Synopsis
Differentiate early and late dumping, nutritional deficiency, bile reflux, marginal ulcer and mechanical complications after gastric surgery, and act urgently on obstruction, internal hernia, bleeding or thiamine deficiency.
- Establish the exact operation and reconstruction: total or partial gastrectomy, sleeve, Roux-en-Y bypass, anastomoses, vagotomy and small-bowel limb lengths create different physiology and hazards.
- Early dumping occurs during or soon after eating through rapid hyperosmolar delivery, causing abdominal symptoms, flushing, tachycardia and faintness; late dumping one to three hours later is predominantly reactive hypoglycaemia.
- Persistent vomiting, food sticking, severe focal pain, gastrointestinal bleeding or pain after Roux-en-Y can indicate stricture, ulcer, internal hernia or obstruction and needs anatomical investigation.
Key red flags
Sweating, tremor, hunger, aggression, cognitive change or collapse one to three hours after food suggests postprandial hyperinsulinaemic hypoglycaemia. Severe neuroglycopenia is an emergency.
Investigation priorities
Obtain the operative report, reconstruction, limb lengths, complications and follow-up plan; record meal composition, symptom timing, stool, vomiting, medicines and weight trajectory.
Management branches
Vasomotor or gastrointestinal symptoms occur reproducibly during or after meals without an acute surgical alarm.
- Map symptom timing and composition, document glucose during late episodes and review diabetes medicines, alcohol and endocrine alternatives.
- Refer to an experienced dietitian for small frequent protein-containing meals, reduced rapidly absorbed carbohydrate, slower eating and separation of drinks from solids.
Key medicines
AcarboseSpecialist-titrated oral dosing with carbohydrate-containing meals, commonly beginning low and increased according to late-dumping response and gastrointestinal tolerance; confirm current BNF.
OctreotideSpecialist subcutaneous or long-acting regimen selected only for severe refractory dumping after diet and simpler measures; verify current BNF and local endocrine or surgical protocol.