Effects of Semaglutide on Dumping Syndrome and Reactive Hypoglycemia After Bariatric Surgery: A Systematic Review and...

Dumping syndrome and reactive hypoglycemia are common complications after bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB). Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has emerged as a potential therapeutic option, but evidence regarding its efficacy remains scattered.

This study aims to systematically evaluate the effects of semaglutide on dumping syndrome symptoms and reactive hypoglycemia in post-bariatric surgery patients.

We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to September 2025. Randomized controlled trials and observational studies evaluating semaglutide in post-bariatric surgery patients with dumping syndrome or reactive hypoglycemia were included. Primary outcomes were changes in dumping symptom scores and hypoglycemic episode frequency. Random-effects meta-analyses were performed.

Seven studies (three RCTs, three cohort studies, one case series) with 337 patients were included. Semaglutide significantly improved dumping symptom scores (standardized mean difference [SMD] -1.18; 95% CI -1.64 to -0.72; p < 0.001; I² = 39%) and reduced hypoglycemic episodes (SMD -0.85; 95% CI -1.22 to -0.48; p < 0.001; I² = 35%). Quality of life improved significantly (SMD 0.73; 95% CI 0.38-1.08; p < 0.001). Glycemic variability decreased (SMD -0.71; 95% CI -1.08 to -0.34; p < 0.001), as did time in hypoglycemia (SMD -0.62; 95% CI -0.95 to -0.29; p < 0.001). Gastrointestinal adverse events were common but rarely led to treatment discontinuation.

Semaglutide demonstrates significant efficacy in improving dumping syndrome symptoms and reactive hypoglycemia after bariatric surgery, with an acceptable safety profile. These findings support its consideration as a therapeutic option for these challenging post-bariatric complications.