Abnormal OGTT May Indicate Dumping Syndrome in Infants With Esophageal Atresia

An oral glucose tolerance test (OGTT) to screen for potential dumping syndrome (DS) around 3 months of age should be considered in infants born with esophageal atresia (EA), according to a prospective case-series study published in Journal of Pediatric Gastroenterology and Nutrition.

The study recruited 38 infants from 7 centers around France and 1 in Australia between 2013 and 2016. The recruited patients underwent type C EA surgery without fundoplication at birth, had no comorbidities associated with DS, and were not undergoing prokinetic treatment. The infants were assessed by an OGTT between 2.5 and 3.5 months of age and for clinical features of colic, esophagitis, early hyperglycemia, and late hypoglycemia.

DS was defined by the occurrence of an early hyperglycemia (>1.8 g/L from ingestion at 30 minutes, >1.7 g/L between 30 and 120 minutes, and >1.4 g/L between 2 and 3 hours) and/or late hypoglycemia (<0.6 g/L after 2 hours).

Of the 38 infants, 29% (n=11) of infants showed abnormal OGTT. Specifically, 5 patients had early hyperglycemia, 4 had late hypoglycemia, and 2 presented with a combination of early hyperglycemia and late hypoglycemia.

Of the infants with an abnormal OGTT, 4 of the early hyperglycemia group (80%) showed at least 1 clinical feature of late hypoglycemia, 1 of the late hypoglycemia group (25%) exhibited clinical features of late hypoglycemia in addition to inconsolable crying, and both early hyperglycemia with late hypoglycemia patients (100%) exhibited clinical features consistent with DS.

The investigators reported no statistical significance between normal and abnormal OGTT patient groups based on clinical symptoms of DS, enteral bolus nutrition, malformations, gestational time, or birth weight.

This study was not a long-term analysis of type C EA surgery and DS. The study participants were evaluated at only 1 time point, so it remains unclear if the observed hyperglycemia and hypoglycemia in the patient population have enduring effects. Furthermore, the study did not measure healthy infants to assess whether OGTT differs from a control group.

Because infants with EA and no prior history of fundoplication are at risk for developing DS, “We propose OGTT to be considered for infants with EA in the first few months of life,” concluded the researchers. Although further research is needed to support the findings from this study, they added, “If DS is found, close monitoring and therapy with cornstarch may be considered for at least 6 months.”

Reference

Aumar M, Gottrand F, Chalouhi C, et al. Frequency of abnormal glucose tolerance test suggestive of dumping syndrome following œsophageal atresia repair [published online January 29, 2020]. J Pediatr Gastroenterol Nutr. doi: 10.1097/MPG.0000000000002651