Diagnostic tools for post‐gastric bypass hypoglycaemia

Abstract

In spite of its evident success, several late complications can occur after gastric bypass surgery. One of these is post-gastric bypass hypoglycaemia. No evidence-based guidelines exist in the literature on how to confirm the presence of this syndrome. This study aims to describe and compare the tests aimed at making a diagnosis of post-gastric bypass hypoglycaemia and to provide a diagnostic approach based upon the available evidence. A search was conducted in PubMed, Cochrane and Embase. A few questionnaires have been developed to measure the severity of symptoms in post-gastric bypass hypoglycaemia but none has been validated. The gold standard for provocation of a hypoglycaemic event is the oral glucose tolerance test or the liquid mixed meal tolerance test. Both show a high prevalence of hypoglycaemia in post-gastric bypass patients with and without hypoglycaemic complaints as well as in healthy volunteers. No uniformly established cut-off values for glucose concentrations are defined in the literature for the diagnosis of post-gastric bypass hypoglycaemia. For establishing an accurate diagnosis of post-gastric bypass hypoglycaemia, a validated questionnaire, in connection with the diagnostic performance of provocation tests, is the most important thing missing. Given these shortcomings, we provide recommendations based upon the current literature.

Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management

“…A systematic review of diagnostic approaches for dumping syndrome was not performed, but the most widely used approaches are described briefly herein. A more in‐depth review of the diagnosis of dumping syndrome has recently been published .…”

“…postoperative complications, strictures, adhesions and insulinoma). Hypoglycemia unawareness may develop as a result of recurrent hypoglycemia, making it even more difficult to diagnose late dumping syndrome in patients who have undergone gastric bypass surgery .…”

“…Provocative testing can be difficult in patients with small gastric pouches as a result of gastric or bariatric surgical procedures. Furthermore, the OGTT frequently detects post‐gastric bypass hypoglycemia in patients with and without symptoms, as well as in healthy individuals . Therefore, the diagnostic accuracy of this test is low and normative values have not been firmly established .…”

“…Furthermore, the OGTT frequently detects post‐gastric bypass hypoglycemia in patients with and without symptoms, as well as in healthy individuals . Therefore, the diagnostic accuracy of this test is low and normative values have not been firmly established . As a result, clinical practice guidelines for adult hypoglycemic disorders developed by the Endocrine Society do not support the use of the OGTT for diagnosing postprandial hypoglycemia .…”

Differences in Anthropometric and Metabolic Parameters Between Subjects with Hypoglycaemia and Subjects with Euglycaemia After an Oral Glucose Tolerance Test Six Months After Laparoscopic Sleeve Gastrectomy

“…This biochemical definition of hypoglycaemia is divergent to the defined Whipple triad for hypoglycaemia [13]; however, blood glucose levels below 60 mg/dl has been shown on a number of physiological studies that can result in counter regulatory responses [14]. Moreover, multiple previous studies have used the cutoff of 60 mg/dl in glucose levels-independently of symptomsto define the postprandial hypoglycaemia after bariatric surgery during an OGTT or mixed meal test [15][16][17]. The occurrence of dumping syndrome symptoms was monitored during the OGTT preoperatively and postoperatively with the use of two questionnaires-the Sigstad score and Arts' questionnaire-as have been previously described [18].…”