Rare complication of bariatric surgeries and the term of NIPHS (non-insulinoma...

My name is Maria Teresa I going to tell you what I am going through as a result of the parascopy, gastro bi-pass or bariatric surgery (reduction of the stomach) that I had in 2003.   I was operated of the stomach in September 2003 weighed 200 pounds, my high is 5'3 feet, I have difficult  to lose weight easily, within 4 weeks of the surgery I had dropped only 15 pounds and had hardly eaten anything. I was under liquid diet, gelatin and nothing more, after 15 days the surgeon put me in a soft diet purees, and beans, lentils, mush potatoes and soft stuff.   Within 4 weeks I try to eat a fried egg and lettuce salad, I almost dying It stuck in my esophagus and couldn’t pass it (eat it); for 3 years I was eating and throwing up for no reason, could be rice, a Tostitos or chips at the end for anything, when I least expected and anywhere, anything could be stuck in my trough, I was like a anorexic person but not wanting to be so.   My husband was very disappointed with me, because he never wanted that I got the stomach surgery, because the complications that could have in the future and which at the time that I got my surgery, this procedure started becoming popular (bariatric surgery). But we “women" wants’ to look good and this prototype that the skinny girl looks more beautiful I did it (I still think the same way).   For nearly 3 years I had in weighing 145 pounds, but it almost always after I eat I had that go to the bathroom to throwing up, after this episodes I try to hide my sickness but when I coming out of the bathroom trying to disguise what I had, only my husband realized what I was going thorough.   After a while I have not had more throwing up problems to pass the food, but then started the suddenly low sugar and high sugar episodes, health problems of suddenly low and high blood pressure without apparent reason.   I went to the doctor many times and explained my case and blood tests only show than my average of insulin in the 3 last months is under (56). I am very frustrate because my body asking me for sugar to compensate the low sugar in my system, I was eating something sweet or bread and rice, for that I've gaining weight.   Because an article of the Mayo Clinic I learned that is the contrary, I must not eat sweet or white carbohydrates because after 2 hours low my sugar more. Now I’m weighing 186 pounds.   I have not found reports of suddenly variations in blood pressure as happened to me, I can go form 175 with 110 blood pressure to lower my pressure until 75 with 35 I was feeling like lifeless, my husband gave me a lot of coffee and still in the hospital my blood pressure was 80 to 40 as I already explain, I have not found reports of this blood pressure changes on the internet.   I would like my case published on the internet to be know what people like me are going through and also to communicate with people like me with the same symptoms of the disease and can be able to exchange information. Plus if this is published and will help as information for another people thinking to have the gastro bi-pass or bariatric surgery, may know that the operation of the stomach is not a final solution and it brings you consequences who will risk your life, I've been in the hospital in emergency at least five times after my operation, and the reason I have had to stay in the hospital , has always been by my blood pressure or my sugar, not for the reason that had gone to the hospital (pneumonia , asthma, broken arm) just other reasons that have nothing to do with sugar or blood pressure. Please publish my case so that other people read to take an important decision, which will have consequences for your lifetime and can bring consequences of life or death.   Maria Teresa Quintero I found this information in the Internet I hope this will be helpful for someone From Mayo clinic web page  NIPHS Mayo Clinic doctors have recognized and reported on a seemingly rare but serious complication following gastric bypass called non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) or post-bariatric surgery hypoglycemia. After a person eats, this condition can result in very low blood sugar levels that lead to severe neurologic symptoms, including visual disturbances, confusion and (rarely) seizures. Mayo Clinic doctors have evaluated and treated several patients with NIPHS. When medical and diet therapies do not work, surgical removal of part of the pancreas has resulted in marked improvement of symptoms for most patients. If the symptoms described above occur, patients should notify their physician immediately. Until this condition is controlled, patients should avoid driving motorized vehicles or performing tasks that could affect the safety of those around them.   ANOTHER REPORT OF THE NIPHS   European Congress of Endocrinology 2009 Istanbul, Turkey
25 April 2009 - 29 April 2009
European Society of Endocrinology

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Endocrine Abstracts (2009) 20 P315 Non-insulinoma pancreatogenic hypoglycemia syndrome (NIPHS): recently described disease entity: case report Aldona Kowalska, Iwona Palyga, Danuta Gasior-Perczak, Jacek Sygut, Janusz Sluszniak & Stanislaw Gozdz     Holycross Cancer Centre, Kielce, Poland. Introduction: Case reports of individuals with non-insulinoma hyperinsulinic hypoglcaemia of organic origin has been more frequently described in literature. This syndrome has been described as a rare complication of bariatric surgeries and the term of NIPHS (non-insulinoma pancreatogenic hypoglycemia syndrome) has been proposed. Aim: The aim of our study is to present patients case who had previously undergone the gastric surgery. Bilroth II and finally diagnosed of NIPHS. Case description: A 45-year-old man who had previously undergone gastric surgery, was refered to our hospital for evaluation of hypoglycemia. At the beginning, the patient experienced only episodes of postprandial hypoglycaemia and subsequently episodes of fasting hypoglycaemia appeared. Diagnostic imaging including ultrasound, CT, Octreoscan and EUS were negative for the patient. Post-operative changes and chronic pancreatitis impeded the interpretation of obtained results. Farmacological treatment with Proglicem or somatostatine analogues led only to transient improvement in control of hypoglycemic status. Because pharmacological treatment was ineffective patient undergone partial pancreatectomy. Finally the diagnosis of NIPHS has been established based on postoperative histological diagnosis established after partial pancreatectomy. Conclusion: 1. NIPHS must always be considered in differential diagnosis of adult patients with hypoglycaemia. 2. NIPHS may occur not only in patients after bariatric surgeries but also after gastric surgeries caused by peptic ulcer. Endocrine Abstracts (2009) 20 P315                                                                                                                       Noninsulinoma pancreatogenous hypoglycemia syndrome

AuthorF John Service, MD, PhD

Section EditorDavid M Nathan, MD

Deputy EditorJean E Mulder, MD

  INTRODUCTION The noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) identifies a group of hyperinsulinemic hypoglycemic patients with unique clinical, diagnostic, surgical, and pathologic features [1,2]. These patients experience predominantly postprandial hypoglycemia and have nesidioblastosis with islet cell hypertrophy, findings different from those in patients with insulinomas. The clinical manifestations, diagnosis, pathological findings, and treatment of NIPHS will be reviewed here. Other causes of hypoglycemia and how to differentiate among these causes are reviewed elsewhere. (See "Overview of hypoglycemia in adults" and "Diagnostic approach to hypoglycemia in adults".) DEFINITION Noninsulinoma pancreatogenous hypoglycemia is a syndrome characterized by endogenous hyperinsulinemic hypoglycemia that is not caused by an insulinoma. Pancreatic specimens from such patients show beta cell hypertrophy, islets with enlarged and hyperchromatic nuclei, and increased periductular islets [1-3]. These histologic findings are characteristic of nesidioblastosis, a term that refers to neoformation of islets of Langerhans from pancreatic duct epithelium [4]. The pathologic findings are similar to those seen in neonates and infants with persistent hyperinsulinemic hypoglycemia. (See "Pathogenesis, clinical features, and diagnosis of persistent hyperinsulinemic hypoglycemia of infancy", section on 'Pathology of the beta cell'.) CLINICAL FEATURES It is usually not difficult to distinguish insulinoma from noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) considering the timing of symptoms, gender preference (male predominance), and radiologic localization study results. Pathologic findings can confirm the presence of nesidioblastosis, which is the typical finding in patients with NIPHS and is only rarely described as a concomitant finding in patients with insulinoma [5,6]. Symptoms — The predominant clinical feature of noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is postprandial hypoglycemia. In a series of 18 patients from the Mayo Clinic, age range 16 to 78 years old with male predominance (70 percent), symptoms occurred postprandially, two to four hours after meals, and only rarely while fasting [1,2]. All patients had neuroglycopenic symptoms, and several lost consciousness or had generalized seizures. In smaller series and case reports, a similar preponderance of postprandial hypoglycemia and male predominance was noted [7-13]. However, fasting hypoglycemia has also been reported [13-15].  

Maria,
I am so sorry that you are going through all this.  My situation has been a bit different, but if you want, you can contact me anytime if you need someone to talk to.  I have a blog on here that I try and keep up to date, feel free to check it out.  You are not alone in your problems, it's just that many people don't want to talk about catastropic complications in settings like support groups for fear of being an "outcast" or putting a damper on all of the accolades being poured on the surgeon.  I will send you a friend request, keep your head up, sounds like you are on the right track :)
Jules

Jules, I have just discovered your post on hypoglycemia for more information..I had my rny in June of '02. I began to experience very odd and drained feelings after I would eat my meals...I began to delay eating at work, because I would always want to sleep!...and I was an elementary art teacher!...and many times I would experience what I now know was a blood sugar drop...my daughter saw how sick I was becoming...as sleeping all the time wasn't normal and I visited my PCP..who performed the fasting glucose test...sure enough...my blood sugar rose and dropped rapidly and I was diagnosed as type 2 diabetes...but the meds given me made the hypoglycemia worse!...and I felt awful...so I visited an endocrinologist...who again gave me the glucose test and he also monitored my insulin levels...and again I crashed...as my blood sugar rose...so did the insulin...until the crash..so he took all meds away and asked that I record my blood sugar readings for a few months..he was pleased with  the blood sugar readings and suggested no meds...just increased my vitamin a and D...but to this day...I still feel dopy when I eat any carbs...I hate how foods make me feel....llike I am drunk...and now that I have had a diabetes diagnosis on record, no insurance company will write me a policy!...any suggestions in your research?

I wonder how this compares to Reactive Hypoglycemia which I have. I took a two hour glucose tolerance test which resulted in a glucose reading of 45 after about an hour and a half and me feeling very jittery, heart racing, dizzy, etc... 
 
I now have what resembles a Bilroth II even though in 89', an attempt was made to undergo a "takedown" from a BPD aka Long Loop Roux-en-Y GBP. I have very little stomach left and the small bowel is still hooked up differently than normies.