Influence of dietary intake and eating patterns on reactive hypoglycemic events in patients postesophagectomy: A prospective observational study using continuous glucose monitoring

Background: Esophagectomy causes anatomical changes that can lead to rapid food transit and reactive hypoglycemia (RH). Patients are advised on eating patterns postesophagectomy to prevent RH, but its true incidence and the impact of dietary recommendations remain under-researched. Materials and Methods: Individuals >12 months postesophagectomy were recruited from the National Centre for Oesophageal and Gastric Cancer at St James's Hospital in Dublin, Ireland. Over 7 days, continuous glucose monitoring (CGM) captured glucose readings, with food and symptom diaries documenting dietary intake and symptoms. The nutrition composition of meals was calculated, and food diaries were coded for the following eating patterns: leaving >3 h between meals, simple sugars with meals, fluid with meals, and alcohol with meals. Data analysis compared eating patterns preceding asymptomatic and symptomatic RH events. In all cases, P < 0.05 was considered statistically significant. Results: Thirty-two participants completed the study, with 21,504 glucose readings and 1276 meals analyzed. CGM identified 226 meals (17.7%) followed by RH events, 19 of which were symptomatic. Meals associated with RH events were higher in carbohydrate (35.3 g vs 31.7 g; P = 0.036), fiber (4.11 g vs 3.15 g; P = 0.020), and sugar (12.65 g vs 10.96 g; P = 0.048). Leaving >3 h between meals and consuming alcohol with meals also increased RH risk. Nutrient composition and eating patterns did not differentiate symptomatic from asymptomatic RH events. Conclusions: Total carbohydrate content and specific eating patterns appeared to significantly influence RH incidence, with most RH events being asymptomatic. CGM may serve as a useful adjunct to dietary interventions in the management of RH in patients postesophagectomy.