Symptomatic reactive hypoglycemia is highly prevalent post-esophagectomy

Summary: Impaired long-term health-related quality of life (HRQL) is a growing concern for disease-free survivors post-esophagectomy. Post-prandial discomfort, neuroglycopenic symptoms, and dumping are common and often linked to reactive hypoglycemia (RH), a condition not yet prospectively studied in this cohort. This study used continuous glucose monitoring (CGM) and detailed diaries to investigate the incidence of symptomatic and asymptomatic RH events in consecutive, disease-free patients post-esophagectomy. Disease-free patients (6–36 months post-esophagectomy, non-diabetic) were recruited. Continuous glucose readings were collected at 15-minute intervals for 7 days using a FreeStyle Libre sensor. Participants completed detailed food and symptom diaries, and validated quality of life and symptom questionnaires. Sensor data were analyzed to detect reactive hypoglycemic events, and symptoms were correlated with glucose readings. Thirty-two patients provided complete data. Almost all participants (96.9%, n = 31) had at least one blood glucose measurement <3.9 mmol/L, with 65.6% (n = 21) recording severe hypoglycemia (<3.0 mmol/L). These events are significantly more prevalent than in healthy reference populations (P < 0.001). The mean total number of hypoglycemic events (defined as interstitial blood glucose <3.9 mmol/L for <15 minutes) was 9.26 (±5.81) over 7 days. Symptomatic RH events (occurring 60–300 minutes post-meal) were experienced by 37.5% of participants (mean 1.25 ± 0.45 events), while asymptomatic events were far more frequent (mean 5.97 ± 4.32). Symptomatic RH included both neuroglycopenic (42%) and abdominal symptoms. Screening questionnaires did not accurately identify all RH cases. Importantly, RH was not associated with impaired HRQL or altered body composition. RH is highly prevalent in disease-free survivors post-esophagectomy, far exceeding general population norms. CGM is a valuable tool for diagnosis, detecting a high rate of both symptomatic and asymptomatic events. Future work should investigate whether dietary modification can reduce these clinically significant RH events.