Department of Surgery, Lenox Hill Hospital, and Department of Orthopedic Surgery, New York University, 186 East 76th Street, New York, NY 10021, USA.
Surg Endosc. 2011 Jun;25(6):1926-32. doi: 10.1007/s00464-010-1489-9. Epub 2010 Dec 24.
Symptoms of reactive hypoglycemia have been reported by patients after Roux-en-Y gastric bypass (RYGB) surgery who experience maladaptive eating behavior and weight regain. A 4-h glucose tolerance test (GTT) was used to assess the incidence and extent of hypoglycemia.
Thirty-six patients who were at least 6 months postoperative from RYGB were administered a 4-h GTT with measurement of insulin levels. Mean age was 49.4±11.4 years, mean preoperative body mass index (BMI) was 48.8±6.6 kg/m2, percent excess BMI lost (%EBL) was 62.6 ± 21.6%, mean weight change from nadir weight was 8.2±8.6 kg, and mean follow-up time was 40.5±26.7 months. Twelve patients had diabetes preoperatively.
Thirty-two of 36 patients (89%) had abnormal GTT. Six patients (17%) were identified as diabetic based on GTT. All six of these patients were diabetic preoperatively. Twenty-six patients (72%) had evidence of reactive hypoglycemia at 2 h post glucose load. Within this cohort of 26 patients, 14 had maximum to minimum glucose ratio (MMGR)>3:1, 5 with a ratio>4:1. Eleven patients had weight regain greater than 10% of initial weight loss (range 4.9-25.6 kg). Ten of these 11 patients (91%) with weight recidivism showed reactive hypoglycemia.
Abnormal GTT is a common finding post RYGB. Persistence of diabetes was noted in 50% of patients with diabetes preoperatively. Amongst the nondiabetic patients, reactive hypoglycemia was found to be more common and pronounced than expected. Absence of abnormally high insulin levels does not support nesidioblastosis as an etiology of this hypoglycemia. More than 50% of patients with reactive hypoglycemia had significantly exaggerated MMGR. We believe this may be due to the nonphysiologic transit of food to the small intestine due to lack of a pyloric valve after RYGB. This reactive hypoglycemia may contribute to maladaptive eating behaviors leading to weight regain long term. Our data suggest that GTT is an important part of post-RYGB follow-up and should be incorporated into the routine postoperative screening protocol. Further studies on the impact of pylorus preservation are necessary.
接受 Roux-en-Y 胃旁路术（RYGB）的患者出现适应性进食行为和体重反弹后，会出现反应性低血糖的症状。4 小时葡萄糖耐量试验（GTT）用于评估低血糖的发生率和严重程度。
对 36 例 RYGB 术后至少 6 个月的患者进行 4 小时 GTT，并测量胰岛素水平。平均年龄为 49.4±11.4 岁，术前平均体重指数（BMI）为 48.8±6.6kg/m2，BMI 过量损失百分比（%EBL）为 62.6±21.6%，从最低体重的体重变化为 8.2±8.6kg，平均随访时间为 40.5±26.7 个月。术前 12 例患者患有糖尿病。
36 例患者中有 32 例（89%）GTT 异常。根据 GTT，6 例（17%）患者被诊断为糖尿病。这 6 例患者术前均患有糖尿病。26 例（72%）患者在葡萄糖负荷后 2 小时出现反应性低血糖。在这 26 例患者中，14 例有最大至最小血糖比（MMGR）>3:1，5 例>4:1。11 例患者体重反弹超过初始体重减轻的 10%（范围为 4.9-25.6kg）。体重反弹的 11 例患者中有 10 例（91%）表现出反应性低血糖。
RYGB 术后 GTT 异常常见。术前患有糖尿病的患者中，50%的患者仍患有糖尿病。在非糖尿病患者中，发现反应性低血糖比预期更为常见和明显。无异常高胰岛素水平不支持神经内分泌细胞瘤作为低血糖的病因。超过 50%的反应性低血糖患者的 MMGR 明显增加。我们认为这可能是由于 RYGB 后缺乏幽门瓣导致食物向小肠的非生理性转移所致。这种反应性低血糖可能导致长期适应性进食行为和体重反弹。我们的数据表明，GTT 是 RYGB 术后随访的重要组成部分，应纳入常规术后筛查方案。进一步研究保留幽门对术后的影响是必要的。
