Gastric dumping syndrome differential diagnosis

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

Overview

Dumping syndrome may often be confused with other similar diseases that cause upper abdominal pain, nausea, and fatigue.

Differentiating Dumping Syndrome from other Diseases

Diseases with similar symptoms

• Post-gastrectomy complications:
  • Post-vagotomy diarrhea
  • Small capacity syndrome
  • Short bowel syndrome
  • Afferent loop syndrome
  • Efferent loop syndrome
• Peptic ulcer disease
• Fistula
• Adhesion
• Stenosis
• Ischemia
• Gastritis
• Internal Hernia
• Insulinoma
• Glucose-lowering medication abuse
• Symptomatic gallstone disease
• Postprandial Hypotension
• Irritable bowel syndrome (IBS)

Differentials based on nausea, vomiting, diarrhea, fatigue and abdominal pain

Gastric dumping syndrome should be differentiated from other diseases presenting with nausea, vomiting, diarrhea, fatigue and abdominal pain. The differentials include the following: Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical manifestations Diagnosis Comments Symptoms Signs Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo- tension Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Chronic pancreatitis Epigastric − − ± ± − + + − − − − N Increased amylase / lipase Increased stool fat content Pancreatic function test CT scan Calcification Pseudocyst Dilation of main pancreatic duct Predisposes to pancreatic cancer Pancreatic carcinoma Epigastric − − + + − + + − − − − N ↑ Alkaline phosphatase ↑ serum bilirubin ↑ gamma-glutamyl transpeptidase ↑ CA 19-9  MDCT with  PET/CT MRI Skin manifestations may include: Bullous pemphigoid Cicatricial pemphigoid Migratory superficial thrombophlebitis (classic Trousseau's syndrome) Pancreatic panniculitis Dumping syndrome Lower and then diffuse − − + − − + + − + − − Hyperactive Glucose challenge test Hydrogen breath test Upper GI series Gastric emptying study Postgastrectomy Differential diagnosis of dumping syndrome based on post-vagotomy complications: They are the following: Differential Diagnosis for Postgastrectomy complications Clinical features Diagnosis Short bowel syndrome Upper abdominal pain, diarrhea, malnutrition, weight loss LFTs, liver biopsy, Upper GI series, CT scan Small-capacity syndrome Early satiety, malnutrition, weight loss Clinical diagnosis with a history of surgery Afferent loop syndrome Upper abdominal pain, early satiety, relief after vomiting Ultrasound, Barium enema Efferent loop syndrome Upper abdominal pain, distention, vomiting CT scan, Upper GI series Postvagotomy diarrhea Watery Diarrhea Clinical diagnosis with a history of surgery Differential diagnosis of dumping syndrome based on early dumping syndrome symptoms: Early dumping syndrome should be differentiated from other diseases presenting with abdominal pain, vomiting, nausea and early satiety. The differentials include the following:: Differential Diagnosis for Early Dumping Syndrome symptoms Clinical features Diagnosis Adhesions Upper abdominal pain, vomiting, distention CT scan, Upper GI series Internal hernia Upper abdominal pain, vomiting, early satiety CT scan, Diagnostic laproscopy Fistula Upper abdominal pain, relief after vomiting, early satiety Fistuloscopy, Endoscopy, Colonoscopy, Dye injection, CT scan Ischemia Upper abdominal pain, vomiting, diarrhea, distention CT Angiography Ulcer Upper abdominal pain with food, nausea, acid reflux Gastroscopy Stenosis Upper abdominal pain with food, nausea, acid reflux, dysphagia Gastroscopy, Gastrografin swallow Differential Diagnosis of dumping syndrome based on late dumping syndrome symptoms: The differential diagnosis of dumping syndrome is based on the early dumping syndrome timeline.They are as follows: Differential Diagnosis for Late Dumping Syndrome symptoms Clinical features Diagnosis Insulinoma Fasting hypoglycemia After a 72 hour fast do labs: Serum Glucose, C-peptide, Insulin, Proinsulin Glucose-lowering medication abuse Hypoglycemia Sulfonylurea and C-peptide assay Postprandial Hypotension Nausea, lightheadedness, Blood pressure checked before and after a meal