SAT-559 - Dumping Syndrome Alleviated with Semaglutide in a Patient with Hypoglycemia Refractory to Standard Therapy

Dumping syndrome after Nissen fundoplication is an uncommon complication that presents significant therapeutic challenges. Patients often develop gastrointestinal distress neuroglycopenic manifestations, and substantial impairment in quality of life. Late dumping may manifest as recurrent postprandial hyperinsulinemic hypoglycemia. Accelerated gastric transit and dysregulated incretin-mediated insulin secretion are believed to drive postprandial hyperinsulinemic hypoglycemia; however, current therapeutic strategies frequently fail to achieve sustained symptom control and are often constrained by adverse effects. This case presents GLP-1 receptor agonist as a potential novel approach to address both glycemic instability and gastrointestinal symptoms.

We present a 55-year-old male with prior history of Nissen fundoplication with over 10 years of persistent gastrointestinal distress and frequent symptomatic postprandial hypoglycemic events, including irritability, fatigue, and cognitive impairment. Following a hospitalization to rule out an insulinoma, outpatient follow-up led to a diagnosis of dumping syndrome with recurrent, severe hypoglycemic events. He was initiated on off-label semaglutide 0.25 mg subcutaneously weekly, reassessed after 4 weeks, and then titrated to 0.5 mg weekly, which he continued with subsequent four-week follow-ups. After three months, there was a substantial decline in the frequency of hypoglycemic events, accompanied by notable improvement in gastrointestinal symptoms and quality of life. This therapy stabilized his glycemic variability and improved his gastrointestinal symptoms.

This case highlights the potential utility of off-label GLP-1 receptor agonist therapy in patients with dumping syndrome, resulting in improved glycemic stability and a marked reduction in postprandial hypoglycemic episodes. While emerging reports suggest similar benefits, evidence remains limited. Clinical studies are needed to define efficacy, safety, and optimal patient selection before GLP-1-based therapies can be formally recommended. Glycemic stability and a reduction in hypoglycemic events were achieved suggesting a potential therapeutic role for GLP-1 receptor agonists in select patients. Although emerging reports have described similar benefits, evidence remains limited: therefore, further prospective studies are needed to clarify efficacy, safety, and appropriate patient selection before GLP-1-based therapies can be formally recommended for dumping syndrome.

Disclaimer: “This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.”

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