Hormonal Response to a Mixed-Meal Challenge After Reversal of Gastric Bypass for Hypoglycemia
Hormonal Response to a Mixed-Meal Challenge After Reversal of Gastric Bypass for Hypoglycemia
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DOI：
10.1210/jc.2013-1151
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发表时间：
2013-07-01
影响因子：
5.8
通讯作者：
Elahi, Dariush
中科院分区：
文献类型：
--
作者：
Lee, Clare J.;Brown, Todd;Elahi, Dariush
背景：严重低血糖是 Roux-en-Y 胃绕道手术 (RYGB) 的一种罕见且具有挑战性的并发症，其特点是餐后状态下胰岛素和肠促胰岛素激素分泌过多。 目的：本研究的目的是确定 2 名 RYGB 后低血糖患者逆转 RYGB 后对混合膳食挑战的临床和激素反应。我们假设 RYGB 的逆转将通过肠促胰素激素分泌的减弱而导致低血糖的临床改善。 设计/设置/受试者/结果测量：两名 RYGB 后低血糖患者分别在 RYGB 逆转前、后 8 个月和 18 个月接受标准化膳食耐受性测试，测量胰高血糖素样肽-1 (GLP-1)、葡萄糖依赖性促胰岛素多肽(GIP)、胰岛素和葡萄糖水平。通过将小胃袋重新连接到绕过的远端胃并切除Roux肢体以恢复食物团的正常流动来逆转胃绕道术。结果：在RYGB逆转后，两名受试者都表现出持续的低血糖证据和明显的高胰岛素血症。 RYGB 逆转后的 GLP-1 水平分别比逆转前水平下降了 76% 和 70%，降至 RYGB 后非低血糖对照水平。相比之下，RYGB逆转后的GIP水平比逆转前增加了3-10倍，是RYGB后非低血糖对照组的8-26倍。结论：RYGB逆转并不能缓解我们患者混合膳食挑战后的高胰岛素性低血糖，因此表明其作为治疗RYGB后低血糖的临床益处有限。我们的患者中 GIP 水平显着升高，同时 GLP-1 水平降低，表明 GIP 在 RYGB 逆转后持续性高胰岛素性低血糖中可能发挥作用。
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 theRYGBreversal increased by 3-10 times the level before the reversal and 8-26 times that of the nonhypoglycemic post-RYGB controls.Conclusions: Reversal of RYGB did not alleviate hyperinsulinemic hypoglycemia upon a mixed-meal challenge in our patients, thus suggesting its limited clinical benefit as treatment of post-RYGB hypoglycemia. The marked increase in GIP levels and concurrent decrease in GLP-1 levels in our patients suggest a possible role of GIP in persistent hyperinsulinemic hypoglycemia after the reversal of RYGB.