Gastric dumping syndrome diagnostic study of choice: Difference between revisions

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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]

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:

Oral glucose tolerance test is the ideal study of choice for the diagnosis of early dumping syndrome and late dumping syndrome.^[1]^[2]^[3]
A mixed-meal tolerance test is the study of choice for the diagnosis of late dumping syndrome.^[4]^[5]^[6]

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
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 sensitive) OR After ingestion, a pulse increase of 10 beats per minute after 30 minutes is diagnostic (most sensitive) OR After ingestion, induction of symptoms of dumping syndrome is diagnostic (more specifically) for late dumping syndrome

Mixed-meal tolerance test
The patient fasts overnight A meal consisting of lipids, proteins and 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

Hydrogen breath test
The patient is given an oral glucose load of 50 grams to 75 grams After ingestion, differences in the rise in breath hydrogen support upper gut bacterial overgrowth (a rise of 10 to 15 parts per million). This is evidence for small intestinal malabsorption of glucose

References

↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.

Template:WH Template:WS

[pmid8976007-1] 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.

[pmid89760072-2] 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.

[pmid26315925-3] 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.

[pmid243159902-4] 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.

[pmid24315990-5] 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.

[pmid23787216-6] 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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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{CMG}} {{AE}}
+{{CMG}}; {{AE}} {{UA}}
 {{Gastric dumping syndrome}}
 == Overview ==
-The two most sensitive and specific tests used in diagnosing Dumping syndrome are the Oral Glucose Provocation test and the Hydrogen Breath test.
+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]].
 == Diagnostic Study of Choice ==
 === Study of choice: ===
-* Oral glucose provocation test is the study of choice for the diagnosis of dumping syndrome.
+* [[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>
-==== The comparison table for diagnostic studies of choice for Dumping syndrome ====
+==== The comparison table for diagnostic studies of choice for dumping syndrome ====
 {|
 |- 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;" |Specificity
@@ Line 25: / Line 26: @@
 ! style="background: #696969; color: #FFFFFF; text-align: center;" |Hydrogen breath
 | 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>
 ===== Diagnostic results =====
-The following result of the oral glucose provocation test is confirmatory of dumping syndrome:
+{| class="wikitable"
-* 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.
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Test
-The following result of the hydrogen breath test is confirmatory of dumping syndrome:
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Confirmatory result
-* A positive hydrogen breath test after glucose ingestion.
+|-
+|'''[[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]].
+|}
-=== Diagnostic Criteria ===
+=== Diagnostic criteria ===
-* Here you should describe the details of the diagnostic criteria.
+{| class="wikitable mw-collapsible"
-*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.
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Oral glucose tolerance test
-*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.
+* The patient fasts overnight
-*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
+* An oral [[glucose]] load of 50 grams to 75 grams in [[solution]] is given
-*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).
+* Readings of the [[heart rate]] and [[blood pressure]] are taken before the [[ingestion]]
-*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.
+* [[Blood]] is drawn before the [[ingestion]]
-* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
+* After [[ingestion]], every 30 minutes until 180 minutes, readings and [[blood]] are taken
-* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
+* 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]]
+|}
-* 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].
+==References==
-* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
+{{Reflist|2}}
-* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
+[[Category:Gastroenterology]]
-** Criteria 1
-** Criteria 2
-** Criteria 3
-IF there are clear, established diagnostic criteria:
+{{WH}}
-*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].
+{{WS}}
-*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].
-==References==
-* 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.
-* For information on how to add references into your page, click [[Adding References to Articles|here]].