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Hypoglycemia and Dysautonomia After Bariatric Surgery: a Systematic Review and Perspective

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Abstract

Introduction

With the increasing performance of bariatric surgery, rare complications are becoming prevalent. We review the diagnosis and treatment of dysautonomia after bariatric surgery and the limited treatment options available. We summarize the suggested mechanisms and explain why a complete understanding of the etiology has yet to be determined.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was performed.

Results

Of 448 studies identified in the literature search, 4 studies were reviewed, describing 87 patients diagnosed with dysautonomia. We present a patient who developed severe dysautonomia following conversion of sleeve gastrectomy to gastric bypass.

Conclusion

Treatment needs to focus on optimizing nutrition, avoiding hypoglycemia, and optimizing volume status.

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Author information

Authors and Affiliations

  1. Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA

    Poppy Addison, Katie Carsky & Mitchell Roslin

  2. Section of Integrative Physiology and Metabolism, Research Division, Joslin Diabetes Center, Boston, MA, USA

    Mary Elizabeth Patti

  3. Harvard Medical School, Boston, MA, USA

    Mary Elizabeth Patti

  4. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Mitchell Roslin

Authors
  1. Poppy Addison
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  2. Katie Carsky
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  3. Mary Elizabeth Patti
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  4. Mitchell Roslin
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Corresponding author

Correspondence to Poppy Addison.

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Informed consent does not apply.

Conflict of Interest

Drs. Addison and Carsky have no conflicts of interest. Dr. Patti is a consultant at Eiger, Poxel, Hanmi, Astra Zeneca, MBX Biosciences, and Fractly and has an investigator-initiated research grant at Dexcom; these are unrelated to the present manuscript. Dr. Roslin is a consultant for Medtronic and Johnson and Johnson and has a research grant from Medtronic; these are unrelated to the present manuscript. We gratefully acknowledge grant support from NIH DK121995 (to MEP).

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Mary Elizabeth Patti and Mitchell Roslin are co-senior authors.

Key Points

1. Hypoglycemia should be assessed in patients with syncope or autonomic symptoms.

2. Medical therapy should be considered for orthostasis but can be ineffective.

3. Advanced cases may not benefit from surgical intervention.

4. Successful treatment of hypoglycemia may not reverse symptoms of dysautonomia.

Supplementary Information

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Addison, P., Carsky, K., Patti, M.E. et al. Hypoglycemia and Dysautonomia After Bariatric Surgery: a Systematic Review and Perspective. OBES SURG 32, 1681–1688 (2022). https://doi.org/10.1007/s11695-022-05960-x

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  • DOI: https://doi.org/10.1007/s11695-022-05960-x

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