Idiopathic dumping syndrome?

[idiopathic dumping]

I am a healthy 38 year old female.  About 7 months ago I started developing dizziness, increased heart rate, flushing of the face and chills about 30 minutes after eating- sometimes followed by a bowel movement. Sometimes my blood pressure rises with this as well. After the episode- it leaves me with dry eyes and complete exhaustion. 3 hours after a meal I get low blood sugar symptoms.  I have had an UGI that noted some possible rapid transit- but the gastric emptying scan showed delayed gastric emptying.  I also had a CT and MRI of the abdomen which didn't show much except the oral contrast taken 30 minutes before was already all in the colon?  Interestingly, 2 weeks before this all started, I had taken a 2 week course of antibiotics (zithromax)- I have also lost 8  lbs (usually 9o pounds) since this all started. They have given ne bentyl, robinal and pamine- but none of these help the symptoms. I was also given acarbose in the beginning and this made the flushing more severe! I have been treated for "panic attacks" with benzos and ssri's which actually made the symptoms worse.  I have not had an endoscopy.  Urine 5 HIAA was negative. Fasting glucose and insulin were normal. morning cortisol normal TSH, celiac antibodies negative as well. Stool cultures for c.diff, ova and parasites and other were all negative. I can't figure out how I could have developed this debilitating problem - Have you ever seen this before?  What might you suggest  I do next??  Iam very concerned and frustrated. Is bacterial overgrowth in the small intestine a possiblity and how could my doctor figure this out?
M

[Kevin Pho, MD]

Carcinoid syndrome was the first thing that came to my mind, but it is less likely with a negative 5-HIAA.  Another consideration would be mastocytosis which is a disorder of mast cells in your body.  It can certainly lead to flushing as well as variety of GI symptoms - including abdominal pain, diarrhea, nausea, vomiting, peptic ulcer disease, and gastrointestinal bleeding.  If this is suspected, a bone marrow biopsy can be considered for further evaluation.  

Regarding bacterial overgrowth - it also may be possible, although this is associated more with loose and frequent bowel movements.  A variety of breath tests can be considered to initially evaluate for this disease.  The best test is known as a jejeunal aspirate, which can be done during an endoscopy.  These options can be considered if suspected by your personal physician.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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