Post-bypass hypoglycaemia: a review of current findings

Gastric bypass is one of the most efficient strategies for long-term weight loss and reduction of the comorbidities associated with morbid obesity. Of the complications secondary to gastric bypass, hypoglycaemic episodes have so far been poorly studied. The present study is a comprehensive report of the fewer than 100 cases described in the literature. It shows that strict diagnostic criteria should be applied to differentiate true intense neuroglucopenic symptoms associated with low glucose values (<2.8 mmol/L) from the more frequent symptoms of the dumping syndrome and those occurring in the context of lower-than-normal plasma glucose concentrations. The pancreatic beta-cell hyperfunction initially deemed responsible for hypoglycaemic episodes because of frequent islet abnormalities is described and reappraised in this report. The few validated therapeutic options are also discussed.