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

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:

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

Skin manifestations may include:

Dumping syndrome Lower and then diffuse + + + + Hyperactive
  • Glucose challenge test
  • Hydrogen breath test
  • Upper GI series
  • Gastric emptying study
  • Postgastrectomy

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

Differential diagnosis of dumping syndrome based on post-vagotomy complications:

Gastric dumping syndrome should be differentiated from other diseases presenting with weight lossvomitingdiarrhea, and abdominal pain. The differentials include the following:[1][2][3][4][5]

Differential Diagnosis for Postgastrectomy complications Clinical features Diagnosis
Short bowel syndrome
Small-capacity syndrome
  • Clinical diagnosis with a history of surgery
Afferent loop syndrome
Efferent loop syndrome
Postvagotomy 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:[6][7][8]

Differential Diagnosis for Early Dumping Syndrome symptoms Clinical features Diagnosis
Adhesions
Internal hernia
Fistula
Ischemia
Ulcer
Stenosis


Differential diagnosis of dumping syndrome based on late dumping syndrome symptoms:

Late dumping syndrome should be differentiated from other diseases presenting with hypoglycemia and nausea. The differentials include the following:[9]

Differential Diagnosis for Late Dumping Syndrome symptoms Clinical features Diagnosis
Insulinoma
Glucose-lowering medication abuse
Postprandial Hypotension


To review the differential diagnosis of Abdominal Pain, click here.

References

  1. "Mastery of Surgery - Google Books".
  2. Bushkin FL, Woodward ER (1976). "The afferent loop syndrome". Major Probl Clin Surg. 20: 34–48. PMID 957782.
  3. Gorbashko AI (1992). "[The pathogenesis, diagnosis and treatment of postvagotomy diarrhea]". Vestn. Khir. Im. I. I. Grek. (in Russian). 148 (3): 254–62. PMID 8594740.
  4. Kwak JM, Kim J, Suh SO (2010). "Anterograde jejunojejunal intussusception resulted in acute efferent loop syndrome after subtotal gastrectomy". World J. Gastroenterol. 16 (27): 3472–4. PMC 2904898. PMID 20632454.
  5. Parrish CR, DiBaise JK (2017). "Managing the Adult Patient With Short Bowel Syndrome". Gastroenterol Hepatol (N Y). 13 (10): 600–608. PMC 5718176. PMID 29230136.
  6. Burridge K (2017). "Focal adhesions: a personal perspective on a half century of progress". FEBS J. 284 (20): 3355–3361. doi:10.1111/febs.14195. PMID 28796323.
  7. Bertozzi M, Melissa B, Magrini E, Di Cara G, Esposito S, Apignani A (2017). "Obstructive internal hernia caused by mesodiverticular bands in children: Two case reports and a review of the literature". Medicine (Baltimore). 96 (46): e8313. doi:10.1097/MD.0000000000008313. PMC 5704788. PMID 29145243.
  8. Vitturi BK, Frias A, Sementilli R, Racy M, Caffaro RA, Pozzan G (2017). "Mycotic aneurysm with aortoduodenal fistula". Autops Case Rep. 7 (2): 27–34. doi:10.4322/acr.2017.015. PMC 5507566. PMID 28740836. Vancouver style error: initials (help)
  9. Matej A, Bujwid H, Wroński J (2016). "Glycemic control in patients with insulinoma". Hormones (Athens). 15 (4): 489–499. doi:10.14310/horm.2002.1706. PMID 28222404.



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