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Dig Dis Sci (2010) 55:117123 DOI 10.1007/s10620-009-0939-5
ORIGINAL ARTICLE
Dumping Syndrome: Establishing Criteria for Diagnosis and Identifying New Etiologies
Reza A. Hejazi Harshal Patil Richard W. McCallum
Received: 24 March 2009 / Accepted: 3 August 2009 / Published online: 28 August 2009 Springer Science+Business Media, LLC 2009
AbstractAims To investigate the current incidence and identify the current etiologies of rapid gastric emptying (dumping syndrome) in patients with a spectrum of gastrointestinal symptoms, including nausea, vomiting, abdominal pain, or diarrhea.
Methods The results for a 4-h radionuclide gastric emptying test (GET) using a standardized scintigraphic technique were reviewed in 545 patients to see which patients met criteria for rapid gastric emptying, dened as [50%
emptying of isotope-labeled solid meal at 1 h.
Results Forty-eight of 545 (8.8%) patients (28 females, mean age 46 2 years, range 3258 years) had rapid GET. Seventeen of 59 (35%) met Rome III diagnostic criteria for cyclic vomiting syndrome (CVS). Twelve of these 59 (25%) patients were regarded as non-ulcer dyspepsia and six (13%) had dyspepsia in the setting of diabetes mellitus. Five (10.5%) were post-fundoplication surgery, where an accidental vagotomy was conrmed by sham meal challenge; previous gastric bypass surgery for obesity had been performed in three (6%) patients. Five(10.5%) patients with unexplained abdominal pain and
diarrhea had the working diagnosis of irritable bowel syndrome.
Conclusions Rapid gastric emptying can be identied in a sizeable subset (9%) of patients with unexplained nausea, vomiting, abdominal pain, and diarrhea when criteria are applied to the standardized scintigraphic gastric emptying meal.
Keywords Gastric emptying test Dumping syndrome
Etiology
Introduction
The impairment of gastric motility can lead to a variety of undesirable and chronic sequelae. When gastric emptying is rapid, it leads to dumping syndrome, characterized by gastrointestinal and vasomotor symptoms that occur after the ingestion of meals. The term dumping syndrome was introduced by Andrews and Mix in 1920, who reported a rapid gastric emptying of radiographic contrast in patients with typical post-prandial symptoms after undergoing a gastrectomy [1].
When these symptoms are explained by rapid gastric emptying, the symptoms are termed dumping syndrome. The incidence of rapid gastric emptying is clinically signicant in the patients with a spectrum of symptoms ranging from nausea, vomiting, abdominal pain, diarrhea, weakness, and faintness to...