Cholecystectomy increases the risk of dumping syndrome and postbariatric hypoglycemia after bariatric surgery

Abstract

Background: Dumping syndrome (DS) and postbariatric hypoglycemia (PBH) are frequent complications of bariatric surgery. Bile acids (BA) have been implicated in their pathogenesis because both bariatric surgery and cholecystectomy (CCx) are known to modulate human BA metabolism. Objectives: Our investigation aimed to compare the prevalence of self-reported complaints of DS and PBH in postbariatric patients with and without CCx. Setting: A large peripheral hospital in the Netherlands. Methods: All patients who underwent bariatric surgery in 2008-2011 received standardized questionnaires on DS/PBH complaints. The relative risk (RR) of CCx was calculated as the risk of perceived DS and PBH in patients with and without CCx.Results: Of 590 participants, 146 (25%) had CCx before assessment of DS/PBH complaints. Participants were mostly female (82%) with median age of 46 years (interquartile range, 39-53). The RR for DS after CCx was higher in patients with body mass index ,30 kg/m 2 at the study (RR, 1.59; 95% CI, 1.04-2.42; P 5 .007) and in primary Roux-and-Y gastric bypass surgery patients (RR, 1.63; 95% CI, 1.10-2.42; P 5.018). Detailed analysis of the latter group associated women, age younger than 50 years, without diabetes and (most prominently) with excess weight loss 70% (RR, 2.73; 95% CI, 1.57-4.77; P 5 .0004) with greater risk of DS. The RR for PBH was higher after CCx in sleeve gastrectomy patients (RR, 4.5; 95% CI, 1.00-20.3; P 5 .036). Conclusion: High suspicion of DS and PBH after CCx is increased after bariatric surgery in certain subgroups, suggesting involvement of altered BA metabolism in their pathophysiology.

Altered bile acid kinetics contribute to postprandial hypoglycaemia after Roux-en-Y gastric bypass surgery

“…In addition, our data suggest that cholecystectomized subjects are more prone to develop postprandial BAinduced hypoglycaemia upon RYGB. In fact, a recent study on self-reported complaints of dumping syndrome and postbariatric hypoglycemia in 590 patients who underwent bariatric surgery in the period 2008-2011 in the same institution showed that cholecystectomy indeed increases the relative risk of hypoglycemia, particularly in subgroups defined by gender, age, presence of diabetes and % weight loss [31]. Based on these results, it might be worthwhile to evaluate the potential beneficial effects of BA sequestration as treatment of postprandial hypoglycaemia after RYGB.…”

Medical and surgical treatment of postbariatric hypoglycaemia: Retrospective data from daily practice

“…8 Preoperative prevalence of type 2 diabetes (18%) was somewhat lower and previous cholecystectomy (37%) higher compared with an average bariatric Roux-en-Y gastric bypass (RYGB) population, as both are known to confer protection from and increase the risk for PBH, respectively. 9,10 RYGB was the most performed surgical procedure, followed by In total, 15 of those 23 who had surgical intervention for PBH remained without medication after a median follow-up of 38 months.…”

Dumping Syndrome and Postbariatric Hypoglycemia: Supporting Evidence for a Common Etiology

“…Many questions of course remain, among which one of the main that comes up is why some develop DS and PBH and others do not, or why disease severity can fluctuate remarkably over time. These remains to be answered, but the etiology is probably multifactorial with an interplay of changes in hormones, microbiome, different surgery techniques and potentially also a regulating role for bile acids [19].…”