Gastric dumping syndrome history and symptoms: Difference between revisions
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Early dumping | |||
Symptoms of cramp-like contractions, bloating and diarrhoea in patients with a history of upper GI surgery may also occur as a consequence of complications such as stenosis, fistula formation, adhesions and ischemia. A marginal ulcer or gastritis is generally characterized by pain during meals, acid reflux, and nausea, and the diagnosis can be confirmed via gastroscopy. Symptoms of stenosis or anastomoses are similar to symptoms of marginal ulcer accompanied by dysphagia, and the diagnosis can be confirmed via gastroscopy or a barium or gastrografin swallow. Internal herniation generally results in pain, sometimes colic pain, a sensation of fullness quickly after meals, sometimes ileus and vomiting and no vegetative symptoms. A diagnosis of internal herniation can be confirmed via computed tomography or diagnostic laparoscopy. The main characteristics of obstipation are a feeling of fullness, pain and defecation only once in 3 days. Symptomatic gallstone disease is characterized by colicky pain attacks, with an urge to move, nausea, and, often, vomiting. Pain generally lasts for at least 1 h. Diagnoses can be confirmed with an ultrasound showing gallbladder stones and blood testing confirming liver function abnormalities after colic. | |||
Late dumping | |||
A differential diagnosis of hyperinsulinemic hypoglycemia is important in patients with late dumping symptoms. Late dumping occurs during the postprandial period (1-3 h after eating). In contrast, an insulinoma, which is extremely rare, should be considered if fasting hypoglycemia occurs (i.e. not provoked by a meal) [41, 42]. A fast of up to 72 h (usually 48 h) in a supervised hospital setting to assess hypoglycemia and the pathological lack of decrease in insulin secretion may be indicated in case of doubt [39, 41]. Surreptitious use of glucose-lowering medications (e.g. sulfonylurea derivatives or insulin) should also be excluded in each case, which can be determined via a sulfonylurea and C-peptide assay, respectively. In the case of hypoglycemia resulting from exogenous insulin injection, C-peptide levels are inappropriately low at the time of hyperinsulinemic hypoglycemia. Finally, postprandial syncope may be similar to loss of consciousness, and the two conditions may be difficult to differentiate, especially in elderly patients. | |||
Experiencing both forms of gastric emptying is not uncommon. | Experiencing both forms of gastric emptying is not uncommon. | ||
Revision as of 22:32, 7 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
History
- History of prior gastric surgery
Symptoms
Early rapid gastric emptying begins either during or right after a meal. Symptoms include:
Late rapid gastric emptying occurs 1 to 3 hours after eating. Symptoms include:
Early dumping
Symptoms of cramp-like contractions, bloating and diarrhoea in patients with a history of upper GI surgery may also occur as a consequence of complications such as stenosis, fistula formation, adhesions and ischemia. A marginal ulcer or gastritis is generally characterized by pain during meals, acid reflux, and nausea, and the diagnosis can be confirmed via gastroscopy. Symptoms of stenosis or anastomoses are similar to symptoms of marginal ulcer accompanied by dysphagia, and the diagnosis can be confirmed via gastroscopy or a barium or gastrografin swallow. Internal herniation generally results in pain, sometimes colic pain, a sensation of fullness quickly after meals, sometimes ileus and vomiting and no vegetative symptoms. A diagnosis of internal herniation can be confirmed via computed tomography or diagnostic laparoscopy. The main characteristics of obstipation are a feeling of fullness, pain and defecation only once in 3 days. Symptomatic gallstone disease is characterized by colicky pain attacks, with an urge to move, nausea, and, often, vomiting. Pain generally lasts for at least 1 h. Diagnoses can be confirmed with an ultrasound showing gallbladder stones and blood testing confirming liver function abnormalities after colic. Late dumping
A differential diagnosis of hyperinsulinemic hypoglycemia is important in patients with late dumping symptoms. Late dumping occurs during the postprandial period (1-3 h after eating). In contrast, an insulinoma, which is extremely rare, should be considered if fasting hypoglycemia occurs (i.e. not provoked by a meal) [41, 42]. A fast of up to 72 h (usually 48 h) in a supervised hospital setting to assess hypoglycemia and the pathological lack of decrease in insulin secretion may be indicated in case of doubt [39, 41]. Surreptitious use of glucose-lowering medications (e.g. sulfonylurea derivatives or insulin) should also be excluded in each case, which can be determined via a sulfonylurea and C-peptide assay, respectively. In the case of hypoglycemia resulting from exogenous insulin injection, C-peptide levels are inappropriately low at the time of hyperinsulinemic hypoglycemia. Finally, postprandial syncope may be similar to loss of consciousness, and the two conditions may be difficult to differentiate, especially in elderly patients. Experiencing both forms of gastric emptying is not uncommon.