Reviewer's report
Title:Hypoglycemia Following Upper Gastrointestinal Surgery: Case Report and
Review of the Literature
Version: 2Date:20 November 2009
Reviewer: Henrik Christesen
Reviewer's report:
In this case report, a 14-y long history of hypoglycemia lead to the diagnosis of
NIPHS. A Nissen fundoplication was performed , after which symptoms
worsened. The hypoglycaemia responded to octreotide.
Major comments:
It is well-known that Nissen fundoplication may lead to lowering of postprandial
blood glucose, associated with increased GLP-1 response and hypersecretion of
insulin, although strict criteria for NIPHS have not been documented previously. It
is much likely, however, that this patient had NIPHS for a very long time,
aggravated by surgery. It is not clear, whether this is a description of NIPHS
detected after surgery, or NIPHS developed after surgery.
It is hard to see the importance of discerning between the effectiveness of
octreotide in NIPHS without any surgery or after Nissen fundoplication. No data
or theory argue for a difference.
The authors refer to gastric bypass hypoglycaemia consistent with NIPHS, but
also highlight symptoms that differ NIPHS from gastric bypass hyperinsulinemic
hypoglycaemia (HH). It is not clear whether they consider gastric bypass HH as
NIPHS or not, and whether they consider gastric bypass HH and
post-fundoplication NIPHS as the same type of hypoglycemia. If the same,
various medical treatments have been reported rendering little news from this
case description.
Overall, this case is most likely a NIPHS patient with aggravation post surgery. It
highlights that premorbidity may be important in some cases, but adds little to
explain the underlying disease. Although insulinoma is well excluded, a genetic
investigation would have been of interest, since three genes are known to be
involved in NIPHS-like postprandial hypoglycaemia with adult onset.
Minor comments:
A negative 72-h fast is not reported in the case, but in the Abstract only.
The patient’s BMI or abdominal circumference would be of interest.
The time between surgery and the worsening of hypoglycaemia or hospitalisation
due to hypoglycaemia should be given.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Hypoglycemia Following Upper Gastrointestinal Surgery: Case Report and
Review of the Literature
Version: 2Date:20 November 2009
Reviewer: Henrik Christesen
Reviewer's report:
In this case report, a 14-y long history of hypoglycemia lead to the diagnosis of
NIPHS. A Nissen fundoplication was performed , after which symptoms
worsened. The hypoglycaemia responded to octreotide.
Major comments:
It is well-known that Nissen fundoplication may lead to lowering of postprandial
blood glucose, associated with increased GLP-1 response and hypersecretion of
insulin, although strict criteria for NIPHS have not been documented previously. It
is much likely, however, that this patient had NIPHS for a very long time,
aggravated by surgery. It is not clear, whether this is a description of NIPHS
detected after surgery, or NIPHS developed after surgery.
It is hard to see the importance of discerning between the effectiveness of
octreotide in NIPHS without any surgery or after Nissen fundoplication. No data
or theory argue for a difference.
The authors refer to gastric bypass hypoglycaemia consistent with NIPHS, but
also highlight symptoms that differ NIPHS from gastric bypass hyperinsulinemic
hypoglycaemia (HH). It is not clear whether they consider gastric bypass HH as
NIPHS or not, and whether they consider gastric bypass HH and
post-fundoplication NIPHS as the same type of hypoglycemia. If the same,
various medical treatments have been reported rendering little news from this
case description.
Overall, this case is most likely a NIPHS patient with aggravation post surgery. It
highlights that premorbidity may be important in some cases, but adds little to
explain the underlying disease. Although insulinoma is well excluded, a genetic
investigation would have been of interest, since three genes are known to be
involved in NIPHS-like postprandial hypoglycaemia with adult onset.
Minor comments:
A negative 72-h fast is not reported in the case, but in the Abstract only.
The patient’s BMI or abdominal circumference would be of interest.
The time between surgery and the worsening of hypoglycaemia or hospitalisation
due to hypoglycaemia should be given.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Hypoglycemia Following Upper Gastrointestinal Surgery: Case Report and
Review of the Literature
Version: 2Date:20 November 2009
Reviewer: Henrik Christesen
Reviewer's report:
In this case report, a 14-y long history of hypoglycemia lead to the diagnosis of
NIPHS. A Nissen fundoplication was performed , after which symptoms
worsened. The hypoglycaemia responded to octreotide.
Major comments:
It is well-known that Nissen fundoplication may lead to lowering of postprandial
blood glucose, associated with increased GLP-1 response and hypersecretion of
insulin, although strict criteria for NIPHS have not been documented previously. It
is much likely, however, that this patient had NIPHS for a very long time,
aggravated by surgery. It is not clear, whether this is a description of NIPHS
detected after surgery, or NIPHS developed after surgery.
It is hard to see the importance of discerning between the effectiveness of
octreotide in NIPHS without any surgery or after Nissen fundoplication. No data
or theory argue for a difference.
The authors refer to gastric bypass hypoglycaemia consistent with NIPHS, but
also highlight symptoms that differ NIPHS from gastric bypass hyperinsulinemic
hypoglycaemia (HH). It is not clear whether they consider gastric bypass HH as
NIPHS or not, and whether they consider gastric bypass HH and
post-fundoplication NIPHS as the same type of hypoglycemia. If the same,
various medical treatments have been reported rendering little news from this
case description.
Overall, this case is most likely a NIPHS patient with aggravation post surgery. It
highlights that premorbidity may be important in some cases, but adds little to
explain the underlying disease. Although insulinoma is well excluded, a genetic
investigation would have been of interest, since three genes are known to be
involved in NIPHS-like postprandial hypoglycaemia with adult onset.
Minor comments:
A negative 72-h fast is not reported in the case, but in the Abstract only.
The patient’s BMI or abdominal circumference would be of interest.
The time between surgery and the worsening of hypoglycaemia or hospitalisation
due to hypoglycaemia should be given.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
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