J. Borovoy et al., BENEFIT OF UNCOOKED CORNSTARCH IN THE MANAGEMENT OF CHILDREN WITH DUMPING SYNDROME FED EXCLUSIVELY BY GASTROSTOMY, The American journal of gastroenterology, 93(5), 1998, pp. 814-818
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.