Plasma Pancreatic Polypeptide Responses to Insulin Hypoglycaemia after Nissen Fundoplication

Abstract

On the basis of the observation that patients occasionally develop symptoms suggesting vagal damage after surgery for gastro-oesophageal reflux disease (GORD), we have studied the pancreatic polypeptide (PP) secretion in response to hypoglycaemia, as indicator of vagus nerve function, in 24 patients with Nissen fundoplication, in 9 non-operated patients with severe GORD, in 6 patients with truncal vagotomy, and in 20 normal control subjects. All subjects had a plasma glucose trough of less than 2.5 mmol/l after intravenous injection of 0.1 U/kg insulin. In the normal subjects plasma PP increments ranged from 94 to 730 pM. Seven of 24 (29%) patients with Nissen fundoplication (p < 0.05), all 6 patients with truncal vagotomy (p< 0.001), but none of the non-operated patients with GORD had plasma PP responses to insulin hypoglycaemia below the lowest value in the control subjects. It is concluded that patients with Nissen fundoplication often have an abnormal plasma PP response to insulin hypoglycaemia. Although this abnormality is most likely due to vagal damage during surgery, prospective studies are needed to elucidate the exact mechanism and to establish the clinical significance of this finding.

Key Words:

• Insulin hypoglycaemia
• Nissen fundoplication
• pancreatic polypeptide
• reflux oesophagitis
• vagotomy