Obesity Surgery

, Volume 22, Issue 2, pp 299–305

Effects of Laparoscopic Gastric Band Applications on Plasma and Fundic Acylated Ghrelin Levels in Morbidly Obese Patients

  • Remise Gelisgen
  • Kagan Zengin
  • Ahmet Kocael
  • Birol Baysal
  • Pınar Kocael
  • Hayriye Erman
  • Mustafa Taskın
  • Hafize Uzun
Clinical Research



It has been proposed that laparoscopic adjustable gastric banding (LAGB) procedure might play a role in modulation of fundic ghrelin production. To test this hypothesis, we examined plasma and tissue concentrations of acylated ghrelin in morbidly obese patients before and 6 months after LAGB. Baseline levels of acylated ghrelin in morbidly obese patients were also compared with those in age-matched, healthy, non-obese controls.


We studied 21 patients who had been operated on for morbid obesity (M/F = 9/12, BMI = 49.3 ± 5.3 kg/m2) and 16 healthy, non-obese persons (M/F = 7/9, BMI = 23.0 ± 1.7 kg/m2). Fasting blood samples were collected once from the non-obese controls as well as the morbidly obese patients before and 6 months after the LAGB. The morbidly obese patients and their respective controls underwent gastroscopy for fundic biopsy. The plasma and fundic acylated ghrelin levels were evaluated in these groups by enzyme-linked immunosorbent assay.


The plasma and fundic acylated ghrelin concentrations were significantly lower in obese patients than in non-obese controls (2.8 ± 1.0 ng/ml, 727 ± 171.7 ng/g tissue, respectively; p = 0.000). These parameters were significantly increased in morbidly obese patients 6 months after LAGB (4.1 ± 1.2 ng/ml and p = 0.001; 999 ± 292.1 ng/g tissue and p = 0.003, respectively).


We showed that fundic production of acylated ghrelin was significantly increased in morbidly obese patients 6 months after LAGB. Moreover, the weight loss after LAGB occurred in spite of the significant increase in the plasma and fundic acylated ghrelin levels. The potential role of ghrelin as being responsible for the weight loss after bariatric surgery needs to be elucidated in further studies.


Morbid obesity Gastric banding Acylated ghrelin Fundic biopsy Stomach 


  1. 1.
    De Vriese C, Delporte C. Ghrelin: a new peptide regulating growth hormone release and food intake. Int J Biochem Cell Biol. 2008;40:1420–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Leite-Moreira AF, Soares JB. Physiological, pathological and potential therapeutic roles of ghrelin. Drug Discov Today. 2007;12:276–88.PubMedCrossRefGoogle Scholar
  3. 3.
    Ueno H, Yamaguchi H, Kangawa K, et al. Ghrelin: a gastric peptide that regulates food intake and energy homeostasis. Regul Pept. 2005;126:11–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Date Y, Kojima M, Hosoda H, 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.PubMedCrossRefGoogle Scholar
  5. 5.
    Lely AJ, Tschop M, Heiman ML, et al. Biological, physiological, pathophysiological, and pharmacological aspects of ghrelin. Endocr Rev. 2004;25:426–57.PubMedCrossRefGoogle Scholar
  6. 6.
    Dadan J, Hady HR, Zbucki RL, et al. The activity of gastric ghrelin positive cells in obese patients treated surgically. Folia Histochem Cytobiol. 2009;47:307–13.PubMedCrossRefGoogle Scholar
  7. 7.
    Uzzan B, Catheline JM, Lagorce C, et al. Expression of ghrelin in fundus is increased after gastric banding in morbidly obese patients. Obes Surg. 2007;17:1159–64.PubMedCrossRefGoogle Scholar
  8. 8.
    Schindler K, Prager G, Ballaban T, et al. Impact of laparoscopic adjustable gastric banding on plasma ghrelin, eating behaviour and body weight. Eur J Clin Invest. 2004;34:549–54.PubMedCrossRefGoogle Scholar
  9. 9.
    Cummings DE, Shannon MH. Roles for ghrelin in the regulation of appetite and body weight. Arch Surg. 2003;138:389–96.PubMedCrossRefGoogle Scholar
  10. 10.
    Kojima M, Hosoda H, Kangawa K. Ghrelin, a novel growth hormone-releasing and appetite-stimulating peptide from stomach. Best Pract Res Clin Endocrinol Metab. 2004;18:517–30.PubMedCrossRefGoogle Scholar
  11. 11.
    Tschop M, Weyer C, Tataranni PA, et al. Circulating ghrelin levels are decreased in human obesity. Diabetes. 2001;50:707–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346:1623–30.PubMedCrossRefGoogle Scholar
  13. 13.
    Pournaras DJ, le Roux CW. Ghrelin and metabolic surgery. Int J Pept. 2010; 2010.Google Scholar
  14. 14.
    Shiiya T, Nakazato M, Mizuta M, et al. Plasma ghrelin levels in lean and obese humans and the effect of glucose on ghrelin secretion. J Clin Endocrinol Metab. 2002;87:240–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Gastrointestinal surgery for severe obesity. National institutes of health consensus development conference draft statement. Obes Surg. 1991;1:257–65.CrossRefGoogle Scholar
  16. 16.
    Osawa H, Nakazato M, Date Y, et al. Impaired production of gastric ghrelin in chronic gastritis associated with Helicobacter pylori. J Clin Endocrinol Metab. 2005;90:10–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Hayahida T, Nakahaara K, Mondal MS, et al. Ghrelin in neonatal rats: distribution in stomach and its possible role. J Endocrinol. 2002;173:239–45.CrossRefGoogle Scholar
  18. 18.
    Flier JS, Maratos-Flier E. The stomach speaks—ghrelin and weight regulation. N Engl J Med. 2002;346:1662–3.PubMedCrossRefGoogle Scholar
  19. 19.
    Fruhbeck G, Diez-Caballero A, Gil MJ, et al. The decrease in plasma ghrelin concentrations following bariatric surgery depends on the functional integrity of the fundus. Obes Surg. 2004;14:606–12.PubMedCrossRefGoogle Scholar
  20. 20.
    Hanusch-Enserer U, Cauza E, Brabant G, et al. Plasma ghrelin in obesity before and after weight loss after laparoscopical adjustable gastric banding. J Clin Endocrinol Metab. 2004;89:3352–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Korner J, Bessler M, Cirilo LJ, et al. Effects of Roux-en-Y gastric bypass surgery on fasting and postprandial concentrations of plasma ghrelin, peptide YY, and insulin. J Clin Endocrinol Metab. 2005;90:359–65.PubMedCrossRefGoogle Scholar
  22. 22.
    Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Cummings DE. Ghrelin and the short- and long-term regulation of appetite and body weight. Physiol Behav. 2006;89:71–84.PubMedCrossRefGoogle Scholar
  24. 24.
    Tatsuguchi A, Miyake K, Gudis K, et al. Effect of Helicobacter pylori infection on ghrelin expression inhuman gastric mucosa. Am J Gastroenterol. 2004;99:2121–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Wren AM, Small CJ, Ward HL, et al. The novel hypothalamic peptide ghrelin stimulates food intake and growth hormone secretion. Endocrinology. 2000;141:4325–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Couce ME, Cottam D, Esplen J, et al. Is ghrelin the culprit for weight loss after gastric bypass surgery? A negative answer. Obes Surg. 2006;16:870–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Fruhbeck G, Rotellar F, Hernandez-Lizoain JL, et al. Fasting plasma ghrelin concentrations 6 months after gastric bypass are not determined by weight loss or changes in insulinemia. Obes Surg. 2004;14:1208–15.PubMedCrossRefGoogle Scholar
  28. 28.
    Geloneze B, Tambascia MA, Pilla VF, et al. Ghrelin: a gutbrain hormone: effect of gastric bypass surgery. Obes Surg. 2003;13:17–22.PubMedCrossRefGoogle Scholar
  29. 29.
    Faraj M, Havel PJ, Phelis S, et al. Plasma acylation-stimulating protein, adiponectin, leptin, and ghrelin before and after weight loss induced by gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2003;88:1594–602.PubMedCrossRefGoogle Scholar
  30. 30.
    Holdstock C, Engstrom BE, Ohrvall M, et al. Ghrelin and adipose tissue regulatory peptides: effect of gastric bypass surgery in obese humans. J Clin Endocrinol Metab. 2003;88:3177–83.PubMedCrossRefGoogle Scholar
  31. 31.
    Nijhuis J, van Dielen FM, Buurman WA, et al. Ghrelin, leptin and insulin levels after restrictive surgery: a 2-year follow-up study. Obes Surg. 2004;14:783–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Stoeckli R, Chanda R, Langer I, et al. Changes of body weight and plasma ghrelin levels after gastric banding and gastric bypass. Obes Res. 2004;12:346–50.PubMedCrossRefGoogle Scholar
  33. 33.
    Mariani LM, Fusco A, Turriziani M, et al. Transient increase of plasma ghrelin after laparoscopic adjustable gastric banding in morbid obesity. Horm Metab Res. 2005;37:242–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Shak JR, Roper J, Perez-Perez GI, et al. The effect of laparoscopic gastric banding surgery on plasma levels of appetite-control, insulinotropic, and digestive hormones. Obes Surg. 2008;18:1089–96.PubMedCrossRefGoogle Scholar
  35. 35.
    Hanusch-Enserer U, Brabant G, Roden M. Ghrelin concentrations in morbidly obese patients after adjustable gastric banding. N Engl J Med. 2003;348:2159–60.PubMedCrossRefGoogle Scholar
  36. 36.
    Leonetti F, Silecchia G, Iacobellis G, 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
  37. 37.
    Morinigo R, Casamitjana R, Moize VV, et al. Short-term effects of gastric bypass surgery on circulating ghrelin levels. Obes Res. 2004;12:1108–16.PubMedCrossRefGoogle Scholar
  38. 38.
    Jeon TY, Lee S, Kim HH, 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
  39. 39.
    Garcia-Fuentes E, Garrido-Sanchez L, Garcia-Almeida JM, et al. Different effect of laparoscopic Roux-en-Y gastric bypass and open biliopancreatic diversion of Scopinaro on serum PYY and ghrelin levels. Obes Surg. 2008;18:1424–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Rodríguez A, Gómez-Ambrosi J, Catalán V, et al. Acylated and desacyl ghrelin stimulate lipid accumulation in human visceral adipocytes. Int J Obes (Lond). 2009;33:541–52.CrossRefGoogle Scholar
  41. 41.
    Korner J, Inabnet W, Febres G, et al. Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass. Int J Obes (Lond). 2009;33:786–95.CrossRefGoogle Scholar
  42. 42.
    Schwartz MW, Woods SC, Seeley RJ, et al. Is the energy homeostasis system inherently biased toward weight gain? Diabetes. 2003;52:232–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Dixon AF, Dixon JB, O’Brien PE. Laparoscopic adjustable gastric banding induces prolonged satiety: a randomized blind crossover study. J Clin Endocrinol Metab. 2005;90:813–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Engstrom BE, Ohrvall M, Sundbom M, Lind L, et al. Meal suppression of circulating ghrelin is normalized in obese individuals following gastric bypass surgery. Int J Obes (Lond). 2007;31:476–80.CrossRefGoogle Scholar
  45. 45.
    Saad MF, Bernaba B, Hwu CM, et al. Insulin regulates plasma ghrelin concentration. J Clin Endocrinol Metab. 2002;87:3997–4000.PubMedCrossRefGoogle Scholar
  46. 46.
    Marandi S, De Keyser N, Saliez A, et al. Insulin signal transduction in rat small intestine: role of MAP kinases in expression of mucosal hydrolases. Am J Physiol. 2001;280:G229–40.Google Scholar
  47. 47.
    Adami GF, Cordera R, Andraghetti G, et al. Changes in serum ghrelin concentration following biliopancreatic diversion for obesity. Obes Res. 2004;12:684–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • Remise Gelisgen
    • 1
  • Kagan Zengin
    • 2
  • Ahmet Kocael
    • 2
  • Birol Baysal
    • 3
  • Pınar Kocael
    • 2
  • Hayriye Erman
    • 1
  • Mustafa Taskın
    • 2
  • Hafize Uzun
    • 1
  1. 1.Department of Biochemistry, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  2. 2.Department of Surgery, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  3. 3.Department of Internal Medicine, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey

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