Diagnostic value of dumping provocation in patients after gastric surgery.

BACKGROUND: In patients after gastric surgery it is often difficult to discern symptoms from dumping from other postcibal complaints. Strict criteria for dumping provocation test have not been defined.

METHODS: The sensitivity and specificity of a dumping provocation using 50 g of glucose orally was assessed in 48 patients after gastric surgery, of whom 19 had a typical history of early dumping and 11 had a history of late dumping. Factors were heart rate, packed cell volume, breath hydrogen excretion, and blood glucose concentration.

RESULTS: An increase in heart rate of > or = 10 beats/min in the 1st h had a sensitivity of 100% and a specificity of 94% in detecting early dumping. An early rise in breath H2 excretion showed a sensitivity of 84% and specificity of 94%. The nadir blood glucose concentration was not a sensitive or specific indicator for late dumping.

CONCLUSIONS: Both an increase in heart rate of > or = 10 beats/min and a positive breath hydrogen excretion are sensitive indicators for early dumping. Late dumping is better recognized by the occurrence of subjective symptoms during provocation.