Hormonal Response to a Mixed-Meal Challenge After Reversal of Gastric Bypass for Hypoglycemia
Open accessAbstract
Context Severe hypoglycemia is a rare and challenging complication of Roux-en-Y gastric bypass (RYGB), which is characterized by hypersecretion of insulin and incretin hormones in the postprandial state. Objective The objective of the study was to determine the clinical and hormonal responses to a mixed-meal challenge after the reversal of RYGB in 2 patients with post-RYGB hypoglycemia. We hypothesized that the reversal of RYGB would lead to clinical improvement in hypoglycemia through the attenuation of incretin hormone secretion. DESIGN/SETTING/SUBJECTS/OUTCOME MEASURES: Two patients with post-RYGB hypoglycemia underwent a standardized meal tolerance test prior to and 8 and 18 months after RYGB reversal, respectively, with the measurement of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), insulin, and glucose levels. Gastric bypass was reversed by reattaching the small gastric pouch to the bypassed distal stomach and resecting the Roux limb to restore the normal flow of food bolus. Results Both subjects showed persistent evidence of hypoglycemia with marked hyperinsulinemia after the RYGB reversal. GLP-1 levels after the RYGB reversal decreased by 76% and 70%, respectively, from their prereversal levels and to the level of nonhypoglycemic post-RYGB controls. In contrast, GIP levels after the RYGB reversal increased by 3-10 times the level before the reversal and 8-26 times that of the nonhypoglycemic post-RYGB controls. Conclusions Rever…
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Various surgical re-interventions have been used, including gastric tube placement, gastric bypass reversal with or without concomitant sleeve resection and gastric pouch restriction.
“Various surgical re-interventions have been used, including gastric tube placement, gastric bypass reversal with or without concomitant sleeve resection and gastric pouch restriction (Table 5) (66,103,105-123).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [107]
Approximately 24% of patients who underwent surgical re-intervention because of refractory severe post-Roux-en-Y gastric bypass hypoglycemia received a gastric bypass reversal and approximately 9% had gastric pouch restriction.
“As shown in Table 5, approximately 24% of patients who underwent surgical re-intervention because of refractory severe post-Roux-en-Y gastric bypass hypoglycemia received a gastric bypass reversal (66,103,106-113) and approximately 9% had gastric pouch restriction (66,114,115).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [107]
Pancreatic resection, the most commonly reported procedure, was performed in approximately 67% of patients.
“Pancreatic resection, the most commonly reported procedure, was performed in approximately 67% of patients (66,103,105,107,114,116-123).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [107]
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“However, in contrast to these results, patients with PPH who undergo reversal of their operation have a reduction in their GLP-1 levels but do not see an improvement in their symptoms(190).”
Result
- Authors
- Lee, C. J., Brown, T., Magnuson, T. H., Egan, J. M., Carlson, O., & Elahi, D.
- Affiliations
- Division of Endocrinology and Metabolism (C.J.L., T.T.B.), Maryland 21224
- National Institutes of Health (US)
- University of Pennsylvania (US)
- Corresponding author
- Brown, Todd
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2013-07-01
- Volume
- 98
- Issue
- 7
- Pages
- E1208-E1212
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC5393460
- OpenAlex
- W2114533974
- Cited by
- 65
- References
- 0
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 13 · 2015: 7 · 2014: 7 · 2013: 2
- FWCI
- 9.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Johns Hopkins University
- National Institutes of Health (UL1TR000424)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- Roux-en-Y gastric bypass, postoperative hypoglycemia, hyperinsulinemic hypoglycemia, incretins, glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, mixed meal tolerance test, insulin secretion
- MeSH terms
- Insulin Secretion, Female, Gastric Inhibitory Polypeptide, Humans, Hypoglycemia, Insulin, Middle Aged, Postoperative Complications, Reoperation, Severity of Illness Index, Gastric Bypass, Treatment Outcome, Postprandial Period, Glucagon-Like Peptide 1, Meals
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