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 sensitive and specific tests used in confirming the clinical suspicion and in diagnosing | 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: === | === Study of choice: === | ||
* Oral glucose tolerance test is the ideal study of choice for the diagnosis of early dumping syndrome and late 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> | * [[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 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> | * 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 | ==== The comparison table for diagnostic studies of choice for dumping syndrome ==== | ||
{| | {| | ||
|- 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 | ||
| Line 26: | Line 26: | ||
! style="background: #696969; color: #FFFFFF; text-align: center;" |Hydrogen breath | ! 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;" |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> | ||
| Line 32: | Line 32: | ||
===== Diagnostic results ===== | ===== Diagnostic results ===== | ||
{| class="wikitable" | {| class="wikitable" | ||
!Test | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Test | ||
!Confirmatory result | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Confirmatory result | ||
|- | |- | ||
|'''Oral glucose tolerance test''' | |'''[[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. | |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''' | |'''Mixed-meal tolerance test''' | ||
|Hypoglycemia between 60 to 180 minutes, after a mixed-meal ( | |[[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|Hydrogen breath test]]''' | ||
|A positive Hydrogen breath test after glucose ingestion. | |A positive [[Hydrogen Breath Test|hydrogen breath test]] (a rise of 10 to 15 parts per million) after [[glucose]] [[ingestion]]. | ||
|} | |} | ||
=== Diagnostic | === Diagnostic criteria === | ||
{| class="wikitable" | {| class="wikitable mw-collapsible" | ||
!Oral glucose tolerance test | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Oral glucose tolerance test | ||
|- | |- | ||
| | | | ||
* The patient fasts overnight | * The patient fasts overnight | ||
* An oral glucose load of 50 grams | * 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 | * Readings of the [[heart rate]] and [[blood pressure]] are taken before the [[ingestion]] | ||
* Blood is drawn before the ingestion | * [[Blood]] is drawn before the [[ingestion]] | ||
* After ingestion, every 30 minutes until 180 minutes, readings and blood are taken | * 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) | * After [[ingestion]], a [[hematocrit]] >3% before 30 minutes is diagnostic (less [[Sensitivity (tests)|sensitive]]) | ||
OR | OR | ||
* After ingestion, a pulse increase of 10 beats per minute after 30 minutes is diagnostic (most sensitive) | * After [[ingestion]], a [[pulse]] increase of 10 beats per minute after 30 minutes is diagnostic (most [[Sensitivity (tests)|sensitive]]) | ||
OR | OR | ||
* After ingestion, induction of symptoms of dumping syndrome is diagnostic (more specifically) for late dumping syndrome | * 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" | {| class="wikitable mw-collapsible" | ||
!Mixed-meal tolerance test | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mixed-meal tolerance test | ||
|- | |- | ||
| | | | ||
* The patient fasts overnight | * The patient fasts overnight | ||
* A meal consisting of | * 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 | * Readings of the [[heart rate]] and [[blood pressure]] are taken before the [[ingestion]] | ||
* Blood is drawn before the ingestion | * [[Blood]] is drawn before the [[ingestion]] | ||
* After ingestion, every 30 minutes until 2 hours, readings and blood are taken | * After [[ingestion]], every 30 minutes until 2 hours, readings and [[blood]] are taken | ||
* After ingestion, hypoglycemia between 60 to 180 minutes is diagnostic | * 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== | ==References== | ||
{{Reflist|2}} | {{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.