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Review
. 2020 Nov 19:13:4469-4482.
doi: 10.2147/DMSO.S233078. eCollection 2020.

Hypoglycemia After Upper Gastrointestinal Surgery: Clinical Approach to Assessment, Diagnosis, and Treatment

Amanda Sheehan  1 , Mary Elizabeth Patti  1   2
Affiliations
Review

Hypoglycemia After Upper Gastrointestinal Surgery: Clinical Approach to Assessment, Diagnosis, and Treatment

Amanda Sheehan et al. Diabetes Metab Syndr Obes. .

Abstract

Context: Post-bariatric hypoglycemia (PBH) is an increasingly encountered complication of upper gastrointestinal surgery; the prevalence of this condition is anticipated to rise given yearly increases in bariatric surgical procedures. While PBH is incompletely understood, there is a growing body of research describing the associated factors, mechanisms, and treatment approaches for this condition.

Evidence acquisition: Data are integrated and summarized from studies of individuals affected by PBH and hypoglycemia following upper gastrointestinal surgery obtained from PubMed searches (1990-2020).

Evidence synthesis: Information addressing etiology, incidence/prevalence, clinical characteristics, assessment, and treatment were reviewed and synthesized for the practicing physician. Literature reports were supplemented by clinical experience as indicated, when published data were not available.

Conclusion: PBH can be life-altering and severe for a subset of individuals. Given the chronic nature of this condition, and sequelae of both acute and recurrent episodes, increasing provider awareness of both the condition and associated risk factors is critical for assessment, prompt diagnosis, treatment, and preoperative identification of individuals at risk.

Keywords: bariatric surgery; hypoglycemia; post-bariatric hypoglycemia; upper gastrointestinal surgery.

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Conflict of interest statement

MEP has been a coinvestigator on an NIH R44 grant together with Xeris Pharmaceuticals. MEP has consulted for Eiger Pharmaceuticals, has received investigator-initiated grant support from Janssen Pharmaceuticals, Dexcom, Medimmune, Sanofi, Astra-Zeneca, Jenesis, and Nuclea, has been a site investigator for XOMA and Xeris, acknowledges clinical trial research trial product support from Ethicon, Covidien, NovoNordisk, Nestle, and Dexcom within the past 5 years, and reports personal fees from Fractyl and grant support from Chan-Zuckerberg Initiative, and Helmsley Trust, during the conduct of the study. In addition, MEP has a patent hypoglycemia treatment issued for hypoglycemia markers and has submitted a patent application regarding plasma proteins contributing to hypoglycemia and pump therapies for hypoglycemia. The authors report no other potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
Mechanisms of hypoglycemia after upper gastrointestinal surgery. *indicates that information about hypoglycemia after fundoplication and other upper GI surgeries is limited, and largely from published case reports and clinical experience.
See this image and copyright information in PMC

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