Molecular Pathological Study on the dynamics of Ghrelin in patients with gastric diseases

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Ghrelin is an endogenous ligand for the growth hormone secretagogue receptor. It is synthesized predominantly in the stomach and stimulates the hypothalamic appetite center. We tested whether plasma ghrelin levels after gastrectomy were correlated with the percentage postoperative reduction in body mass index (BMI). We measured BMI and morning plasma ghrelin levels after overnight fasting, in patients more than 2 months after distal or total gastrectomy due to gastric cancer, as well as after pancreatico-duodenectomy due to pancreatic cancer or common bile duct cancer. We studied 53 patients, aged 38 to 89 years (average 67 years). The percentage reduction in BMI was calculated from the difference between the present and stable BMI (more than 6 month after operation) and the BMI before operation. We also measured plasma leptin as well as ghrelin. We were able to measure plasma ghrelin levels before and after operation in fourteen cases. Comparison of % BMI reductions and plasma ghrelin levels revealed a significant correlation among the patients undergoing gastrectomy. In contrast, no correlation and noo reduction in ghrelin levels were found in cases of pancreatico-duodenectomy, even though BMI decreased more than in cases of gastrectomy. In addition, plasma ghrelin levels declined more after total gastrectomy than after distal gastrectomy, in agreement with the fact that ghrelin-producing endocrine cells are located in the area of the gastric fundic gland. These results lend support to the hypothesis that post-gastrectomy weight loss is partly explained by ghrelin deficiency as well by defective nutrient absorption. In future, treatment with ghrelin or ghrelin agonists may counteract weight loss and other post-gastrectomy symptoms.