<qa>  What is the major improvement in long-term survival after surgery for ulcer disease?It has been suspected for some years that surgery has more profound physiological effects than simple anatomical rearrangement, however recent developments in bariatric surgery have brought this to the fore. The era of surgical treatment of peptic ulcer disease resulted in a large cohort of patients undergoing gastric surgery and suffering post-operative dumping symptoms. These include symptoms attributed to hypovolaemia immediately after a meal, followed by hypoglycaemia within a few hours. There was a significant hiatus in the study of dumping syndrome after the decline of surgery for ulcer disease in the 1980s. The major improvement in long-term survival after surgery for oesophageal and gastric cancer seen in the 21st Century, coupled with the identification of high risk familial cohorts who now undergo prophylactic gastrectomy, has led to a growing cohort of long-term survivors after gastrectomy. This presents the significant challenge of defining and managing the ongoing, quality of life-limiting metabolic consequences of gastrointestinal surgery. The late dumping symptoms suffered by this patient cohort include paradoxical post-prandial hypoglycaemia, likely resulting from an excessive insulin response to particular components of ingested food. 