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Background <p>Postprandial hypoglycemia (PH) is a significant complication following upper gastrointestinal (GI) surgery, characterized by postprandial glucose fluctuations and diverse clinical manifestations. Its complex pathophysiology poses challenges in timely diagnosis and effective management.</p> Methods <p>This narrative review synthesizes current literature on PH following upper GI surgeries, exploring its pathophysiology, risk factors, clinical presentation, diagnostic approaches, and treatment strategies. Diagnostic methods, including plasma glucose measurement, continuous glucose monitoring, and glycemic pattern analysis, are evaluated. Management strategies, such as dietary modifications (e.g., low-carbohydrate, high-protein diets), pharmacologic interventions (e.g., acarbose, somatostatin analogs, GLP-1 receptor antagonists, dasiglucagon), and surgical/endoscopic approaches, are reviewed for their efficacy across different patient populations.</p> Results <p>PH is driven by multifactorial mechanisms, including exaggerated insulin secretion, incretin overproduction (GLP-1, GIP), altered glucose absorption, and autonomic dysfunction. Bariatric procedures, particularly Roux-en-Y gastric bypass (RYGB), and surgeries causing dumping syndrome significantly contribute to its development. Elevated GLP-1 and polypeptide YY levels, reduced renal gluconeogenesis, and bile acid metabolism alterations further complicate its pathogenesis. Management outcomes highlight the need for individualized and multidisciplinary approaches to improve symptom control and quality of life.</p> Conclusion <p>Given the increasing prevalence of upper GI surgeries, the incidence of PH is expected to rise. This review underscores the necessity of early recognition, accurate diagnosis, and tailored interventions to mitigate complications and enhance patient outcomes. A proactive approach to identifying health issues earlier, ensuring that interventions are not only prompt but also practical. Future research should focus on refining predictive markers, optimizing treatment strategies, and developing innovative approaches to improve long-term management and quality of life for affected individuals.</p>

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Postprandial hypoglycemia following upper gastrointestinal tract surgery: Pathophysiology, Diagnosis, and Management Strategies: a narrative review

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年5月7日

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  • Fatemeh Mohammadyari,
  • Amirreza Aflak,
  • Soroush mahdavi hezaveh,
  • Alireza Eidi,
  • Yalda Taati-Alamdari,
  • Zahra Hamidi,
  • Maral Najipoor,
  • Sepehr Olangian-Tehrani

摘要

Background

Postprandial hypoglycemia (PH) is a significant complication following upper gastrointestinal (GI) surgery, characterized by postprandial glucose fluctuations and diverse clinical manifestations. Its complex pathophysiology poses challenges in timely diagnosis and effective management.

Methods

This narrative review synthesizes current literature on PH following upper GI surgeries, exploring its pathophysiology, risk factors, clinical presentation, diagnostic approaches, and treatment strategies. Diagnostic methods, including plasma glucose measurement, continuous glucose monitoring, and glycemic pattern analysis, are evaluated. Management strategies, such as dietary modifications (e.g., low-carbohydrate, high-protein diets), pharmacologic interventions (e.g., acarbose, somatostatin analogs, GLP-1 receptor antagonists, dasiglucagon), and surgical/endoscopic approaches, are reviewed for their efficacy across different patient populations.

Results

PH is driven by multifactorial mechanisms, including exaggerated insulin secretion, incretin overproduction (GLP-1, GIP), altered glucose absorption, and autonomic dysfunction. Bariatric procedures, particularly Roux-en-Y gastric bypass (RYGB), and surgeries causing dumping syndrome significantly contribute to its development. Elevated GLP-1 and polypeptide YY levels, reduced renal gluconeogenesis, and bile acid metabolism alterations further complicate its pathogenesis. Management outcomes highlight the need for individualized and multidisciplinary approaches to improve symptom control and quality of life.

Conclusion

Given the increasing prevalence of upper GI surgeries, the incidence of PH is expected to rise. This review underscores the necessity of early recognition, accurate diagnosis, and tailored interventions to mitigate complications and enhance patient outcomes. A proactive approach to identifying health issues earlier, ensuring that interventions are not only prompt but also practical. Future research should focus on refining predictive markers, optimizing treatment strategies, and developing innovative approaches to improve long-term management and quality of life for affected individuals.