Use of a provocation test for objective assessment of dumping syndrome in patients undergoing surgery for duodenal ulcer.

It is difficult to assess the incidence of dumping after various operations for duodenal ulcer on clinical grounds alone. An objective assessment of dumping has been made with the help of a provocation test. The test, using 50% hypertonic glucose solution labeled with radioactive Indium 113m was performed on 39 preoperative patients and 107 times on 72 patients after operation for duodenal ulcer. The dumping status of all the patients prior to surgery was asymptomatic after ordinary food as well as on test. Among the postoperative studies the clinical status was asymptomatic in 69, uncertain in 32 and six had dumping symptoms. On the basis of the symptoms on-test, the status was asymptomatic in 61, uncertain in 14 and 32 had dumping symptoms. The objective indices further defined the status as 70 asymptomatics, none uncertain and 37 confirmed dumpers and thereby completely abolished the uncertain group. All the objective measurements of the dumping provocation test have clearly differentiated those patients with from those without dumping symptoms. Patients with dumping symptoms on-test had a significantly greater fall in plasma volume, more rapid rates of gastric emptying and steeper rise in blood sugar after ingestion of hypertonic glucose than did the patients without dumping symptoms on-test.