Table 27

Investigation and management of potential dumping

InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
History findingsHistory of upper GI resectional surgeryRefer for dietetic advice.
30–60 min after eating with sweating, dizziness, tachycardiaRefer for dietetic advice:
  1. Eat smaller, more frequent meals.

  2. Eat slowly.

  3. Avoid a lot of fast-acting sugars, eg, cakes, chocolate, sugary drinks and sweets.

  4. Advise more longer-acting carbohydrate foods.

  5. If no response, trial acarbose/octreotide.

  6. Trial of low dose β blocker.

Somnolence 1–3 hours after eating
  1. Monitor blood sugar.

  2. Refer for dietetic advice.

  3. If mild, reassure.

First line
ECG/24 hour tapeCardiac diseaseDiscuss with the supervising clinician within 24 hours.
OGD and SI aspirate (p. 25)SIBOManagement of SIBO (p. 27).
Glucose hydrogen methane breath testSIBOManagement of SIBO (p. 27).
Monitor blood glucoseIf abnormally highRefer to GP/endocrinology.
If abnormally lowRefer for dietetic advice
Second line
Persisting unexplained symptomsConsider insulinoma/neuroendocrine tumourRefer to gastroenterology/endocrinology.
Third line
If normal investigations/no response to interventionReassure.
  • ECG, electrocardiogram; GI, gastrointestinal; GP, general practitioner; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); SI, small intestine; SIBO, small intestinal bacterial overgrowth.