29 · 2023: 35 · 2022: 35 · 2021: 44 · 2020: 26 · 2019: 31 · 2018: 20 · 2017: 14 · 2016: 1
FWCI
21.91
Type
journal article
Language
en
Open access
Licence
Locations
  • Obesity Reviews (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • HAL (Le Centre pour la Communication Scientifique Directe) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
Keywords
dumping syndrome, esophageal surgery, gastric surgery, bariatric surgery, postoperative complications, hypoglycemia, incretins, acarbose, somatostatin analogues, dietary change, oral glucose tolerance test, glycemia, reoperation, continuous enteral feeding
MeSH terms
Diet, Dumping Syndrome, Humans, Postoperative Complications, Quality of Life, Surveys and Questionnaires, Randomized Controlled Trials as Topic, Evidence-Based Medicine, Bariatric Surgery

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-14.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-14.

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