A case of dumping syndrome presenting as hypoglycemic shock with dramatic improvement by octreotide treatment / 대한내과학회지

ABSTRACT

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 hemodynamic changes. We report a case with the place of octreotide in the medical management of the dumping syndrome. The patient was 71-year-old male who had taken total gastrectomy for gastric cancer in 1987. He had been well except intermittent abdominal pain for 8 years after total gastrectomy. But he had suffered from sudden symptoms such as hypoglycemic shock and fainting, which start 2~3 hours after ingesting of a meal for recent 5 years. Studies for diagnosing insulinoma were all negative. We start diet modification and medication such as acarbose to him with impression of dumping syndrome, but there were no improvement of his symptoms. Then we start octreotide, 50 g, given subcutaneously, three-times per day, 30 min prior to each meal. His symptom was dramatically improved.