Post-op dumping syndromes

Acarbose, a glucosidase inhibitor that slows carbohydrate digestion, has been found to result in complete remission of dumping syndrome (DS) in most subjects and substantially decreased the frequency and intensity of both early and late DS events. The study researchers from Brazil, stated that previous studies have been reported an associated acarbose with the remission of late dumping, although not early dumping. Therefore, they wanted to evaluate the role of acarbose in dumping syndrome prevention and treatment and in resistive exercises resistance in bariatric subjects.

The paper, ‘Acarbose promotes remission of both early and late dumping syndromes in post-bariatric patients’, published by Dovepress, included patients who had previously undergone Roux-en-Y gastric bypass surgery and had achieved body weight goal (BMI<27  for men and <25 for women), had a confirmed diagnosis of DS and were refractory to diet recommendations. Inclusion criteria were the complete adherence to an isocaloric (calculated by indirect calorimetry) and high protein (1.5–1.8 g/kg/day) diet plan, proposed resistive exercises (frequency, intensity, and exercise prescription varied among individuals), and age between 18 and 80 years. Patients who lacked regular follow-up were excluded.

Fifty milligrams of acarbose was orally administered 4–5 times a day before meals for 6 months. For those patients who presented with severe flatulence, 120mg simethicone (b.i.d.) was additionally prescribed. The dose of 50mg before meals has been extensively studied and standardised,14–16 whereas the addition of simethicone was thought to attenuate the most important adverse effects of acarbose use (abdominal cramps, bloating, and flatulence).

A total of 25 subjects (13 men and 12 women; mean age, 37.2 years) were regularly followed up. None of the patients withdrew or missed doses. Among these, seven presented with severe flatulence and one patient showed persistent flatulence despite simethicone prescription. None of the subjects stopped acarbose use owing to side effects. Significant improvements (Table 1) were seen in all analysed parameters: 1) mean number of early DS episodes per week (2.18–0.31; 85.8% reduction; p<0.001), 2) mean number of late DS episodes per week (2.79–0.12; 95.7% reduction; p<0.001), 3) self-referred intensity of each episode (6.1–1.65; 73.0% reduction; p<0.001), 4) Sigstad’s score (2.36–0.32; 86.4% reduction; p<0.001), and 5) ability to perform resistive exercises (3.03–7.12; 135.0% improvement; p<0.001). Improvements were observed from the beginning of the use of acarbose and persisted throughout the six months of therapy.

Table 1: Summary of the results

Complete remission of DS (except during exercises) was observed in 21 patients (84% of analyzed subjects), which persisted throughout the 6 months of acarbose use in all 21 subjects.

The authors acknowledge that a limitation of the study is that they did not include a control group to study the possible placebo effect of acarbose, although it is unlikely that the observed improvements are due to placebo effect.

“Further prospective randomised placebo-controlled double-blind clinical trials with monitoring of vital signs and glucose should be performed in order to confirm our findings,” the authors conclude. “Until then, acarbose may be treated as an option for refractory DS subjects.”

The article was edited from the original article, under the Creative Commons license.

Newsletter subscription

stay tuned for our latest news
Gastricband aftercare clinics in the UK and
Ireland 2017 available for all patients