The patient is recommended:
- frequent small meals (Herold 2022)
- food should be eaten slowly and chewed well (Scarpellini 2020)
- the diet should be rich in proteins and low in carbohydrates
- liquids during meals should be avoided (Herold 2022). They should be consumed at the earliest 30 min after a meal (Scarpellini 2020).
- After eating, the patient should lie down for ½ hour (Herold 2022).
If these dietary changes do not result in sufficient improvement in symptoms, pharmacological intervention should be considered (Scarpellini 2020).
This includes taking a bulking agent such as guar with meals, as well as administration of a spasmolytic such as N- butyl- scopolamine (Herold 2022).
In addition, the following medications are recommended:
- Somatostatin- analogues such as octreotide to reduce intestinal secretion. Dosage recommendation: Short-acting octreotide s. c. 50 - 100 µg up to 3 x / d, long-acting octreotide 1 x monthly i. m. 20 mg / 90 mg (Scarpellini 2020).
- Acarbose:
- inhibits glucose absorption
- reduces gastrointestinal hormone release
- reduces the occurrence of hypoglycemia
- is mainly used successfully in late dumping, but success is also reported in early dumping
Dosage recommendation: 50 - 100 mg 3 x / d with meals (Scarpellini 2020).
The last option would be a new surgical intervention, although this has uncertain results and the optimal procedure has not yet been established. Therefore, a purely conservative approach is currently recommended (Scarpellini 2020).