Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry

Background: Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments. Methods: Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia. Results: Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the 'candy cane' roux limb, with resolution of hypoglycemia in all cases. Conclusions: There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure

Manejo nutricional de la esclerosis lateral amiotrófica: resumen de recomendaciones

La esclerosis lateral amiotrófica (ELA) es una enfermedad neurodegenerativa que se caracteriza por debilidad muscular y discapacidad progresivas que acaban produciendo fallo respiratorio y disfagia que conducen a la muerte. El término surge de la combinación de los hallazgos clínicos, caracterizados por la atrofia muscular (amiotrofia), y los hallazgos anatomopatológicos con gliosis y esclerosis del área dorsolateral de la médula espinal, entre otros (1). La ELA es la enfermedad más común de las enfermedades de la motoneurona. Su incidencia global es de 1,5 a 2,7 nuevos casos/100.000 habitantes/año, con una prevalencia media de 2,7 a 7,4 casos/100.000 habitantes (2). En España, según la Sociedad Española de Neurología, se diagnostican tres nuevos casos cada día, lo que supone una incidencia anual de 1/100.000 habitantes y una prevalencia de 3,5/100.000 (3)