A Clinical Diagnostic Index in the Diagnosis of the Dumping Syndrome

Sigstad, H

doi:10.1111/j.0954-6820.1970.tb08072.x

Cited by 147 publications

(34 citation statements)

References 21 publications

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“…Diagnosis of symptomatic hyperinsulinemic hypoglycemia was made using the Sigstad score questionnaire, [17] an oral glucose tolerance test (OGTT) (Accu-Chek Dextro OGT Roche, Switzerland), and a continuous glucose measurement (CGM) (Dexcom G4 Nintamed, San Diego, California). During the OGTT, the serum insulin level in μU/mL, was quantified at the same time as each glucose measurement.…”

Section: Case Presentation and Managementmentioning

confidence: 99%

A case report

Chiappetta

Stier²

2017

Medicine

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Rationale:Postprandial hyperinsulinemic hypoglycemia, known as late dumping syndrome, is a rare but often misdiagnosed complication after gastric surgery. The pathophysiological mechanisms are poorly understood and the treatment of this syndrome is challenging.Patient concerns:New-onset postsurgical late dumping syndrome after Toupet fundoplication.Diagnoses:Sigstad Score, OGTT, CGM.Interventions:Daily subcutaneous injection of liraglutide (0.6 mg and 1.2 mg).Outcomes:Reduction in fasting and postprandial peak insulin level with improvement in symptomatic hypoglycemic events.Lessons:Liraglutide may be a novel treatment option for postprandial hyperinsulinemic hypoglycemia after gastric surgery.

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Section: Case Presentation and Managementmentioning

confidence: 99%

A case report

Chiappetta

Stier²

2017

Medicine

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“…in 1970, sigstad proposed a scoring system, based on the occurrence of different symptoms of dumping syndrome, to calculate a diagnostic index (Box 2). 12 the presence of hypoglycemia concurrently with several other symptoms is a strong indicator of dumping syndrome (although the occurrence of insulinoma needs to be excluded). a provocative test for assessing dumping syndrome can be used to confirm clinical suspicion.…”

Section: Continuing Medical Education Onlinementioning

confidence: 99%

Pathophysiology, diagnosis and management of postoperative dumping syndrome

Tack

Arts

Caenepeel

et al. 2009

Nat Rev Gastroenterol Hepatol

334

314

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Dumping syndrome is a frequent complication of esophageal, gastric or bariatric surgery. Rapid gastric emptying, with the delivery to the small intestine of a significant proportion of solid food as large particles that are difficult to digest, is a key event in the pathogenesis of this syndrome. This occurrence causes a shift of fluid from the intravascular component to the intestinal lumen, which results in cardiovascular symptoms, release of several gastrointestinal and pancreatic hormones and late postprandial hypoglycemia. Early dumping symptoms comprise both gastrointestinal and vasomotor symptoms. Late dumping symptoms are the result of reactive hypoglycemia. Besides the assessment of clinical alertness and endoscopic or radiological imaging, a modified oral glucose tolerance test might help to establish a diagnosis. The first step in treating dumping syndrome is the introduction of dietary measures. Acarbose can be added to these measures for patients with hypoglycemia, whereas several studies advocate guar gum or pectin to slow gastric emptying. Somatostatin analogs are the most effective medical therapy for dumping syndrome, and a slow-release preparation is the treatment of choice. In patients with treatment-refractory dumping syndrome, surgical reintervention or continuous enteral feeding can be considered, but the outcomes of such approaches are variable.

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“…The patient's Sigstad's score was 21 points on admission [4], strongly suggesting that her symptoms were related to dumping syndrome. We initially performed a 75g-OGTT to estimate whether early or late dumping syndrome was primarily responsible for inducing her symptoms.…”

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confidence: 95%

Octreotide improves early dumping syndrome potentially through incretins: a case report

et al. 2013

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Dumping synDrome, or rapid gastric emptying, is a serious complication that may occur after gastric surgery in approximately 5-10% of patients, although it may occur in approximately 20% after vagotomy with pyloroplasty and up to 50% after esophagectomy [1][2][3]. In spite of this level of occurrence, the pathophysiologic mechanisms underlying the symptoms of dumping syndrome are poorly understood. Here, we report a patient with dumping syndrome following distal gastrectomy with Billroth I reconstruction for early-stage gastric cancer. In this case, we have measured the levels of several hormones during a 75g oral glucose tolerance test (75g-OGTT), and found that glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were both inhibited by octreotide treatment. Abstract. Dumping syndrome, or rapid gastric emptying, is a frequent complication after gastric surgery. In this case, the patient was a 47-year-old woman who 10 years previously had undergone distal gastrectomy with Billroth I reconstruction for early-stage gastric cancer. She presented with symptoms of weakness, headache, palpitation, sweating, dizziness and significant fatigue between one and two hours after a meal. Because a 75g oral glucose tolerance test (75g-OGTT) induced both acute postprandial tachycardia (within 1 hour) and postprandial hypoglycemia, we diagnosed this patient with early and late dumping syndrome. Dietary measures and acarbose improved symptoms of late dumping syndrome but did not prevent the symptoms of early dumping syndrome such as postprandial tachycardia, weakness, headache, palpitation, and dizziness. We therefore used the somatostatin analogue octreotide, which has been reported as an effective therapy for early dumping syndrome. Octreotide prevented the symptoms of early dumping syndrome, especially postprandial tachycardia, but caused postprandial hyperglycemia. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were completely suppressed during the 75g-OGTT following subcutaneous injection of octreotide. No change was observed in vasoactive intestinal polypeptide (VIP), which is the gastrointestinal peptide hormone generally responsible for early dumping syndrome, suggesting possible contribution of incretins in early dumping syndrome of this patient.Key words: Dumping syndrome, GLP-1, Octreotide material and methods Laboratory analysesBlood samples were taken after an overnight fast. Plasma glucose concentrations were measured with the hexokinase G6PD UV method. Serum insulin concentrations were measured with a chemiluminescent enzyme immunoassay. Serum triglyceride concentrations were determined by Enzymatic method. Serum total cholesterol concentrations were measured by a cholesterol dehydrogenase ultraviolet method. Serum HDL cholesterol concentrations were determined by a direct method (Cholestest ® N HDL, Sekisui Medical, Japan). Hemoglobin A1c (NGSP) levels were measured by high performance liquid chromatographic assay (HPLC). Serum total GIP and...

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A Clinical Diagnostic Index in the Diagnosis of the Dumping Syndrome

Cited by 147 publications

References 21 publications

A case report

A case report

Pathophysiology, diagnosis and management of postoperative dumping syndrome

Octreotide improves early dumping syndrome potentially through incretins: a case report

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