The place of octreotide in the medical management of the dumping syndrome

Following gastric surgery, 25-50% of patients experience dumping symptoms. Early dumping usually involves both gastro-intestinal and vasomotor complaints, while late dumping involves mainly the latter. Management is mainly achieved by dietary modification. Drug therapy has been investigated, without consistent success. However, the somatostatin analogue octreotide alleviates dumping by slowing gastric emptying, inhibiting insulin release, decreasing enteric peptide secretion and intestinal absorption of water and sodium, slowing monosaccharide absorption, increasing gut transit time and preventing haemodynamic changes. The short-term efficacy of octreotide has been confirmed in five randomised, controlled trials. Promising results are also available from long-term studies on a limited number of patients.