Abstract
Postbariatric hypoglycemia (PBH) is an established complication of bariatric surgery,
encountered especially after Roux-en-Y gastric bypass (RYGB). The sole manifestation
is postprandial hyperinsulinemic hypoglycemia, which often takes place within the
immediate 1 to 3 years postsurgery. Over the last decade, the knowledge of the PBH
has robustly improved, and the management has evolved following a better understanding
of its pathophysiology, advancements in diagnostic options, and the dynamic placement
of therapeutic options. This review compares the three major available clinical consensus/guidelines
published in 2017, 2022, and 2024, from different societies, respectively. Our report
highlights the dramatic unfolding in diagnostic tools, dietary and pharmacological
management, and, when needed, surgical interventions. This evolution of the guidelines
reflects a consensus trend toward individualized, case-driven decision and management.
Lately, the introduction of personalized dietary modification, adopting the approach
of continuous glucose monitoring-assisted management response, and the advancement
of pasireotide to be the second-line pharmacotherapy after the classical Acarbose
were the highlights of the latest guidelines in 2024. This report will help understand
and simplify the dynamic science in the relatively new field of PBH.
Keywords
bariatric surgery - dumping syndrome - guidelines - hypoglycemia - obesity - PBH -
postbariatric
