Postprandial hypoglycemia after upper gastrointestinal tract surgery: prevalence and pathophysiology (part 1)

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Abstract

Nowadays obesity is a major health problem worldwide. Surgery is the most promising treatment for morbid obesity. There are two types of bariatric procedures, one to reduce the food intake volume and the other to limit the absorption of nutrients. Despite the indisputable advantages of bariatric surgery for weight loss, it is necessary to remember the potential risk of severe complications, such as hypoglycemic syndrome at 2 to 3 hours after ingestion of rapidly absorbable carbohydrates manifested by adrenergic and neuroglycopenic symptoms. According to the literature, the prevalence of post-bariatric postprandial hyperinsulinemic hypoglycemia (PHH) varies from 10% to 75%. PHH in post-bariatric patients should be differentiated from the syndrome of non-insulinoma pancreatogenic hypoglycemia and from insulinoma; however, these diseases are described also in patients after bariatric surgery.

The mechanisms of PHH as an outcome of shunting bariatric procedures are currently not fully clear. According to the recent studies, incretin hypersecretion in response to the accelerated flow of carbohydrates into the small intestine plays a leading role in the inappropriate excess production of insulin by the pancreas. In addition, there are hypotheses on a slower normalization of insulin production during more rapid bodyweight decrease and regression of insulin resistance, the role of alpha-cell dysfunction, disturbed negative feedback between insulin and ghrelin, compensatory hyperplasia and hypertrophy of the remaining enterocytes (including L-cells), changes in gut microflora, bile acids level and composition. A number of other mechanisms have also been proposed that require further studies.

About the authors

M. Yu. Yukina

National Medical Research Center for Endocrinology

Author for correspondence.
Email: endo-yukina@yandex.ru
ORCID iD: 0000-0002-8771-8300

Marina Yu. Yukina - MD, PhD, Leading Research Fellow, Department of Therapeutic Endocrinology.

11 Dm. Ul'yanovа ul., Moscow, 117036.

Tel.: +7 (495) 668 20 73.

Russian Federation

M. O. Chernova

National Medical Research Center for Endocrinology

Email: fake@neicon.ru
ORCID iD: 0000-0002-7250-4588

Maria O. Chernova – Resident.

11 Dm. Ul'yanovа ul., Moscow, 117036.

Russian Federation

E. A. Troshina

National Medical Research Center for Endocrinology

Email: fake@neicon.ru
ORCID iD: 0000-0002-8520-8702

Ekaterina A. Troshina - MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director of the Institute of Clinical Endocrinology.

11 Dm. Ul'yanovа ul., Moscow, 117036.

Russian Federation

V. V. Evdoshenko

Institute of Plastic Surgery and Cosmetology; N.I. Pirogov Russian National Research Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0002-1339-4868

Vladimir V. Evdoshenko - MD, PhD, Head of the Clinical Center for Surgery of Overweight and Metabolic Disorders, Institute of Plastic Surgery and Cosmetology; Professor, Chair of Experimental and Clinical Surgery, Biomedical Faculty, N.I. Pirogov Russian National Research Medical University.

27 Ol'khovskaya ul., Moscow, 105066; 1 Ostrovityanova ul., Moscow, 117997.

Russian Federation

N. M. Platonova

National Medical Research Center for Endocrinology

Email: fake@neicon.ru
ORCID iD: 0000-0001-6388-1544

Nadezhda M. Platonova - MD, PhD, Head of Department of Therapeutic Endocrinology.

11 Dm. Ul'yanovа ul., Moscow, 117036.

Russian Federation

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