Symptoms of dumping syndrome and post-bariatric hypoglycaemia (PBH) appears to be more prevalent after RYGB, compared to LSG, whilst persistent T2D seems to be a protective factor against PBH symptoms, researchers from Örebro University, Örebro, Sweden, have found. The findings were reported in the paper, ‘Prevalence of dumping and hypoglycaemia symptoms after bariatric surgery: A questionnaire-based cross-sectional study’, published in Clinical Obesity.
Dumping syndrome and late dumping syndrome, now called post-bariatric hypoglycaemia (PBH) are both complications from bariatric surgery. The former usually occurs within the first few hours after a meal due to the rapid passage of undigested food into the jejunum. Whereas the latter, a type of hyperinsulinemic hypoglycaemia, usually more than one year after bariatric surgery. Both symptomatic dumping and hypoglycaemia can result in a significant reduction in quality of life.
The Dumping Severity Scale (DSS) also used to assess symptoms of dumping and hypoglycaemia after bariatric surgery and has been translated into Swedish (DSS-Swe). The DSS-Swe includes eight items regarding dumping symptoms and six items regarding hypoglycaemia symptoms.
According to the researchers, the aim of this study was to estimate the prevalence of symptoms of dumping and hypoglycaemia before bariatric surgery, as well as at six months, one year, two years and five years after RYGB and LSG. Information on baseline characteristics, surgery and follow-up was based on data from the Scandinavian Obesity Surgery Registry (SOReg).
Outcomes
In total, 742 questionnaires from 634 unique individuals were included in the study, with 99 patients completing the DSS-Swe questionnaire at two or more separate time points.
The average age at surgery was 42.0 years with most patients undergoing RYGB (66.3%). The proportion of patients with symptoms consistent with highly suspected dumping increased from 5.3% before surgery to 20.3% at the five-year follow-up, with an odds ratio (OR) of 5.08 after adjustment for surgical procedure, sex, BMI and T2D at baseline.
The proportion of patients with highly suspected hypoglycaemia increased from 1.6% to 14.8%, with an adjusted OR of 12.19. The proportion of highly suspected dumping in RYGB patients increased from 4.9% before surgery to 26.3% at the five-year follow-up. For SG patients, no significant increase in dumping symptoms was observed during follow-up compared to baseline.
The proportion of RYGB patients with highly suspected PBH increased from 1.4% before surgery to 19.3% at five-year follow-up. In patients who underwent SG, there was a nonsignificant increase in the prevalence of PBH symptoms from 2.1% to 5.7%. For patients who underwent RYGB, the two-year follow-up was the first time a significant increase in PBH symptoms was observed. However, after SG, no increase was reported.
At five-years, there was a significantly greater risk of developing dumping symptoms when adjusted for BMI, sex and T2D at baseline, and PBH symptoms in RYGB patients vs. SG patients. None of the patients with persistent T2D reported symptoms consistent with highly suspected PBH after RYGB or after SG.
“A clear increase in the prevalence of symptoms consistent with dumping and PBH was reported by patients who underwent RYGB, while no major difference was reported among patients who underwent SG,” stated. “This finding is consistent with the results of previous studies.”
There was also a clear difference between patients with and without T2D at follow-up, with none of the patients with T2D at follow-up reported pronounced symptoms of hypoglycaemia. Therefore, T2D appears to be a protective factor against the development of hypoglycaemic symptoms, which may be explained by the decreased insulin sensitivity in patients with persistent T2D. Insulin sensitivity has previously been reported to be greater in patients who suffer from PBH.
The significant increase in hypoglycaemic symptoms after RYGB was first demonstrated at two-year follow-up, suggesting that the median time between surgery and the development of symptomatic PBH is usually 2–3 years.
“It is important to realise that the DSS-Swe should not be used for diagnostic purposes, but rather as a screening tool with the aim of identifying those individuals who should be investigated further,” they cautioned.
The researchers added that as the Swedish bariatric surgical population is similar to those of many other European countries, the results of this study could, with caution, be generalised to patients undergoing bariatric surgery in other parts of Europe as well.
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