BENEFIT OF UNCOOKED CORNSTARCH IN THE MANAGEMENT OF CHILDREN WITH DUMPING SYNDROME FED EXCLUSIVELY BY GASTROSTOMY

Objectives: Children with dumping syndrome fed exclusively by gastrost omy are difficult to manage because liquid diets are given directly in to the antrum, The gastric contents are emptied rapidly into the small intestine, with consequent hyperglycemia followed by a delayed hypogl ycemia and multiple, often debilitating, symptoms. Uncooked cornstarch is a complex carbohydrate that provides a slow and continuous glucose source and may delay gastric emptying. The objective of this study wa s to determine the efficacy of uncooked cornstarch in the treatment of these children. Methods: The medical records of eight children with d umping syndrome fed exclusively by gastrostomy were reviewed. Dumping syndrome was diagnosed if there was consistent symptomatology, rapid g astric emptying, and abnormal glucose measurements after a glucose tol erance test. Enough uncooked cornstarch to match hepatic glucose produ ction for 4 h was added to control hypoglycemia, and the feeding formu la was modified to control hyperglycemia, Results: All patients had de bilitating symptoms, Weight z-score on admission was -2.31 +/- 0.29. G lucose shifts mere controlled in all. There was a significant differen ce between the maximum (221.3 +/- 19.3 mg/dl vs 121.3 +/- 6.9 mg/dl; p < 0.008) and minimum serum glucose (47 +/- 7.8 mg/dl vs 65.6 a 4 mg/d l; p < 0.04) before and after uncooked cornstarch, Weight increased fr om 11.87 +/- 1.4 kg to 15.10 +/- 2.3 kg (p = 0.06). In seven patients, bolus feedings were successfully administered, and symptoms improved or resolved. Conclusions: Uncooked cornstarch controlled the glucose s hifts, resolved most of the symptoms, allowed bolus feedings, and enha nced weight gain in these children. (C) 1998 by Am. Cell. of Gastroent erology.