Roux en Y gastric bypass hypoglycemia resolves with gastric feeding or reversal: Confirming a non-pancreatic etiology.
Roux en Y gastric bypass hypoglycemia resolves with gastric feeding or reversal: Confirming a non-pancreatic etiology.
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DOI：
10.1016/j.molmet.2017.12.011
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发表时间：
2018-03
影响因子：
8.1
通讯作者：
Campos GM
中科院分区：
文献类型：
--
作者：
Davis DB;Khoraki J;Ziemelis M;Sirinvaravong S;Han JY;Campos GM
餐后低血糖是Roux-en-Y胃旁路手术（RYGB）的一种罕见但致残的并发症。关于观察到的餐后高胰岛素血症是由于胰腺β细胞质量或功能的固有变化还是由于RYGB解剖结构引起的可逆性改变，仍然存在争议。我们的目的是确定胃饲或逆转RYGB是否会使症状性低血糖患者的餐后血糖和激素波动正常化。我们完成了一项前瞻性研究，6例严重症状性RYGB低血糖患者接受RYGB逆转。还前瞻性研究了另一例接受RYGB逆转的无低血糖受试者。在RYGB设置中以及在RYGB逆转后数月，经口（RYGB解剖学）、经由胃造口术管在排除的胃中进行混合餐耐受性测试（MTT）。所有受试者均报告在RYGB逆转后低血糖症状改善。逆转后的体重增加是中度和可变的。餐后血糖、胰岛素和GLP-1波动在胃饲和逆转后显著减少。胰岛素分泌与葡萄糖水平成正比，逆转后胰岛素清除率增加。整个研究期间胰高血糖素/胰岛素比值相似。我们进一步比较了改良袖状胃切除术逆转术与全胃切除术的影响，发现体重恢复或餐后血糖或激素水平无显著差异。恢复RYGB是严重餐后低血糖的有效治疗选择。这种疾病的病理生理学主要是由于RYGB解剖结构导致葡萄糖、肠道和胰腺激素水平改变以及胰岛素清除率降低，而不是固有的β细胞增生或功能亢进。低血糖受试者胃饲和转流的前瞻性研究。肠道解剖结构的改变是餐后血糖和激素波动的主要驱动因素。在胃旁路相关低血糖中，β细胞功能不会发生固有改变。转流术是治疗胃转流相关低血糖的有效方法。
Postprandial hypoglycemia is an infrequent but disabling complication of Roux-en-Y gastric bypass (RYGB) surgery. Controversy still exists as to whether the postprandial hyperinsulinemia observed is due to inherent changes in pancreatic β-cell mass or function or to reversible alterations caused by RYGB anatomy. We aimed to determine if gastric feeding or reversal of RYGB would normalize postprandial glucose and hormone excursions in patients with symptomatic hypoglycemia. We completed a prospective study of six patients with severe symptomatic RYGB hypoglycemia who underwent RYGB reversal. An additional subject without hypoglycemia who underwent RYGB reversal was also studied prospectively. Mixed meal tolerance testing (MTT) was done orally (RYGB anatomy), via gastrostomy tube in the excluded stomach in the setting of RYGB, and several months after RYGB reversal. All subjects reported symptomatic improvement of hypoglycemia after reversal of RYGB. Weight gain after reversal was moderate and variable. Postprandial glucose, insulin, and GLP-1 excursions were significantly diminished with gastric feeding and after reversal. Insulin secretion changed proportional to glucose levels and insulin clearance increased after reversal. Glucagon/insulin ratios were similar throughout study. We further compared the impact of modified sleeve gastrectomy reversal surgery to those with restoration of complete stomach and found no significant differences in weight regain or in postprandial glucose or hormone levels. Reversal of RYGB is an effective treatment option for severe postprandial hypoglycemia. The pathophysiology of this disorder is primarily due to RYGB anatomy resulting in altered glucose, gut, and pancreatic hormone levels and decreased insulin clearance, rather than inherent β-cell hyperplasia or hyperfunction. Prospective study of gastric feeding and bypass reversal in hypoglycemic subjects. Altered gut anatomy is the main driver of postmeal glucose and hormone excursions. Beta-cell function is not inherently altered in gastric-bypass related hypoglycemia. Bypass reversal is effective therapy for gastric-bypass related hypoglycemia.
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影响因子：
6.9
作者：
Lee, Clare J.;Clark, Jeanne M.;Schweitzer, Michael;Magnuson, Thomas;Steele, Kimberley;Koerner, Olivia;Brown, Todd T.
通讯作者：
Brown, Todd T.
影响因子：
5.8
作者：
Lee, Clare J.;Brown, Todd;Elahi, Dariush
通讯作者：
Elahi, Dariush
影响因子：
8.2
作者：
Marsk, R.;Jonas, E.;Naslund, E.
通讯作者：
Naslund, E.
影响因子：
5.8
作者：
Myint, K. S.;Greenfield, J. R.;Finer, N.
通讯作者：
Finer, N.
影响因子：
5.8
作者：
Abrahamsson, Niclas;Engstrom, Britt Eden;Karlsson, F. Anders
通讯作者：
Karlsson, F. Anders