Hyperinsulinemic hypoglycemia after gastric bypass surgery: what's up and what's down?
Hyperinsulinemic hypoglycemia after gastric bypass surgery: what's up and what's down?
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DOI：
10.1038/ijo.2017.257
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发表时间：
2017-10-13
期刊：
影响因子：
--
通讯作者：
Salehi M
中科院分区：
文献类型：
--
作者：
Yaqub A;Smith EP;Salehi M
肥胖症是一个全球性的公共卫生问题，在大多数肥胖者中，试图用有或没有药物干预的生活方式来治疗这种疾病的尝试都没有成功。到目前为止，治疗肥胖症最有效的方法是减肥手术。Roux-en-Y胃旁路手术(RYGB)是全球最广泛使用的治疗肥胖症的手术之一，已被证明除了显著和可持续的体重减轻外，还可以诱导糖尿病缓解。在过去的二十年里，随着这种手术的数量的增加，很明显，有一部分人在手术后几年会出现餐后低血糖。RYGB的这种衰弱的晚期并发症通常与意识丧失或癫痫发作有关，在严重的情况下，它对改变饮食或其他可用的治疗方案只有部分反应。诊断往往是一项挑战，导致延迟接受受影响个人的护理。虽然其潜在的机制目前仍在研究中，但越来越多的证据表明，膳食来源的营养物质对全身循环的夸大外观以及进食后胰岛和肠道激素反应的改变在这种疾病的发病机制中发挥了作用。本综述的目的是强调有关RYGB这一危及生命的并发症的新视角。将在文献回顾的基础上讨论倾销的病因、诊断、如何与经典倾销和当前可用的治疗方法相区分的建议。此外，胃旁路术后易患低血糖综合征的生理变化也将被强调。
Obesity is a global public health problem and attempts to treat this condition using life style with and without pharmacological interventions have not been successful in majority of obese individuals. To date, the most effective treatment for obesity is weight loss surgery. One of the most widely used procedures to treat obesity worldwide, Roux-en-Y gastric bypass surgery (RYGB), has shown to induce diabetes remission in addition to significant and sustainable weight loss. As the number of this procedure performed over the last two decades increased, it has become clear that a subgroup of individuals develop postprandial hypoglycemia several years after surgery. This debilitating late complication of RYGB is often associated with loss of consciousness or seizures, and in severe cases, it is only partially responsive to diet modification or other available therapeutic options. The diagnosis is often a challenge resulting in delays in receiving care in the affected individuals. Although the underlying mechanisms are under current investigations, growing evidence suggest that a combination of exaggerated meal-derived nutrient appearance to systemic circulation and altered islet and gut hormone response after eating have a role in pathogenesis of this condition. The goal of this review is to highlight new perspectives regarding this life-threatening complication of RYGB. The etiology, diagnosis, recommendation on how to distinguish from classic dumping and current available treatment based on literature review will be discussed. In addition, physiologic changes after gastric bypass predisposing to hypoglycemia syndrome will be highlighted.
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影响因子：
158.5
作者：
BANTLE, JP;LAINE, DC;GOETZ, FC
通讯作者：
GOETZ, FC
影响因子：
16.2
作者：
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DOI：
10.1001/jama.2016.7602
发表时间：
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期刊：
JAMA
影响因子：
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作者：
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通讯作者：
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影响因子：
7.7
作者：
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通讯作者：
Eriksson, Jan W.
影响因子：
9.8
作者：
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通讯作者：
BARBARINO, A