Continuous Glucose Monitoring to Diagnose Hypoglycemia Due to Late Dumping Syndrome in Children After Gastric Surgeries

Chesser, Hannah; Abdulhussein, Fatema; Huang, Alyssa; Lee, Janet Y.; Gitelman, Stephen E.

doi:10.1210/jendso/bvaa197

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…GI disorders are common in individuals with Down syndrome and surgical management of this can lead to iatrogenic hypoglycaemia as a result of dumping syndrome. 14,15 Furthermore, one of these individuals had confirmed post-prandial hypoglycaemia following surgery lending further support to this diagnosis. 16 This patient also had a portosystemic shunt, with surgical closure resulting in a resolution of the hypoglycaemia.…”

Section: Discussionmentioning

confidence: 59%

“…Two children had surgery to correct a gastrointestinal (GI) disorder prior to the onset of HI (Table 1). GI disorders are common in individuals with Down syndrome and surgical management of this can lead to iatrogenic hypoglycaemia as a result of dumping syndrome 14,15 . Furthermore, one of these individuals had confirmed post‐prandial hypoglycaemia following surgery lending further support to this diagnosis 16 .…”

Section: Discussionmentioning

confidence: 88%

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Increased referrals for congenital hyperinsulinism genetic testing in children with trisomy 21 reflects the high burden of non‐genetic risk factors in this group

et al. 2022

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Background Hyperinsulinism results from inappropriate insulin secretion during hypoglycaemia. Down syndrome is causally linked to a number of endocrine disorders including Type 1 diabetes and neonatal diabetes. We noted a high number of individuals with Down syndrome referred for hyperinsulinism genetic testing, and therefore aimed to investigate whether the prevalence of Down syndrome was increased in our hyperinsulinism cohort compared to the population. Methods We identified individuals with Down syndrome referred for hyperinsulinism genetic testing to the Exeter Genomics Laboratory between 2008 and 2020. We sequenced the known hyperinsulinism genes in all individuals and investigated their clinical features. Results We identified 11 individuals with Down syndrome in a cohort of 2011 patients referred for genetic testing for hyperinsulinism. This represents an increased prevalence compared to the population (2.5/2011 expected vs. 11/2011 observed, p = 6.8 × 10−5). A pathogenic ABCC8 mutation was identified in one of the 11 individuals. Of the remaining 10 individuals, five had non‐genetic risk factors for hyperinsulinism resulting from the Down syndrome phenotype: intrauterine growth restriction, prematurity, gastric/oesophageal surgery, and asparaginase treatment for leukaemia. For five individuals no risk factors for hypoglycaemia were reported although two of these individuals had transient hyperinsulinism and one was lost to follow‐up. Conclusions Down syndrome is more common in patients with hyperinsulinism than in the population. This is likely due to an increased burden of non‐genetic risk factors resulting from the Down syndrome phenotype. Down syndrome should not preclude genetic testing as coincidental monogenic hyperinsulinism and Down syndrome is possible.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 88%

Increased referrals for congenital hyperinsulinism genetic testing in children with trisomy 21 reflects the high burden of non‐genetic risk factors in this group

et al. 2022

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“…For late dumping, the mean time after surgery was 27.6 months. It can also be successfully used to evaluate how well various treatments and diet plans function [24,[33][34][35][36].…”

Section: Diagnosismentioning

confidence: 99%

“…CGM helps direct treatment measures like feeding adjustments, cornstarch, and acarbose [33]. The use of dietary modification with more frequent or continuous feeds and dietary supplements with fiber, cornstarch, or gelling agents are the first-line treatments for PPH brought on by late DS.…”

Section: Diagnosismentioning

confidence: 99%

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Dumping Syndrome in Children: A Narrative Review

Al-Jafari¹,

Alrosan²,

Alkhawaldeh³

et al. 2023

Cureus

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Dumping syndrome (DS) is a typical side effect of stomach surgery, which includes cancer, non-cancer esophageal and gastric surgery, and bariatric surgery. It is marked by the fast evacuation of undigested food from the stomach into the small intestine, which causes a variety of symptoms. Early dumping symptoms include gastrointestinal symptoms such as stomach discomfort, diarrhea, and nausea, as well as vasomotor symptoms such as drowsiness and face flushing, and occur within the first hour following a meal. Late dumping symptoms appear one to three hours after a meal and are related to reactive hypoglycemia, resulting in hypoglycemia, sweating, palpitations, and confusion.Early dumping pathophysiology involves abnormalities in stomach structure and function, which result in rapid transit of stomach contents to the duodenum, insufficient digestion, and fluid transfers from the vascular compartment to the intestine. Late dumping occurs as a result of hyperinsulinemia caused by the fast passage of undigested foods to the gut. Symptom-based questionnaires and diagnostic testing such as plasma glucose measurement and stomach emptying studies can be used to confirm a diagnosis of DS.The primary approach to managing DS is dietary modifications, including eating smaller, more frequent meals and avoiding high glycemic index carbohydrates. Dietary supplements and medications may be used to slow down gastric emptying or control blood glucose levels. Pharmacological options include alphaglycosidase inhibitors, somatostatin analogs, glucagon-like peptide-1 analogs, and sodium-glucose cotransporter inhibitors. In severe cases, refractory to conservative measures, surgical interventions may be considered.DS can arise in children following gastric surgery for obesity or corrective surgery for congenital abnormalities. It is frequently misdiagnosed and can have serious implications, such as hypoglycemiarelated cognition deficits. Screening and early identification using glucose tolerance testing and continuous glucose monitoring (CGM) are critical in at-risk youngsters. Children's treatment techniques are similar to those used in adults, with dietary changes and medication therapies serving as the cornerstone of care.Overall, DS is a complex condition that requires a multidisciplinary approach to diagnosis and management. Further research is needed to improve understanding of its pathophysiology and optimize treatment strategies, particularly in children.This review aims to provide a well-rounded informative summary of the most recent literature on the underrecognized clinical and scientific aspects of DS among the children age group. It incorporates the quality of life, pathophysiology, diagnosis, prevalence, and treatment.

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Continuous Glucose Monitoring to Diagnose Hypoglycemia Due to Late Dumping Syndrome in Children After Gastric Surgeries

Cited by 6 publications

References 18 publications

Increased referrals for congenital hyperinsulinism genetic testing in children with trisomy 21 reflects the high burden of non‐genetic risk factors in this group

Increased referrals for congenital hyperinsulinism genetic testing in children with trisomy 21 reflects the high burden of non‐genetic risk factors in this group

Dumping Syndrome in Children: A Narrative Review

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