Dumping syndrome and postbariatric hypoglycemia: supporting evidence for a common etiology.

ABSTRACT Background Dumping syndrome (DS) and postbariatric hypoglycemia (PBH) are frequent complications of bariatric surgery. Previously known as ‘early and late dumping', they have been separated due to differences in onset and behavior of disease. Objectives To investigate a potential common etiology of DS and PBH using an analysis of a Mixed Meal Test (MMT) study. Setting A large teaching hospital in the Netherlands. Methods From all patients who underwent bariatric surgery in 2008-2011, a random selection completed a MMT (n=47). Patients scored complaints related to DS and PBH with a standardized questionnaire at several time intervals. The groups were divided in patients with (DS+, N=22) and without (DS-, N=25) an increase of DS symptoms after start of the MMT. Glucose and gut hormone levels were compared. Hypoglycemia was defined as blood glucose below 3.3 mmol/L. Results The DS+ group had lower blood glucose values compared to DS-, which reached significance at t=90 and 120 min (P Conclusion Patients with DS complaints had lower postprandial glucose values. GLP-1 and PYY were elevated in the DS+ group early and late during the test. These hormones also correlated with DS. These findings support the hypothesis of a common etiology of DS and PBH and a role of GLP-1 and PYY in both complications.