SHM Converge Scientific Abstract ePoster Gallery-Beyond the Rush: Effective Management of Dumping Syndrome With Acarbose

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This case report describes a 69-year-old man who developed severe dumping syndrome with recurrent symptomatic hypoglycemia after a complicated Whipple procedure and revision to Roux-en-Y. Two months after surgery, he was hospitalized with wound dehiscence, nausea, vomiting, diarrhea, poor oral intake, and profound hypoglycemia as low as 15 mg/dL. Initial treatment with D50 provided only temporary relief, and dietary changes such as a low-carbohydrate, high-protein diet were not enough to control his episodes.<br /><br />Because symptoms persisted, the patient was started on acarbose 25 mg three times daily and later titrated to 50 mg three times daily. After this change, he experienced marked improvement in glucose stability, better oral intake, and resolution of nausea and vomiting.<br /><br />The report explains that dumping syndrome is a challenging complication of gastrointestinal surgery. Early dumping syndrome occurs within one hour after eating and typically causes dizziness, palpitations, sweating, and diarrhea. Late dumping syndrome occurs 1–3 hours after meals and is caused by an exaggerated insulin response leading to hypoglycemia, with symptoms such as shakiness, confusion, and even loss of consciousness.<br /><br />Acarbose, an alpha-glucosidase inhibitor, works by slowing carbohydrate absorption and reducing postprandial glucose spikes and subsequent hypoglycemia. Prior studies support its use in similar patients after Roux-en-Y gastric bypass, showing reduced symptomatic hypoglycemia with doses ranging from 50–100 mg three times daily.<br /><br />Overall, this case highlights that acarbose can be an effective treatment for late dumping syndrome when dietary measures alone are insufficient, and early recognition can significantly improve patient quality of life.

Asset Subtitle

Sarah Kosse

Meta Tag

Author List Andrea Duque López, Bharat Monga, Niurka Liranzo Tejera, Sarah Kosse

Category Clinical Vignettes

Concept Dumping Syndrome

Concept Postprandial Hypoglycemia

Concept Rapid Gastric Emptying

Concept Acarbose

Concept Early Dumping Syndrome

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai Morningside/West

Presenting Author Sarah Kosse

Track Adult

Keywords

dumping syndrome

hypoglycemia

Whipple procedure

Roux-en-Y

acarbose

alpha-glucosidase inhibitor

postprandial hypoglycemia

gastrointestinal surgery

late dumping syndrome

dietary management

Dumping Syndrome

Postprandial Hypoglycemia

Rapid Gastric Emptying

Acarbose

Early Dumping Syndrome