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. 2025 Aug;35(8):2915-2925.
doi: 10.1007/s11695-025-07929-y. Epub 2025 Jun 6.

The Value of Liquid and Solid Mixed Meal Tolerance Tests in Diagnosis of Postprandial Reactive Hypoglycaemic Syndrome After Gastric Bypass Surgery

Stéphanie Desmedt  1 , Joke Marlier  2 , Frederique Van de Velde  2 , Yves Van Nieuwenhove  2 , Arsene-Helene Batens  2 , Imke Matthys  2 , Bruno Lapauw  3
Affiliations

The Value of Liquid and Solid Mixed Meal Tolerance Tests in Diagnosis of Postprandial Reactive Hypoglycaemic Syndrome After Gastric Bypass Surgery

Stéphanie Desmedt et al. Obes Surg. 2025 Aug.

Abstract

Background: Precise diagnostics for postprandial reactive hypoglycaemic syndrome (PRHS) after gastric bypass surgery (GBS) are lacking. Oral glucose tolerance tests (OGTT) are advocated but might cause early dumping and lack specificity. This study aims to evaluate glucometabolic responses and symptoms during liquid and solid mixed meal tolerance tests (LMMTT and SMMTT).

Methods: Twenty-two subjects at least 1 year after GBS, divided into PRHS and non-PRHS based on clinical assessment and 14 control subjects (6 normal-weight, 8 with obesity) participated. All underwent 3-h LMMTT and SMMTT during which glucometabolic responses as well as hypoglycaemic symptoms using the Edinburgh hypoglycaemia symptom scale (EHSS) were assessed.

Results: During LMMTT, nadir glucose levels nor frequency of levels < 70 mg/dl and < 54 mg/dl did differ between groups. LMMTT could not differentiate between PRHS and non-PRHS in terms of total count of symptoms, and the number of symptoms was not associated with low glycaemia. During SMMTT, glucometabolic responses were similar between PRHS and non-PRHS. However, significantly more hypoglycaemic symptoms were evocated in the group with PRHS compared to those without during the second phase of SMMTT, with more neuroglycopenic and malaise symptoms in the subjects with PRHS. The decrease rate of glucose was higher in subjects with PRHS with malaise symptoms from 105 to 180 min compared to those without malaise.

Conclusion: LMMTT is not able to differentiate hypoglycaemic symptoms and low glycaemic values between subjects with PRHS and subjects without PRHS, whereas SMMTT could be of greater value. The clinical value of set glucose levels and the use of other biochemical parameters used to diagnose PRHS needs to be further evaluated.

Keywords: Bariatric surgery; Mixed meal test; Postprandial reactive syndrome.

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Conflict of interest statement

Declarations. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent: Informed consent was obtained from all individual participants included in the study. Conflict of interest: The authors declare no competing interests.

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