Published online Mar 15, 2022. doi: 10.4239/wjd.v13.i3.278
Peer-review started: September 24, 2021
First decision: January 12, 2022
Revised: January 21, 2022
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: March 15, 2022
Processing time: 171 Days and 21.5 Hours
Postbariatric hypoglycemia is a rare but increasingly recognized complication of bariatric surgery, with significant associated morbidity, and many patients often require multimodal treatment. A mixed meal challenge test is often helpful to diagnose this condition. This manuscript highlights the underlying mechanisms that lead to this condition and the novel emerging therapeutic targets that target these mechanisms.
Core Tip: Postbariatric hypoglycemia is an uncommon complication presenting months to years after bariatric surgery (mostly in Roux-en-Y gastric bypasses) as postprandial hyperinsulinemic hypoglycaemia occurring 1-3 h after meals, and the associated neuroglycopenic symptoms can be incapacitating. Medical nutrition therapy forms the foundation of management, with pharmacotherapy and surgical interventions available for those who do not respond. An increased understanding of the implicated mechanisms has led to the development of targeted agents like avexitide, which has demonstrated good efficacy in a Phase 2 clinical trial (PREVENT) recently.