Role of the duodenum in regulation of plasma ghrelin levels and body mass index after subtotal gastrectomy

• Published in: World journal of gastroenterology : WJG Vol. 14; no. 15; pp. 2425 - 2429
• Main Authors: Wang, Hai-Tao, Lu, Qi-Cheng, Wang, Qing, Wang, Rong-Chao, Zhang, Yun, Chen, Hai-Long, Zhao, Hong, Qian, Hai-Xin
• Format: Journal Article
• Language: English
• Published: United States Department of Gastroenterology, 3rd Affiliated Hospital, Suzhou University, Changzhou 213003, Jiangsu Province, China%Department of Nuclear Medicine,3rd Affiliated Hospital, Suzhou University, Changzhou 213003,Jiangsu Province, China%Department of Gastroenterology, First Affiliated Hospital, Suzhou University, Suzhou 215006, Jiangsu Province, China 21.04.2008; The WJG Press and Baishideng
• Subjects: Adult; Anastomosis, Surgical; Body Mass Index; Duodenum - metabolism; Duodenum - surgery; Female; Gastrectomy; Gastric Mucosa - metabolism; Ghrelin - blood; Humans; Jejunum - surgery; Male; Middle Aged; Radioimmunoassay; Rapid Communication; Stomach - surgery; Stomach Neoplasms - metabolism; Stomach Neoplasms - surgery; Time Factors; Treatment Outcome; 十二指肠; 消化系统; 等离子调节; 胃切除术; Body mass index; Digestive reconstruction; Duodenum; Ghrelin; Subtotal gastrectomy
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.14.2425

AIM： To investigate the role of the duodenum in the regulation of plasma ghrelin levels and body mass index （BMI）, and the correlation between them after subtotal gastrectomy. METHODS： Forty-two patients with T0-1N0-1M0 gastric cancer were divided into two groups after gastrectomy according to digestive reconstruction pattern, Billroth Ⅰ group （n = 23） and Billroth Ⅱ group （n = 19）. Ghrelin levels were determined with radioimmunoassay （RIA） before and on d 1, 7, 30 and 360 after gastrectomy, and BMI was also measured. RESULTS： The two groups had identical postoperative trends in ghrelin alterations during the early stage, both decreasing sharply to a nadir on d 1 （36.7% vs 35.7%）, then markedly increasing on d 7 （51.0% vs 51.1%）. On d 30, ghrelin levels in the Billroth Ⅰ group were slightly higher than those in the Billroth Ⅱ group. However, those of the Billroth Ⅰ group recovered to 93.6% on d 360, which approached, although lower than, the preoperative levels, and no statistically significant difference was observed. Those of the Billroth Ⅱ group recovered to only 81.6% and manifested significant discrepancy with preoperative levels （P = 0.033）. Compared with preoperative levels, ghrelin levels of the two groups decreased by 6.9% and 18.4% and BMI fellby 3.3% and 6.4%, respectively. The linear regression correlations were revealed in both groups between decrease of ghrelin level and BMI （R12 = 0.297, P = 0.007; R22 = 0.559, P 〈 0.001）.CONCLUSION： Anatomically and physiologically, the duodenum compensatively promotes ghrelin recovery and accordingly enhances BMI after gastrectomy. Regarding patients with insufficient ghrelin secretion, ghrelin is positively associated with BMI.