Abstract
Dumping syndrome (DS) and postbariatric hypoglycemia (PBH) are frequent complications of bariatric surgery. Previously known as "early and late dumping," these complications have been separated due to differences in their onset and behaviors. To investigate a potentially common etiology of DS and PBH using an analysis of a mixed meal test (MMT) study. A large teaching hospital in the Netherlands. From all patients who underwent bariatric surgery in 2008-2011, a random selection completed an MMT (n = 47). Patients scored complaints related to DS and PBH with a standardized questionnaire at several time intervals. The groups were divided into patients with (DS+; n = 22) and without (DS-; n = 25) an increase in DS symptoms after the start of the MMT. Glucose and gut hormone levels were compared. Hypoglycemia was defined as a blood glucose level below 3.3 mmol/L. The DS+ group had lower blood glucose values compared to the DS- group, which reached significance at 90 and 120 minutes (P < .05). For the DS+ group, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and satiety were higher at various time intervals (P < .05) compared to the DS- group. No differences were found for insulin and hunger score. GLP-1 and PYY were correlated with symptoms of DS. Patients with DS complaints had lower postprandial glucose values. GLP-1 and PYY values were elevated in the DS+ group early and late during the test. These hormones also correlated with DS. These findings support the hypothesis of a common etiology of DS and PBH and a role of GLP-1 and PYY in both complications.
Highlights
postbariatric hypoglycemia (PBH) is thought to occur in the setting of high weight loss after bariatric surgery, when increased insulin sensitivity is combined with increased insulin secretion by beta cells, leading to a hyperinsulinemic hypoglycemic event, the principal hallmark of PBH [9]
In our previous questionnaire study, we showed that patients were more likely to develop Dumping syndrome (DS) complaints after a primary Roux-en-Y gastric bypass than after sleeve gastrectomy (SG; 9%) [4]
In a meal test we found that DS was related to active glucagon-like peptide-1 (GLP-1), the key hormone in the pathophysiology of PBH [11]
Summary
PBH is defined by a hypoglycemic event, usually starting 1 to 3 hours after a meal It presents with hypoglycemia-related symptoms (drowsiness/unconsciousness, irritability, confusion) and adrenergic symptoms (sweating, palpitations, hunger, tremor) caused by vagal and sympathetic activation [7]. These hypoglycemic episodes can occur several times a day [8]. In a recent study in 11 women with PBH after gastric bypass surgery, hormone excursions associated with PBH appeared to be related to symptoms of DS [13] This raises the possibility that an overlap exists between DS and PBH and that both are occurring within the same dumping disease spectrum. The aim of the current study was to further explore the relationship between DS and PBH, using data from our previous meal test study in a group of patients after RYGB [11]
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