title: Postprandial Hypoglycemia in Children after Gastric Surgery: Clinical Characterization and Pathophysiology.
abstract: OBJECTIVE
  Dumping syndrome is a common complication in children after fundoplication and other gastric surgeries and is characterized by postprandial hypoglycemia (PPH). Children with PPH have an exaggerated GLP-1 response to a meal with an exaggerated insulin surge and subsequent hypoglycemia. We evaluated the role of GLP-1 in the pathogenesis of PPH by examining the effects of GLP-1 receptor blockade on glucose and insulin response to a meal.
  
  
  METHODS
  Six children with known PPH after surgery underwent a mixed meal tolerance test with/without the GLP-1 receptor antagonist exendin-(9-39) using an open-label crossover design.
  
  
  RESULTS
  Average nadir plasma glucose concentration was ≥65 mg/dl in all treatment conditions; however, 3 out of the 6 subjects had a nadir plasma glucose <65 mg/dl during vehicle infusion, while only 1 out of the 6 had a nadir plasma glucose <65 mg/dl during infusion of exendin-(9-39). Exendin-(9-39) suppressed postmeal insulin concentrations when compared to vehicle, with a lower peak insulin concentration observed in the children who received 500 pmol/kg/min of exendin-(9-39) (131.3 ± 125.1 pmol/l) compared to children who received 300 pmol/kg/min (231.1 ± 153.4 pmol/l) or vehicle (259.7 ± 120.2 pmol/l). Gastric emptying was not different between groups.
  
  
  CONCLUSIONS
  Our results suggest that the exaggerated insulin response to a meal is at least in part due to the effects of GLP-1 on the pancreatic β-cell and suggest that GLP-1 receptor antagonists may represent a potential avenue of treatment for children with PPH.
authors.affiliation: Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pa., USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Calabria
authors.forename: Lawrenshey
authors.initials: L
authors.lastname: Charles
authors.forename: Stephanie
authors.initials: S
authors.lastname: Givler
authors.forename: Diva D
authors.initials: DD
authors.lastname: De León
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication; D005746:Gastric Emptying; D052216:Glucagon-Like Peptide 1 / Q000502:physiology*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D010446:Peptide Fragments; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology
chemical_list: D010446:Peptide Fragments; C083773:exendin (9-39); D052216:Glucagon-Like Peptide 1