Gastric dumping syndrome diagnostic study of choice: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}} {{AE}} | {{CMG}}; {{AE}} {{UA}} | ||
{{Gastric dumping syndrome}} | {{Gastric dumping syndrome}} | ||
== Overview == | == Overview == | ||
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 == | == Diagnostic Study of Choice == | ||
===== | === 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> | |||
==== The comparison table for diagnostic studies of choice for dumping syndrome ==== | |||
==== The comparison table for diagnostic studies of choice for | |||
{| | {| | ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! style="background: # | ! 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;" | | ! 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;" | | ! 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 ===== | ||
{| class="wikitable" | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Test | |||
! 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]]. | |||
|} | |||
==== | === Diagnostic criteria === | ||
The [ | {| class="wikitable mw-collapsible" | ||
* The patient | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |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 [[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]] | |||
|} | |||
=== | ==References== | ||
{{Reflist|2}} | |||
[[Category:Gastroenterology]] | |||
{{WH}} | |||
{{WS}} | |||
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:
- 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 |
---|
OR
OR
|
Mixed-meal tolerance test |
---|
|
Hydrogen breath test |
---|
|
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.