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{{CMG}} {{AE}}
{{CMG}}; {{AE}} {{UA}}


{{Gastric dumping syndrome}}
{{Gastric dumping syndrome}}
== Overview ==
== Overview ==
* The page name should be '''"Diagnostic study of choice for [disease name]"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
The two most [[Sensitivity (tests)|sensitive]] and [[Specificity (tests)|specific]] tests used in confirming the clinical suspicion and in diagnosing dumping syndrome are the [[Glucose tolerance test|oral glucose tolerance test]] and the [[Hydrogen Breath Test|hydrogen breath test]].
* '''Goal:'''
**To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
**To describe the gold standard test for the diagnosis of [disease name].
**To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
* As with all microchapter pages linking to the main page, at the top of the edit box put <nowiki>{{CMG}}</nowiki>, your name template, and the microchapter navigation template you created at the beginning.
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* Remember to follow the same format and capitalization of letters as outlined in the template below.
* You should include the name of the disease in the first sentence of every subsection.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


===== Template statements =====
=== Study of choice: ===
* [[Glucose tolerance test|Oral glucose tolerance test]] is the ideal study of choice for the [[diagnosis]] of early [[Gastric dumping syndrome|dumping syndrome]] and late [[Gastric dumping syndrome|dumping syndrome]].<ref name="pmid8976007">{{cite journal |vauthors=van der Kleij FG, Vecht J, Lamers CB, Masclee AA |title=Diagnostic value of dumping provocation in patients after gastric surgery |journal=Scand. J. Gastroenterol. |volume=31 |issue=12 |pages=1162–6 |year=1996 |pmid=8976007 |doi= |url=}}</ref><ref name="pmid89760072">{{cite journal |vauthors=van der Kleij FG, Vecht J, Lamers CB, Masclee AA |title=Diagnostic value of dumping provocation in patients after gastric surgery |journal=Scand. J. Gastroenterol. |volume=31 |issue=12 |pages=1162–6 |year=1996 |pmid=8976007 |doi= |url=}}</ref><ref name="pmid26315925">{{cite journal |vauthors=Emous M, Ubels FL, van Beek AP |title=Diagnostic tools for post-gastric bypass hypoglycaemia |journal=Obes Rev |volume=16 |issue=10 |pages=843–56 |year=2015 |pmid=26315925 |doi=10.1111/obr.12307 |url=}}</ref>
* A mixed-meal tolerance [[test]] is the study of choice for the [[diagnosis]] of late [[Gastric dumping syndrome|dumping syndrome]].<ref name="pmid243159902">{{cite journal |vauthors=Salehi M, Gastaldelli A, D'Alessio DA |title=Blockade of glucagon-like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass |journal=Gastroenterology |volume=146 |issue=3 |pages=669–680.e2 |year=2014 |pmid=24315990 |pmc=3943944 |doi=10.1053/j.gastro.2013.11.044 |url=}}</ref><ref name="pmid24315990">{{cite journal |vauthors=Salehi M, Gastaldelli A, D'Alessio DA |title=Blockade of glucagon-like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass |journal=Gastroenterology |volume=146 |issue=3 |pages=669–680.e2 |year=2014 |pmid=24315990 |pmc=3943944 |doi=10.1053/j.gastro.2013.11.044 |url=}}</ref><ref name="pmid23787216">{{cite journal |vauthors=Khoo CM, Muehlbauer MJ, Stevens RD, Pamuklar Z, Chen J, Newgard CB, Torquati A |title=Postprandial metabolite profiles reveal differential nutrient handling after bariatric surgery compared with matched caloric restriction |journal=Ann. Surg. |volume=259 |issue=4 |pages=687–93 |year=2014 |pmid=23787216 |pmc=3901799 |doi=10.1097/SLA.0b013e318296633f |url=}}</ref>


=== Gold standard/Study of choice: ===
==== The comparison table for diagnostic studies of choice for dumping syndrome ====
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The following result of [gold standard test] is confirmatory of [disease name]:
** Result 1
** Result 2
* The [name of investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison table for diagnostic studies of choice for [disease name] ====
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Test characteristic
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
! style="background: #696969; color: #FFFFFF; text-align: center;" |<small>✔ </small>Oral glucose provocation
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |92%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
! style="background: #696969; color: #FFFFFF; text-align: center;" |Hydrogen breath
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" | -
|}
|}
<small> ✔= The best test based on the feature </small>
<small> ✔= The best test based on the feature </small>


===== Diagnostic results =====
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
{| class="wikitable"
* Result 1
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Test
* Result 2
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Confirmatory result
|-
|'''[[Glucose tolerance test|Oral glucose tolerance test]]'''
|An increase in the [[heart rate]] by 10 beats per minute or more in the first hour after an oral [[glucose]] challenge of 50 grams [[glucose]] after fasting for 10 hours.
|-
|'''Mixed-meal tolerance test'''
|[[Hypoglycemia]] between 60 to 180 minutes, after a mixed-meal ([[Lipid|lipids]], [[Carbohydrate|carbohydrates]], [[Protein|proteins]]) after fasting for 10 hours.
|-
|'''[[Hydrogen Breath Test|Hydrogen breath test]]'''
|A positive [[Hydrogen Breath Test|hydrogen breath test]] (a rise of 10 to 15 parts per million) after [[glucose]] [[ingestion]].
|}


===== Sequence of Diagnostic Studies =====
=== Diagnostic criteria ===
The [name of investigation] should be performed when:
{| class="wikitable mw-collapsible"
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Oral glucose tolerance test
* A positive [test] is detected in the patient, to confirm the diagnosis.
|-
|
* The patient fasts overnight
* An oral [[glucose]] load of 50 grams to 75 grams in [[solution]] is given
* Readings of the [[heart rate]] and [[blood pressure]] are taken before the [[ingestion]]
* [[Blood]] is drawn before the [[ingestion]]
* After [[ingestion]], every 30 minutes until 180 minutes, readings and [[blood]] are taken
* After [[ingestion]], a [[hematocrit]] >3% before 30 minutes is diagnostic (less [[Sensitivity (tests)|sensitive]])
OR
* After [[ingestion]], a [[pulse]] increase of 10 beats per minute after 30 minutes is diagnostic (most [[Sensitivity (tests)|sensitive]])
OR
* After [[ingestion]], induction of [[Symptom|symptoms]] of [[Gastric dumping syndrome|dumping syndrome]] is diagnostic (more specifically) for late [[Gastric dumping syndrome|dumping syndrome]]
|}
{| class="wikitable mw-collapsible"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mixed-meal tolerance test
|-
|
* The patient fasts overnight
* A meal consisting of [[Lipid|lipids]], [[Protein|proteins]] and [[Carbohydrate|carbohydrates]] is given
* Readings of the [[heart rate]] and [[blood pressure]] are taken before the [[ingestion]]
* [[Blood]] is drawn before the [[ingestion]]
* After [[ingestion]], every 30 minutes until 2 hours, readings and [[blood]] are taken
* After [[ingestion]], [[hypoglycemia]] between 60 to 180 minutes is [[diagnostic]]
|}
{| class="wikitable mw-collapsible"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hydrogen breath test
|-
|
* The patient is given an [[Mouth|oral]] [[glucose]] load of 50 grams to 75 grams
* After [[ingestion]], differences in the rise in breath [[hydrogen]] support upper [[Gastrointestinal tract|gut]] [[Small bowel bacterial overgrowth syndrome|bacterial overgrowth]] (a rise of 10 to 15 parts per million). This is evidence for [[Small intestine|small intestinal]] [[malabsorption]] of [[glucose]]
|}


=== Diagnostic Criteria ===
==References==
* Here you should describe the details of the diagnostic criteria.
{{Reflist|2}}
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


[[Category:Gastroenterology]]


==References==
{{WH}}
* References should be cited for the material that you have put on your page. Type in <nowiki>{{reflist|2}}</nowiki>.This will generate your references in small font, in two columns, with links to the original article and abstract.
{{WS}}
* For information on how to add references into your page, click [[Adding References to Articles|here]].

Latest revision as of 22:11, 18 December 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Umar Ahmad, M.D.[2]

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Overview

The two most sensitive and specific tests used in confirming the clinical suspicion and in diagnosing dumping syndrome are the oral glucose tolerance test and the hydrogen breath test.

Diagnostic Study of Choice

Study of choice:

The comparison table for diagnostic studies of choice for dumping syndrome

Test characteristic Sensitivity Specificity
✔ Oral glucose provocation 100% 92%
Hydrogen breath 100% -

✔= The best test based on the feature

Diagnostic results
Test Confirmatory result
Oral glucose tolerance test An increase in the heart rate by 10 beats per minute or more in the first hour after an oral glucose challenge of 50 grams glucose after fasting for 10 hours.
Mixed-meal tolerance test Hypoglycemia between 60 to 180 minutes, after a mixed-meal (lipids, carbohydrates, proteins) after fasting for 10 hours.
Hydrogen breath test A positive hydrogen breath test (a rise of 10 to 15 parts per million) after glucose ingestion.

Diagnostic criteria

Oral glucose tolerance test

OR

OR

Mixed-meal tolerance test
Hydrogen breath test

References

  1. ↑ van der Kleij FG, Vecht J, Lamers CB, Masclee AA (1996). "Diagnostic value of dumping provocation in patients after gastric surgery". Scand. J. Gastroenterol. 31 (12): 1162–6. PMID 8976007.
  2. ↑ van der Kleij FG, Vecht J, Lamers CB, Masclee AA (1996). "Diagnostic value of dumping provocation in patients after gastric surgery". Scand. J. Gastroenterol. 31 (12): 1162–6. PMID 8976007.
  3. ↑ Emous M, Ubels FL, van Beek AP (2015). "Diagnostic tools for post-gastric bypass hypoglycaemia". Obes Rev. 16 (10): 843–56. doi:10.1111/obr.12307. PMID 26315925.
  4. ↑ Salehi M, Gastaldelli A, D'Alessio DA (2014). "Blockade of glucagon-like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass". Gastroenterology. 146 (3): 669–680.e2. doi:10.1053/j.gastro.2013.11.044. PMC 3943944. PMID 24315990.
  5. ↑ Salehi M, Gastaldelli A, D'Alessio DA (2014). "Blockade of glucagon-like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass". Gastroenterology. 146 (3): 669–680.e2. doi:10.1053/j.gastro.2013.11.044. PMC 3943944. PMID 24315990.
  6. ↑ Khoo CM, Muehlbauer MJ, Stevens RD, Pamuklar Z, Chen J, Newgard CB, Torquati A (2014). "Postprandial metabolite profiles reveal differential nutrient handling after bariatric surgery compared with matched caloric restriction". Ann. Surg. 259 (4): 687–93. doi:10.1097/SLA.0b013e318296633f. PMC 3901799. PMID 23787216.

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