A Possible Role of GLP-1 in the Pathophysiology of Early Dumping Syndrome

Yamamoto, Hiroshi; Mori, Taisuke; Tsuchihashi, Hiroshi; Akabori, Hiroya; Naito, Hiroyuki; Tani, Tohru

doi:10.1007/s10620-005-3046-2

Cited by 41 publications

(28 citation statements)

References 28 publications

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“…In our study the median time from surgery to symptoms was 2.7 years, which is consistent with the time lag of 1-5 years that has been reported in case studies [5]. Dumping syndrome is seen after gastric bypass surgery [10,11]. Many patients with post-gastric bypass hypoglycaemia report dumping early after surgery [5] but this is controlled by dietary intervention, making it unlikely that dumping and post-gastric bypass hypoglycaemia are part of the same disease.…”

Section: Discussionsupporting

confidence: 89%

Nationwide cohort study of post-gastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986–2006 in Sweden

et al. 2010

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Aims/hypothesis Symptomatic hypoglycaemia with related confusion, syncope, epilepsy or seizures is a newly recognised complication of gastric bypass surgery for obesity. The incidence of these conditions is not known. We therefore studied the incidence of post-gastric bypass hypoglycaemia and related symptoms in patients who have undergone gastric bypass and a reference cohort from the general population of Sweden. Methods This is a nationwide cohort study based on national registries with 5,040 persons who underwent gastric bypass, vertical banded gastroplasty or gastric banding for obesity in Sweden between 1 January 1986 and 31 December 2006 and a cohort of ten referents per patient matched for sex and age randomly sampled from the general population. The incidence rates of hospitalisation for hypoglycaemia, confusion, syncope, epilepsy or seizures before and after dates of surgery or inclusion in the reference cohort were studied. Results Preoperative incidences of hospitalisation for hypoglycaemia were similar in the surgical and referent cohorts. After gastric bypass surgery, the adjusted hazard ratios were significantly elevated for hypoglycaemia (2.7 [95% CI 1. participants affected by hypoglycaemia were very low (0.2% and 0.04%, respectively). There was no increased risk of hypoglycaemia after vertical banded gastroplasty or gastric banding compared with the referent population. Conclusions/interpretation Obese persons who have undergone gastric bypass have an increased risk of hospitalisation for diagnoses associated with post-gastric bypass hypoglycaemia, although few patients are affected.

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Section: Discussionsupporting

confidence: 89%

Nationwide cohort study of post-gastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986–2006 in Sweden

et al. 2010

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“…Yamamoto et al reported the relation between GLP-1 and early dumping syndrome. They concluded that increasing catecholamine through the effect of GLP-1 on the central nervous system, which activates catecholamine neurons, might produce the symptoms of early dumping syndrome [23]. GLP-1 might confound postprandial hypotension and tachycardia by enhancing insulin-mediated vasodilatation through an increase in nitric oxide production [24,25].…”

Section: Fig 2 Continuous Glucose Monitoring (Cgm) Over 24 Hoursmentioning

confidence: 99%

Octreotide improves early dumping syndrome potentially through incretins: a case report

et al. 2013

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Dumping synDrome, or rapid gastric emptying, is a serious complication that may occur after gastric surgery in approximately 5-10% of patients, although it may occur in approximately 20% after vagotomy with pyloroplasty and up to 50% after esophagectomy [1][2][3]. In spite of this level of occurrence, the pathophysiologic mechanisms underlying the symptoms of dumping syndrome are poorly understood. Here, we report a patient with dumping syndrome following distal gastrectomy with Billroth I reconstruction for early-stage gastric cancer. In this case, we have measured the levels of several hormones during a 75g oral glucose tolerance test (75g-OGTT), and found that glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were both inhibited by octreotide treatment. Abstract. Dumping syndrome, or rapid gastric emptying, is a frequent complication after gastric surgery. In this case, the patient was a 47-year-old woman who 10 years previously had undergone distal gastrectomy with Billroth I reconstruction for early-stage gastric cancer. She presented with symptoms of weakness, headache, palpitation, sweating, dizziness and significant fatigue between one and two hours after a meal. Because a 75g oral glucose tolerance test (75g-OGTT) induced both acute postprandial tachycardia (within 1 hour) and postprandial hypoglycemia, we diagnosed this patient with early and late dumping syndrome. Dietary measures and acarbose improved symptoms of late dumping syndrome but did not prevent the symptoms of early dumping syndrome such as postprandial tachycardia, weakness, headache, palpitation, and dizziness. We therefore used the somatostatin analogue octreotide, which has been reported as an effective therapy for early dumping syndrome. Octreotide prevented the symptoms of early dumping syndrome, especially postprandial tachycardia, but caused postprandial hyperglycemia. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were completely suppressed during the 75g-OGTT following subcutaneous injection of octreotide. No change was observed in vasoactive intestinal polypeptide (VIP), which is the gastrointestinal peptide hormone generally responsible for early dumping syndrome, suggesting possible contribution of incretins in early dumping syndrome of this patient.Key words: Dumping syndrome, GLP-1, Octreotide material and methods Laboratory analysesBlood samples were taken after an overnight fast. Plasma glucose concentrations were measured with the hexokinase G6PD UV method. Serum insulin concentrations were measured with a chemiluminescent enzyme immunoassay. Serum triglyceride concentrations were determined by Enzymatic method. Serum total cholesterol concentrations were measured by a cholesterol dehydrogenase ultraviolet method. Serum HDL cholesterol concentrations were determined by a direct method (Cholestest ® N HDL, Sekisui Medical, Japan). Hemoglobin A1c (NGSP) levels were measured by high performance liquid chromatographic assay (HPLC). Serum total GIP and...

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“…However, following RYGB, increased (58) or unchanged (81) GIP levels have been reported in type 2 diabetic patients. On the other hand, GLP-1 has been implicated in the dumping syndrome and the reactive hypoglycemia that may follow gastric surgery (82). Its trophic actions on ␤-cells have been called upon to explain six cases of histologically proven nesidioblastosis after RYGB (83).…”

Section: Mechanismsmentioning

confidence: 99%

Impact of Different Bariatric Surgical Procedures on Insulin Action and β-Cell Function in Type 2 Diabetes

2009

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A Possible Role of GLP-1 in the Pathophysiology of Early Dumping Syndrome

Cited by 41 publications

References 28 publications

Nationwide cohort study of post-gastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986–2006 in Sweden

Nationwide cohort study of post-gastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986–2006 in Sweden

Octreotide improves early dumping syndrome potentially through incretins: a case report

Impact of Different Bariatric Surgical Procedures on Insulin Action and β-Cell Function in Type 2 Diabetes

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