Ashna Grover, Maryam Farahmandsadr, Hamayle Saeed, Cameron Cummings, Amanda Sheehan, Lei Pei, Donald C. Simonson, Mary Elizabeth Patti
{"title":"确定胃旁路术后出现和未出现减肥后低血糖症患者的临床特征。","authors":"Ashna Grover, Maryam Farahmandsadr, Hamayle Saeed, Cameron Cummings, Amanda Sheehan, Lei Pei, Donald C. Simonson, Mary Elizabeth Patti","doi":"10.1111/cen.15169","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Context</h3>\n \n <p>Post-bariatric hypoglycemia (PBH) is a complication of bariatric surgery including Roux-en-Y gastric bypass (RYGB). It remains unclear why only some individuals develop PBH.</p>\n </section>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>To identify clinical characteristics distinguishing post-RYGB individuals with PBH, versus without symptomatic hypoglycemia (RYGB non-hypo).</p>\n </section>\n \n <section>\n \n <h3> Design and Setting</h3>\n \n <p>Cross-sectional observational study in academic referral centre. Adults 18–70, without current diabetes, were recruited into three groups: (1) PBH (<i>n</i> = 39); (2) RYGB non-hypo (<i>n</i> = 25); and (3) individuals without history of upper gastrointestinal surgery (<i>n</i> = 17). Outcome measures included between-group differences in medical history and medication use, and survey-based scores for hypoglycemia, dumping syndrome, and autonomic symptoms.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>PBH participants were 92% female, age 53.4 ± 11.9 y, BMI 31.2 ± 5.6 kg/m<sup>2</sup>, versus RYGB non-hypo (100% female, age 53.2 ± 10.5 y, BMI 32.2 ± 8.0 kg/m<sup>2</sup>) and controls (65% female, age 44.5 ± 14.6 y, BMI 30.8 ± 6.3 kg/m<sup>2</sup>). 87% of PBH reported level 3 hypoglycemia, with emergency visits in 28% and vehicle accidents in 8%. Reduced hypoglycemia awareness was reported by 82%; 13%–17% were classified as unaware (modified Clarke/Gold scores). Preoperative hypoglycemia symptoms and family history were reported by 26% and 18% of PBH. PBH had significantly higher survey scores for hypoglycemia, dumping syndrome, and autonomic symptoms, and higher self-reported neuropathy, autonomic neuropathy, orthostatic hypotension, reflux esophagitis, intestinal dysmotility, and IBS (all <i>p</i> < 0.05 vs. RYGB non-hypo). Gabapentin and PPI use was more frequent in PBH.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>High rates of IBS, dumping symptoms, and orthostatic hypotension suggest disordered autonomic regulation as a potential contributor to PBH. Self-reported preoperative symptoms and family history of hypoglycemia suggest possible preoperative differences in glucose metabolism in PBH.</p>\n </section>\n </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"102 2","pages":"111-120"},"PeriodicalIF":3.0000,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Defining Clinical Characteristics of Individuals With and Without Post-Bariatric Hypoglycemia After Gastric Bypass\",\"authors\":\"Ashna Grover, Maryam Farahmandsadr, Hamayle Saeed, Cameron Cummings, Amanda Sheehan, Lei Pei, Donald C. Simonson, Mary Elizabeth Patti\",\"doi\":\"10.1111/cen.15169\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Context</h3>\\n \\n <p>Post-bariatric hypoglycemia (PBH) is a complication of bariatric surgery including Roux-en-Y gastric bypass (RYGB). It remains unclear why only some individuals develop PBH.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To identify clinical characteristics distinguishing post-RYGB individuals with PBH, versus without symptomatic hypoglycemia (RYGB non-hypo).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Design and Setting</h3>\\n \\n <p>Cross-sectional observational study in academic referral centre. Adults 18–70, without current diabetes, were recruited into three groups: (1) PBH (<i>n</i> = 39); (2) RYGB non-hypo (<i>n</i> = 25); and (3) individuals without history of upper gastrointestinal surgery (<i>n</i> = 17). Outcome measures included between-group differences in medical history and medication use, and survey-based scores for hypoglycemia, dumping syndrome, and autonomic symptoms.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>PBH participants were 92% female, age 53.4 ± 11.9 y, BMI 31.2 ± 5.6 kg/m<sup>2</sup>, versus RYGB non-hypo (100% female, age 53.2 ± 10.5 y, BMI 32.2 ± 8.0 kg/m<sup>2</sup>) and controls (65% female, age 44.5 ± 14.6 y, BMI 30.8 ± 6.3 kg/m<sup>2</sup>). 87% of PBH reported level 3 hypoglycemia, with emergency visits in 28% and vehicle accidents in 8%. Reduced hypoglycemia awareness was reported by 82%; 13%–17% were classified as unaware (modified Clarke/Gold scores). Preoperative hypoglycemia symptoms and family history were reported by 26% and 18% of PBH. PBH had significantly higher survey scores for hypoglycemia, dumping syndrome, and autonomic symptoms, and higher self-reported neuropathy, autonomic neuropathy, orthostatic hypotension, reflux esophagitis, intestinal dysmotility, and IBS (all <i>p</i> < 0.05 vs. RYGB non-hypo). Gabapentin and PPI use was more frequent in PBH.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>High rates of IBS, dumping symptoms, and orthostatic hypotension suggest disordered autonomic regulation as a potential contributor to PBH. Self-reported preoperative symptoms and family history of hypoglycemia suggest possible preoperative differences in glucose metabolism in PBH.</p>\\n </section>\\n </div>\",\"PeriodicalId\":10346,\"journal\":{\"name\":\"Clinical Endocrinology\",\"volume\":\"102 2\",\"pages\":\"111-120\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-11-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Endocrinology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/cen.15169\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Endocrinology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cen.15169","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Defining Clinical Characteristics of Individuals With and Without Post-Bariatric Hypoglycemia After Gastric Bypass
Context
Post-bariatric hypoglycemia (PBH) is a complication of bariatric surgery including Roux-en-Y gastric bypass (RYGB). It remains unclear why only some individuals develop PBH.
Objective
To identify clinical characteristics distinguishing post-RYGB individuals with PBH, versus without symptomatic hypoglycemia (RYGB non-hypo).
Design and Setting
Cross-sectional observational study in academic referral centre. Adults 18–70, without current diabetes, were recruited into three groups: (1) PBH (n = 39); (2) RYGB non-hypo (n = 25); and (3) individuals without history of upper gastrointestinal surgery (n = 17). Outcome measures included between-group differences in medical history and medication use, and survey-based scores for hypoglycemia, dumping syndrome, and autonomic symptoms.
Results
PBH participants were 92% female, age 53.4 ± 11.9 y, BMI 31.2 ± 5.6 kg/m2, versus RYGB non-hypo (100% female, age 53.2 ± 10.5 y, BMI 32.2 ± 8.0 kg/m2) and controls (65% female, age 44.5 ± 14.6 y, BMI 30.8 ± 6.3 kg/m2). 87% of PBH reported level 3 hypoglycemia, with emergency visits in 28% and vehicle accidents in 8%. Reduced hypoglycemia awareness was reported by 82%; 13%–17% were classified as unaware (modified Clarke/Gold scores). Preoperative hypoglycemia symptoms and family history were reported by 26% and 18% of PBH. PBH had significantly higher survey scores for hypoglycemia, dumping syndrome, and autonomic symptoms, and higher self-reported neuropathy, autonomic neuropathy, orthostatic hypotension, reflux esophagitis, intestinal dysmotility, and IBS (all p < 0.05 vs. RYGB non-hypo). Gabapentin and PPI use was more frequent in PBH.
Conclusion
High rates of IBS, dumping symptoms, and orthostatic hypotension suggest disordered autonomic regulation as a potential contributor to PBH. Self-reported preoperative symptoms and family history of hypoglycemia suggest possible preoperative differences in glucose metabolism in PBH.
期刊介绍：
Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.
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