Postprandial Symptoms in a Mixed-Meal-Test after Bariatric Surgery: Clinical Experience and a Critical Review of Dumping Syndrome Definition and Management.

IF 3.9 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Obesity Facts Pub Date : 2024-10-15 DOI:10.1159/000541780

Azat Samigullin, Julia Weihrauch, Mirko Otto, Andrea Rech, Sandra Buchenberger, Michael Morcos, Per M Humpert

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Abstract

Introduction: Despite recent attempts to reach a consensus on the diagnostic criteria and treatment of dumping syndrome (DS) after bariatric surgery, many questions about the clinical applicability and significance of standardized provocation tests remain unanswered. The objective of this study was to retrospectively evaluate a mixed-meal-test (MMT) based on general nutritional recommendations after bariatric surgery and its clinical value in diagnosing DS.

Methods: The MMT contained 15.5 g of protein, 10 g of fat, 20.7 g of carbohydrates, and 3.1 g of dietary fiber, totaling 241 kcal. Symptoms based on the Sigstad Score, along with blood sugar, hematocrit, pulse rate, and blood pressure, were collected as primary readouts. The analysis included 58 MMTs from 56 patients who reported postprandial symptoms indicative of DS and were referred to the clinic by surgeons or general practitioners.

Results: Although all individuals reported significant symptoms at home, the MMT showed a positive symptom score (Sigstad Score ≥7) in only 16 cases (28%). Neither a heart rate increase >10 BPM nor the 3% hematocrit increase suggested as cut-offs for early DS by the consensus paper were associated with the Sigstad Score or individually reported symptoms. None of the participants had a postprandial glucose decrease below 50 mg/dL; one fell below 60 mg/dL and 14 fell below 70 mg/dL. A blood glucose decrease below 70 mg/dL was not associated with symptoms.

Conclusion: The MMT showed that only a minority of patients reported classical DS symptoms under controlled conditions. Changes in hematocrit, heart rate, and blood sugar decrease below 70 mg/dL did not help to predict symptoms in the individuals studied. The data, in the context of existing evidence, suggest that provocation tests have little value in clinical practice and that DS as a clinical entity after bariatric surgery should be reevaluated.

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减肥手术后混合餐测试中的餐后症状--临床经验以及对倾倒综合征定义和管理的批判性回顾。

导言：尽管最近人们试图就减肥手术后倾倒综合征（Dumping Syndrome，DS）的诊断标准和治疗方法达成共识，但关于标准化激惹试验的临床适用性和意义的许多问题仍未得到解答。本研究的目的是对基于减肥手术后一般营养建议的混合餐试验（MMT）及其在诊断 Dumping 综合征方面的临床价值进行回顾性评估。方法 MMT 含有 15.5 克蛋白质、10 克脂肪、20.7 克碳水化合物和 3.1 克膳食纤维，总热量为 241 千卡。主要读数包括基于 Sigstad 评分的症状、血糖、血细胞比容、脉搏和血压。分析包括 56 名患者的 58 份 MMT，这些患者报告的餐后症状提示 DS，并由外科医生或全科医生转介到诊所。结果虽然所有患者在家中都报告了明显的症状，但只有 16 例（28%）患者的 MMT 显示出阳性症状评分（Sigstad 评分≥7）。共识文件建议的早期 DS 临界值--心率增加 10 BPM 或血细胞比容增加 3% 都与 Sigstad 评分或个人报告的症状无关。没有一位参与者的血糖降至 50 mg/dl 以下；1 人降至 60 mg/dl 以下，14 人降至 70 mg/dl 以下。血糖降至 70 毫克/分升以下与症状无关。结论 MMT 显示，在受控条件下，只有少数患者报告了典型的 DS 症状。血细胞比容、心率和血糖下降到 70 毫克/分升以下的变化无助于预测研究对象的症状。从现有证据来看，这些数据表明激惹试验在临床实践中价值不大，因此应重新评估减肥手术后 DS 这一临床实体。

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来源期刊

Obesity Facts 医学-内分泌学与代谢

CiteScore

6.80

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： ''Obesity Facts'' publishes articles covering all aspects of obesity, in particular epidemiology, etiology and pathogenesis, treatment, and the prevention of adiposity. As obesity is related to many disease processes, the journal is also dedicated to all topics pertaining to comorbidity and covers psychological and sociocultural aspects as well as influences of nutrition and exercise on body weight. The editors carefully select papers to present only the most recent findings in clinical practice and research. All professionals concerned with obesity issues will find this journal a most valuable update to keep them abreast of the latest scientific developments.