The Impact of Cholecystectomy in Patients with Post-Bariatric Surgery Hypoglycemia

Data de publicação: 01/07/2024 Data Ahead of Print: 01/06/2024

Autores da FMUP

• Hugo Miguel Teixeira Ferraz Santos Sousa

  Autor

• Bárbara Neves Peleteiro

  Autor

• André Manuel Costa Pinho

  Autor

• Paula Isabel Marques Simões De Freitas

  Autor

Participantes de fora da FMUP

• Sardao, Daniel
• Resende, Fernando
• Preto, John
• Lima-da-Costa, Eduardo

Unidades de investigação

• Ciências da Saúde Pública e Forenses, e Educação Médica

• Cirurgia e Fisiologia

• Medicina

Abstract

Background Metabolic surgery is the foremost treatment for obesity and its associated medical conditions. Nonetheless, post-bariatric hypoglycemia (PBH) emerges as a prevalent complication. PBH pathophysiology implicates heightened insulin and glucagon-like peptide 1 (GLP-1) levels, with bile acids (BA) contributing to GLP-1 release. A plausible association exists between cholecystectomy and PBH, which is attributed to alterations in BA metabolism and ensuing hormonal responses. The objective of this retrospective cohort study was to evaluate the impact of cholecystectomy on PBH pharmacological treatment, diagnostic timelines and metabolic parameters.Materials and methods Patients diagnosed with PBH after bariatric surgery were evaluated based on their history of cholecystectomy. Demographic, anthropometric and clinical data were collected. Mixed meal tolerance tests (MMTT) results were compiled to assess metabolic responses.Results Of the 131 patients with PBH included in the study, 29 had prior cholecystectomy. The time to PBH diagnosis was similar across groups. Patients with prior cholecystectomy required higher doses of acarbose (p = 0.046), compared to those without prior cholecystectomy. Additionally, MMTT revealed higher insulin (t = 60 min: p = 0.010 and t = 90 min: p = 0.034) and c-peptide levels (t = 60 min: p = 0.008) and greater glycemic variability in patients with prior cholecystectomy (p = 0.049), highlighting the impact of cholecystectomy on glucose metabolism.Conclusion Our study offers novel insights into PBH pharmacotherapy, indicating that PBH patients with a history of cholecystectomy require elevated doses of acarbose for symptom control than PBH patients without such surgical history. Furthermore, our findings underscore the pivotal role of hyperinsulinism in PBH aetiology, emphasizing the significance of the BA-GLP-1-insulin axis.

Keywords

• Post-bariatric hypoglycemia; Cholecystectomy; Bariatric surgery; Acarbose; Glucose metabolism; Bile acids; Glucagon-like peptide 1