Roux en Y gastric bypass hypoglycemia resolves with gastric feeding or reversal: Confirming a non-pancreatic etiology.,Molecular Metabolism

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Roux en Y gastric bypass hypoglycemia resolves with gastric feeding or reversal: Confirming a non-pancreatic etiology.
Molecular Metabolism ( IF 7.0 ) Pub Date : 2018-01-31 , DOI: 10.1016/j.molmet.2017.12.011
Dawn Belt Davis ₁ , Jad Khoraki ₂ , Martynas Ziemelis ₃ , Sirinart Sirinvaravong ₄ , Jee Young Han ₄ , Guilherme M Campos ₂

Affiliation

Objective

Postprandial hypoglycemia is an infrequent but disabling complication of Roux-en-Y gastric bypass (RYGB) surgery. Controversy still exists as to whether the postprandial hyperinsulinemia observed is due to inherent changes in pancreatic β-cell mass or function or to reversible alterations caused by RYGB anatomy. We aimed to determine if gastric feeding or reversal of RYGB would normalize postprandial glucose and hormone excursions in patients with symptomatic hypoglycemia.

Methods

We completed a prospective study of six patients with severe symptomatic RYGB hypoglycemia who underwent RYGB reversal. An additional subject without hypoglycemia who underwent RYGB reversal was also studied prospectively. Mixed meal tolerance testing (MTT) was done orally (RYGB anatomy), via gastrostomy tube in the excluded stomach in the setting of RYGB, and several months after RYGB reversal.

Results

All subjects reported symptomatic improvement of hypoglycemia after reversal of RYGB. Weight gain after reversal was moderate and variable. Postprandial glucose, insulin, and GLP-1 excursions were significantly diminished with gastric feeding and after reversal. Insulin secretion changed proportional to glucose levels and insulin clearance increased after reversal. Glucagon/insulin ratios were similar throughout study. We further compared the impact of modified sleeve gastrectomy reversal surgery to those with restoration of complete stomach and found no significant differences in weight regain or in postprandial glucose or hormone levels.

Conclusions

Reversal of RYGB is an effective treatment option for severe postprandial hypoglycemia. The pathophysiology of this disorder is primarily due to RYGB anatomy resulting in altered glucose, gut, and pancreatic hormone levels and decreased insulin clearance, rather than inherent β-cell hyperplasia or hyperfunction.

中文翻译：

Roux en Y胃绕道低血糖可通过胃饲或逆转来解决：确认非胰腺病因。

客观的

餐后低血糖是 Roux-en-Y 胃绕道手术 (RYGB) 手术的一种罕见但致残的并发症。关于观察到的餐后高胰岛素血症是否是由于胰腺 β 细胞质量或功能的固有变化，还是由于 RYGB 解剖结构引起的可逆性改变，仍然存在争议。我们的目的是确定胃饲或逆转 RYGB 是否会使有症状低血糖患者的餐后血糖和激素波动正常化。

方法

我们完成了一项前瞻性研究，对象为 6 名患有严重 RYGB 低血糖症状且接受 RYGB 逆转的患者。还对另一名没有低血糖且接受 RYGB 逆转的受试者进行了前瞻性研究。混合膳食耐受性测试 (MTT) 是通过口服（RYGB 解剖学）进行的，在 RYGB 环境中通过胃造口管在 RYGB 环境中排除的胃中进行，并在 RYGB 逆转后几个月进行。

结果

所有受试者均报告 RYGB 逆转后低血糖症状得到改善。逆转后的体重增加是中等且可变的。胃饲和逆转后，餐后血糖、胰岛素和 GLP-1 偏移显着减少。胰岛素分泌与葡萄糖水平成正比，逆转后胰岛素清除率增加。在整个研究过程中胰高血糖素/胰岛素比率相似。我们进一步比较了改良袖状胃切除逆转手术与完全胃恢复手术的影响，发现体重恢复或餐后血糖或激素水平没有显着差异。