Table 27

Investigation and management of potential dumping

Investigations	Potential results	Clinical management plan
Actions from history, medication and dietary assessment
History findings	History of upper GI resectional surgery	Refer for dietetic advice.
	30–60 min after eating with sweating, dizziness, tachycardia	Refer for dietetic advice: Eat smaller, more frequent meals. Eat slowly. Avoid a lot of fast-acting sugars, eg, cakes, chocolate, sugary drinks and sweets. Advise more longer-acting carbohydrate foods. If no response, trial acarbose/octreotide. Trial of low dose β blocker.
	Somnolence 1–3 hours after eating	Monitor blood sugar. Refer for dietetic advice. If mild, reassure.
First line
ECG/24 hour tape	Cardiac disease	Discuss with the supervising clinician within 24 hours.
OGD and SI aspirate (p. 25)	SIBO	Management of SIBO (p. 27).
Glucose hydrogen methane breath test	SIBO	Management of SIBO (p. 27).
Monitor blood glucose	If abnormally high	Refer to GP/endocrinology.
	If abnormally low	Refer for dietetic advice
Second line
Persisting unexplained symptoms	Consider insulinoma/neuroendocrine tumour	Refer to gastroenterology/endocrinology.
Third line
If normal investigations/no response to intervention		Reassure.

ECG, electrocardiogram; GI, gastrointestinal; GP, general practitioner; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); SI, small intestine; SIBO, small intestinal bacterial overgrowth.