Roux-en-Y gastric bypass surgery (RYGB) promotes long term remission of T2D in up to 90% of patients. Approximately 38%, however, develop post bariatric hypoglycemia (PBH), with 11.8%. Why some and not others develop this complication is unknown. We have previously shown that altered nutrient transit, with overstimulation of hind gut causes postprandial hypoglycemia via hypersecretion of GLP1 and insulin, which is reversible by restoring normal route of nutrient transit or by blocking GLP1. We hypothesized that following surgery, individuals with faster pouch emptying would comprise a group at higher risk for developing PBH. We tested this hypothesis by quantifying pouch emptying rates in post-RYGB patients with and without PBH.15 RYGB patients with PBH, 10 postsurgical controls (without PBH), and 12 nonsurgical BMI-matched controls underwent a solid meal scintigraphy with dynamic imaging for 60 minutes followed by additional imaging at 2, 3, and 4 hours to quantify pouch emptying rate. Both PBH and postsurgical controls had markedly accelerated pouch emptying as compared to nonsurgical controls (p=9.8E-7, and 0.0059, respectively). The PBH group had significantly faster emptying at 1-hour in comparison to the post-surgical controls (5.9% vs 17.8% residual, respectively; p=0.024).
Conclusion: PBH individuals have more rapid pouch emptying versus post-surgical controls, pointing to a potential route for treatment or prevention of PBH.
N. Turk: None. F. Moradi: Research Support; GE health care, Ashvattha Therapeutics. E.M. Ayhan: None. T. McLaughlin: Stock/Shareholder; Eiger BioPharmaceuticals. Board Member; January, Inc. Research Support; Eli Lilly and Company, Weight Watchers International, Merck & Co., Inc., Vogenyx.
American Diabetes Association (1-19-ICTS-073)
