A Rare Case of Idiopathic Rapid Gastric Emptying.

Idiopathic rapid gastric emptying (IRGE), also called idiopathic dumping syndrome, is a rare gastrointestinal (GI) motility disorder marked by an abnormally accelerated gastric emptying with no history of gastric surgery, diabetes mellitus, or other structural anomalies of the stomach or small intestine. This disorder has a similar presentation to classic dumping syndrome. Yet, it happens in patients with an intact stomach and pylorus, with no evidence of previous gastric surgeries. Due to its similarity with other endocrine hypoglycemic syndromes and functional GI disorders, IRGE remains misdiagnosed and/or underreported. Thus, it is a significant diagnostic challenge for physicians. We present a case of a 21-year-old female with a chronic history of postprandial diarrhea, carbohydrate intolerance, and symptomatic postprandial hypoglycemia. She had no history of prior gastric surgery, and her investigations, including endoscopy and radiology, demonstrated normal findings. Gastric emptying scintigraphy (GES) revealed 100% gastric emptying at 60 minutes (retained meal value of less than 70% at 30 minutes or less than 30% at 1 hour is indicative of rapid gastric emptying). Based on these findings and after exclusion of other differential diagnoses, a diagnosis of IRGE was established. This case highlights the importance of identifying IRGE as a distinct clinical entity that causes postprandial hypoglycemia and GI symptoms. Early recognition can help in timely diagnosis and targeted therapy.