Abstract Context Hypoglycemia occurring after bariatric and other forms of upper gastrointestinal surgery is increasingly encountered by clinical endocrinologists. The true frequency of this condition remains uncertain, due in part to differences in the diagnostic criteria and in the affected populations, as well as relative lack of patient and physician awareness and understanding of this condition. Post-bariatric hypoglycemia (PBH) can be severe and disabling for some patients, with neuroglycopenia (altered cognition, seizures, and loss of consciousness) leading to falls, motor vehicle accidents, and job and income loss. Moreover, repeated episodes of hypoglycemia can result in hypoglycemia unawareness, further impairing safety and requiring the assistance of others to treat hypoglycemia. Evidence Acquisition In this review, we summarize and integrate data from studies of patients affected by hypoglycemia after roux-en-Y gastric bypass (RYGB) surgery, obtained from both PubMed searches (1990-2017) and reference searches of relevant retrieved articles. While hypoglycemia can also be observed following sleeve gastrectomy and fundoplication, this review is focused on post-RYGB given the greater body of published clinical studies at present. Evidence Synthesis Data addressing specific aspects of diagnosis, pathophysiology, and treatment were reviewed by the authors; when not available, the authors have provided opinions based on clinical experience with this challenging condition. Conclusions Hypoglycemia occurring after gastric bypass surgery is challenging for patients and physicians alike. This review provides a systematic approach to diagnosis and treatment based on the underlying pathophysiology. Copyright © 2018 Endocrine Society
Journal of Clinical Endocrinology and Metabolism – Oxford University Press
Published: May 4, 2018
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