Surgery Today

, Volume 44, Issue 11, pp 2131–2137 | Cite as

Serum ghrelin levels partially recover with the recovery of appetite and food intake after total gastrectomy

  • Masaru Koizumi
  • Yoshinori Hosoya
  • Katsuya Dezaki
  • Toshihiko Yada
  • Hiroshi Hosoda
  • Kenji Kangawa
  • Hideo Nagai
  • Alan T. Lefor
  • Naohiro Sata
  • Yoshikazu Yasuda
Original Article

Abstract

Purpose

Ghrelin may lead to weight gain by appetite stimulation. This prospective study investigated the association between weight loss and the ghrelin levels in patients after gastrectomy.

Methods

Thirty-three males and eight females were enrolled in the study. The average age was 66 years. Measurements of the serum ghrelin level and an appetite questionnaire were performed preoperatively and at one, three, six and 12 months postoperatively.

Results

The preoperative serum total ghrelin level was 51.6 ± 31.9 (fmol/ml ± SD), and that at one, three, six and 12 months postoperatively was 16.9 ± 9.0, 21.2 ± 16.0, 28.0 ± 19.1 and 29.6 ± 20.6 (fmol/ml ± SD), respectively. The appetite score was 2.02 ± 1.09 points at 1 month, and increased significantly to 2.61 ± 1.00 by 12 months.

Conclusions

The ghrelin levels were reduced after gastrectomy and did not recover by 12 months postoperatively. Further studies are needed to evaluate these results as the basis of a therapeutic trial.

Keywords

Ghrelin Gastrectomy Weight loss 

References

  1. 1.
    Bae JM, Park JW, Yang HK, Kim JP. Nutritional status of gastric cancer patients after total gastrectomy. World J Surg. 1998;22:254–60.PubMedCrossRefGoogle Scholar
  2. 2.
    Melissas J, Kampitakis E, Schoretsanitis G, Mouzas J, Kouromalis E, Tsiftsis DD. Does reduction in gastric acid secretion in bariatric surgery increase diet-induced thermogenesis? Obes Surg. 2002;12:399–403.PubMedCrossRefGoogle Scholar
  3. 3.
    Adachi S, Takeda T, Fukao K. Evaluation of esophageal bile reflux after total gastrectomy by gastrointestinal and hepatobiliary dual scintigraphy. Surg Today. 1999;29:301–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Iesato H, Ohya T, Ohwada S, Itagaki S, Yokomori T, Morishita Y. Jejunal pouch interposition with an antiperistaltic conduit as a pyloric ring substitute after standard distal gastrectomy: a comparison with the use of an isoperistaltic conduit. Hepatogastroenterology. 2000;47:756–60.PubMedGoogle Scholar
  5. 5.
    Braga M, Zuliani W, Foppa L, DiCarlo V, Cristallo M. Food intake and nutritional status after total gastrectomy: results of a nutritional follow-up. Br J Surg. 1988;75:477–80.PubMedGoogle Scholar
  6. 6.
    Bergh C, Sjostedt S, Hellers G, Zandian M, Sodersten P. Meal size, satiety and cholecystokinin in gastrectomized humans. Physiol Behav. 2003;78:143–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Fein M, Fuchs KH, Thalheimer A, Freys SM, Heimbucher J, Thiede A. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial. Ann Surg. 2008;247:759–65.PubMedCrossRefGoogle Scholar
  8. 8.
    Yamashita K, Sakuramoto S, Shibata T, Nemoto M, Mieno H, Katada N, Kikuchi S, Watanabe M. Survival outcome of laparoscopic gastrectomy for early (cT1) gastric cancer. Surg Today. 2013;43:1013–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Liedman B. Symptoms after total gastrectomy on food intake, body composition, bone metabolism, and quality of life in gastric cancer patients: is reconstruction with a reservoir worthwhile? Nutrition. 1999;15:677–82.PubMedCrossRefGoogle Scholar
  10. 10.
    Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60.PubMedCrossRefGoogle Scholar
  11. 11.
    Shintani M, Ogawa Y, Ebihara K, Aizawa-Abe M, Miyanaga F, Takaya K, et al. Ghrelin, an endogenous growth hormone secretagogue, is a novel orexigenic peptide that antagonizes leptin action through the activation of hypothalamic neuropeptide Y/Y1 receptor pathway. Diabetes. 2001;50:227–32.PubMedCrossRefGoogle Scholar
  12. 12.
    Masuda Y, Tanaka T, Inomata N, Ohnuma N, Tanaka X, Itoh Z, et al. Ghrelin stimulates gastric acid secretion and motility in rats. Biochem Biophys Res Commun. 2000;276:905–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Date Y, Kojima M, Hosoda H, Sawaguchi A, Mondai MS, Sugunuma T, et al. Ghrelin, a novel growth hormone-releasing acylated peptide, is synthesized in a distinct endocrine cell type in the gastrointestinal tracts of rats and humans. Endocrinology. 2000;141:4255–61.PubMedGoogle Scholar
  14. 14.
    Cummings DE, Weigle DS, Frayo RS, Breen PA, Ma MK, Dellinger EP, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346:1623–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Hosoda H, Kojima M, Mizushima T, Shimizu S, Kangawa K. Structural divergence of human ghrelin. Identification of multiple ghrelin-derived molecules produced by post-translational processing. J Biol Chem. 2003;278:64–70.PubMedCrossRefGoogle Scholar
  16. 16.
    Leonetti F, Silecchia G, Iacobellis G, Ribaudo MC, Zappaterrano A, Tiberti C, et al. Different plasma ghrelin levels after laparoscopic gastric bypass and adjustable gastric banding in morbid obese subjects. J Clin Endocrinol Metab. 2003;88:4227–31.PubMedCrossRefGoogle Scholar
  17. 17.
    Doki Y, Takachi K, Ishikawa O, Miyashiro I, Sasaki Y, Ohigashi H, et al. Ghrelin reduction after esophageal substitution and its correlation to postoperative body weight loss in esophageal cancer patients. Surgery. 2006;139:797–805.PubMedCrossRefGoogle Scholar
  18. 18.
    Hosoda H, Kojima M, Matsuo H, Kangawa K. Ghrelin and des-acyl ghrelin: two major forms of rat ghrelin peptide in gastrointestinal tissue. Biochem Biophys Res Commun. 2000;279:909–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Takachi K, Doki Y, Ishikawa O, Miyashiro I, Sasaki Y, Ohigashi H, et al. Postoperative ghrelin levels and delayed recovery from body weight loss after distal or total gastrectomy. J Surg Res. 2006;130:1–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Jeon TY, Lee S, Kim HH, Kim YJ, Son HC, Kim DH, et al. Changes in plasma ghrelin concentration immediately after gastrectomy in patients with early gastric cancer. J Clin Endocrinol Metab. 2004;89:5392–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Asakawa A, Inui A, Kaga T, Yuzuriha H, Nagata T, Ueno N, et al. Ghrelin is an appetite-stimulatory signal from stomach with structural resemblance to motilin. Gastroenterology. 2001;120:337–45.PubMedCrossRefGoogle Scholar
  22. 22.
    Date Y, Murakami N, Toshinai K, Matsukura S, Nijima A, Matsuo H, et al. The role of the gastric afferent vagal nerve in ghrelin-induced feeding and growth hormone secretion in rats. Gastroenterology. 2002;123:1120–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Williams DL, Grill HJ, Cummings DE, Kaplan JM. Vagotomy dissociates short- and long-term controls of circulating ghrelin. Endocrinology. 2003;144:5184–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Nakamura M, Kido Y, Yano M, Hosoya Y. Reliability and validity of a new scale to assess postoperative dysfunction after resection of upper gastrointestinal carcinoma. Surg Today. 2005;35:535–42.PubMedCrossRefGoogle Scholar
  25. 25.
    Nakamura M, Hosoya Y, Yano M, Doki Y, Miyashiro I, Kurashina K, et al. Extent of gastric resection impacts patient quality of life: the dysfunction after upper gastrointestinal surgery for cancer (DAUGS32) scoring system. Ann Surg Oncol. 2011;18:314–20.PubMedCrossRefGoogle Scholar
  26. 26.
    Neary NM, Small CJ, Wren AM, Lee JL, Druce WR, Palmieri C, et al. Ghrelin increases energy intake in cancer patients with impaired appetite: acute, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89:2832–6.PubMedCrossRefGoogle Scholar
  27. 27.
    le Roux CW, Neary NM, Halsey TJ, Small CJ, Martinez-Isla AM, Ghatei MA, et al. Ghrelin does not stimulate food intake in patients with surgical procedures involving vagotomy. J Clin Endocrinol Metab. 2005;90:4521–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Koizumi M, Hosoya Y, Dezaki K, Yada T, Hosoda H, Kangawa K, et al. Postoperative weight loss does not resolve after esophagectomy despite normal serum ghrelin levels. Ann Thor Surg. 2011;91:1032–8.CrossRefGoogle Scholar
  29. 29.
    Yamamoto K, Takiguchi S, Miyata H, Adachi S, Hiura Y, Yamasaki M, et al. Randomized phase II study of clinical effects of ghrelin after esophagectomy with gastric tube resection. Surgery. 2010;148:31–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Wren AM, Seal LJ, Cohen MA, Brynes AE, Frost GS, Murphy KG, et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86:5992.PubMedCrossRefGoogle Scholar
  31. 31.
    Nagaya N, Miyatake K, Uematsu M, Oya H, Shimizu W, Hosoda H, et al. Hemodynamic, renal, and hormonal effects of ghrelin infusion in patients with chronic heart failure. J Clin Endocrinol Metab. 2001;86:5854–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2014

Authors and Affiliations

  • Masaru Koizumi
    • 1
    • 2
  • Yoshinori Hosoya
    • 1
  • Katsuya Dezaki
    • 2
  • Toshihiko Yada
    • 2
  • Hiroshi Hosoda
    • 3
  • Kenji Kangawa
    • 3
  • Hideo Nagai
    • 1
    • 4
  • Alan T. Lefor
    • 1
  • Naohiro Sata
    • 1
  • Yoshikazu Yasuda
    • 1
  1. 1.Department of SurgeryJichi Medical University School of MedicineShimotsukeJapan
  2. 2.Division of Integrative Physiology, Department of PhysiologyJichi Medical University School of MedicineShimotsukeJapan
  3. 3.Department of BiochemistryNational Cardiovascular Center Research InstituteOsakaJapan
  4. 4.Department of SurgeryIbaraki Prefectural Central HospitalIbarakiJapan

Personalised recommendations