ContextPost‐bariatric hypoglycemia (PBH) is a complication of bariatric surgery including Roux‐en‐Y gastric bypass (RYGB). It remains unclear why only some individuals develop PBH.ObjectiveTo identify clinical characteristics distinguishing post‐RYGB individuals with PBH, versus without symptomatic hypoglycemia (RYGB non‐hypo).Design and SettingCross‐sectional observational study in academic referral centre. Adults 18–70, without current diabetes, were recruited into three groups: (1) PBH (n = 39); (2) RYGB non‐hypo (n = 25); and (3) individuals without history of upper gastrointestinal surgery (n = 17). Outcome measures included between‐group differences in medical history and medication use, and survey‐based scores for hypoglycemia, dumping syndrome, and autonomic symptoms.ResultsPBH participants were 92% female, age 53.4 ± 11.9 y, BMI 31.2 ± 5.6 kg/m2, versus RYGB non‐hypo (100% female, age 53.2 ± 10.5 y, BMI 32.2 ± 8.0 kg/m2) and controls (65% female, age 44.5 ± 14.6 y, BMI 30.8 ± 6.3 kg/m2). 87% of PBH reported level 3 hypoglycemia, with emergency visits in 28% and vehicle accidents in 8%. Reduced hypoglycemia awareness was reported by 82%; 13%–17% were classified as unaware (modified Clarke/Gold scores). Preoperative hypoglycemia symptoms and family history were reported by 26% and 18% of PBH. PBH had significantly higher survey scores for hypoglycemia, dumping syndrome, and autonomic symptoms, and higher self‐reported neuropathy, autonomic neuropathy, orthostatic hypotension, reflux esophagitis, intestinal dysmotility, and IBS (all p < 0.05 vs. RYGB non‐hypo). Gabapentin and PPI use was more frequent in PBH.ConclusionHigh rates of IBS, dumping symptoms, and orthostatic hypotension suggest disordered autonomic regulation as a potential contributor to PBH. Self‐reported preoperative symptoms and family history of hypoglycemia suggest possible preoperative differences in glucose metabolism in PBH.
