Gastric dumping syndrome diagnostic study of choice

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

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.

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]

Test characteristic	Sensitivity	Specificity
✔ Oral glucose provocation	100%	92%
Hydrogen breath	100%	–

✔= The best test based on the feature

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.

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 sensitive) OR After ingestion, a pulse increase of 10 beats per minute after 30 minutes is diagnostic (most sensitive) OR After ingestion, induction of symptoms of dumping syndrome is diagnostic (more specifically) for late dumping syndrome

Mixed-meal tolerance test
The patient fasts overnight A meal consisting of lipids, proteins and 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

Hydrogen breath test
The patient is given an oral glucose load of 50 grams to 75 grams After ingestion, differences in the rise in breath hydrogen support upper gut bacterial overgrowth (a rise of 10 to 15 parts per million). This is evidence for small intestinal malabsorption of glucose

↑ 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.