Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet

Kellogg, Todd A.; Bantle, John P.; Leslie, Daniel B.; Redmond, J. Bruce; Slusarek, Bridget; Swan, Therese; Buchwald, Hēnry; Ikramuddin, Sayeed

doi:10.1016/j.soard.2008.05.005

Cited by 200 publications

(156 citation statements)

References 21 publications

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“…However, the surgery is also associated with procedure-related complications. One such complication is hypoglycaemia [8] and this nationwide populationbased study of the occurrence of hypoglycaemia after gastric bypass surgery demonstrates that inpatient care for hypoglycaemia and conditions commonly attributed to hypoglycaemia is significantly more common after surgery than in the general population. However, the actual number of patients affected is low, with less than 1% of patients affected.…”

Section: Discussionmentioning

confidence: 92%

“…These diagnoses were selected because they have been reported in case series to be associated with post-gastric bypass hypoglycaemia [4,7,8]. Hospitalisations for diabetes mellitus (ICD-8, ICD-9: 250; ICD-10: E10-E14) were studied and the diagnosis was used for adjustments in the Cox proportional hazards regression models.…”

Section: Data Sourcesmentioning

confidence: 99%

“…Patients have presented with hypoglycaemia associated with confusion, syncope and seizures attributed to changes in glucose homeostasis [5]. Most patients have presented between 2 and 4 years after surgery [5] and in some the condition responds poorly to nutritional therapy, acarbose and somatostatin analogues and may even require partial pancreatectomy [6,7] whereas others have reported that the condition responds to meals that are low in carbohydrates [8].…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 92%

Section: Data Sourcesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Several other groups have since reported similar observations. [31][32][33][34][35][36] At a recent meeting devoted to this topic at Harvard, B135 cases of severe, lateonset, post-RYGB hyperinsulinemic hypoglycemia were discussed, many with intractable neuroglycopenic episodes necessitating pancreatectomy.…”

Section: Mechanisms Of Diabetes Improvement Following Bariatric Surgerymentioning

confidence: 99%

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

2009

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Bariatric surgery is currently the most effective method to promote major, sustained weight loss. Roux-en-Y gastric bypass (RYGB), the most commonly performed bariatric operation, ameliorates virtually all obesity-related comorbid conditions, the most impressive being a dramatic resolution of type 2 diabetes mellitus (T2DM). After RYGB, 84% of patients with T2DM experience complete remission of this disease, and virtually all have improved glycemic control. Increasing evidence indicates that the impact of RYGB on T2DM cannot be explained by the effects of weight loss and reduced energy intake alone. Weightindependent antidiabetic actions of RYGB are apparent because of the very rapid resolution of T2DM (before weight loss occurs), the greater improvement of glucose homeostasis after RYGB than after an equivalent weight loss from other means, and the occasional development of very late-onset, pancreatic b-cell hyperfunction. Several mechanisms probably mediate the direct antidiabetic impact of RYGB, including enhanced nutrient stimulation of L-cell peptides (for example, GLP-1) from the lower intestine, intriguing but still uncharacterized phenomena related to exclusion of the upper intestine from contact with ingested nutrients, compromised ghrelin secretion, and very probably other effects that have yet to be discovered. Research designed to prioritize these mechanisms and identify potential additional mechanisms promises to help optimize surgical design and might also reveal novel pharmaceutical targets for diabetes treatment. Keywords: diabetes; gastric bypass; bariatric surgery; ghrelin; GLP-1 Bariatric operations traditionally have been thought to cause weight loss through gastric restriction and/or intestinal malabsorption. Restrictive operations such as adjustable gastric banding (AGB) create a small pouch in the proximal stomach to reduce functional gastric capacity and retard gastric emptying. Malabsorptive procedures such as biliopancreatic diversion (BPD) leave much of the stomach intact but divert ingested food from the stomach to the ileum; thus, only a small segment of the distal bowel can absorb nutrients. The typical proximal Roux-en-Y gastric bypass (RYGB) creates gastric restriction and also causes food to bypass most of the stomach and a short segment of the proximal intestine, primarily the duodenum, leaving enough intact small bowel in digestive continuity to avoid clinically significant malabsorption. RYGB causes weight loss through gastric restriction and additional mechanisms involving changes in gut hormones and other processes under active investigation. 1-14 RYGB and BPD produce the highest and most rapid rates of remission of type 2 diabetes mellitus (T2DM). Remission of diabetes after RYGBAlthough bariatric surgery was designed to facilitate weight loss, anecdotal reports of rapid postoperative remission of T2DM emerged as early as the 1970s. In 1995, Pories et al. 4 reported long term results from 608 severely obese patients who underwent gastric bypass, with a 93% follow-up rate ov...

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“…Hipogliseminin tedavisi için bazı cerrahlar tarafından subtotal ya da total pankreatektomi önerilmektedir. 27 …”

Section: B Hipoglisemiunclassified

Endocrinologic and Metabolic Monitoring Following Bariatric Surgery: Review

Akyay¹,

Çetinarslan²,

Cantürk³

et al. 2016

Turkiye Klinikleri J Endocrin

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Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet

Cited by 200 publications

References 21 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

Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery

Endocrinologic and Metabolic Monitoring Following Bariatric Surgery: Review

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