Acarbose promotes remission of both early and late dumping syndromes in post-bariatric patients

Abstract

ObjectiveAcarbose is a glucosidase inhibitor that slows carbohydrate digestion. It could thus be effective to promote remission of dumping syndrome (DS). Previous studies associating acarbose and late dumping, although not early dumping, have been reported. Herein, we aimed to evaluate the role of acarbose in dumping syndrome prevention and treatment and in resistive exercises resistance in bariatric subjects.MethodsBariatric patients with DS and complete adherence to diet plan and resistive exercises were included (n=25). Number of early and late episodes, self-referred intensity of each episode, and ability to increase intensity of resistive exercise were evaluated, on a 0–10 scale. Acarbose was administered orally (50 mg) for 6 months, 4–5 times a day before meals.ResultsAcarbose administration was associated with a decrease in the number of early (2.18–0.31) and late (2.79–0.12) episodes per week and intensity of each episode (6.10–1.65) and an increase in the ability to perform resistive exercises (3.03–7.12). Complete remission of DS was seen in 21 patients (84%), which persisted for 6 months with the use of acarbose.ConclusionAcarbose prevented dumping in almost all studied subjects and helped improve exercise capacity.

Herbal Medicine for Dumping Syndrome: A Systematic Review and Meta-Analysis

“…Current treatment for dumping syndrome includes pharmacological and surgical interventions. Dietary supplements (pectin, guar gum, acarbose 25-30 ), somatostatin analogs (pasireotide, 5,31-33 octreotide 31 ), miglitol, 34-36 iraglutide, 37 exendin-(9-39), 38 and diazoxide 39 are prescribed for postprandial hypoglycemia or hyperglycemia caused by dumping syndrome. The GLP-1 receptor blocker can improve hypoglycemia caused by dumping syndrome.…”

Amylase

“…Normally, they are used as a second line medication often in conjunction with metformin (36). Evidence also exists that Acarbose can reduce dumping syndrome after bariatric surgery (11). A host of natural plant products with amylase inhibitor activities have been proposed or studied as a treatment for diabetes but little conclusive evidence exists for their effectiveness.…”

Dumping syndrome after bariatric surgery

“…53 Indeed, several investigators have used CGM systems and found that glucose variability is exaggerated after gastric bypass, that subgroups exists according hyperglycemic pattern in these patients, and that treatment with diet and accarbose improves glycemic excursions. 54…”

“…A number of short-term studies involving the ingestion of up to 15 g of guar gum or pectin with each meal have demonstrated the efficacy of these dietary supplements in slowing gastric emptying, reducing GI hormone release, improving hyperglycemia, and controlling dumping symptoms (Table 2). [48][49][50][51][52][53][54][55][56][57] A single study reported that glucomannan significantly improved glucose tolerance but had no effect on glucose absorption in children with dumping syndrome who underwent various types of gastric surgery. 57 However, the palatability and tolerability of many dietary supplements are poor.…”

“…The participants in this study were highly comparable to the nonresponders, with the exception of age. Participants were slightly older (median [interquartile range]: 44 [37,49] versus 41 [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] years; P = 0.02). No differences were seen in excess weight loss, weight before operation, preoperative comorbidities (diabetes, hypertension and hyperlipidemia).…”