title: The decrease in plasma ghrelin concentrations following bariatric surgery depends on the functional integrity of the fundus.
abstract: BACKGROUND
  Gastric bypass surgery, which involves the production of a reduced stomach pouch,has been shown to markedly suppress circulating ghrelin concentrations. Since bypassing the ghrelin-producing cell population may be relevant to the disruption of fundic-derived factors participating in food intake signaling, the effect of weight loss induced by either adjustable gastric banding (AGB), Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion (BPD) was studied.
  
  
  METHODS
  16 matched obese patients [35.0 + 2.4 years; initial body weight 124.8 +/- 5.7 kg; body mass index (BMI) 47.1 +/- 2.2 kg/m(2)] in whom similar weight loss had been achieved by either AGB (n=7), RYGBP (n=6) or BPD (n=3) were studied. Blood was obtained for biochemical and hormonal analyses. Body composition was assessed by air-displacement-plethysmography.
  
  
  RESULTS
  Comparable weight loss (AGB: 26.1 +/- 5.1 kg; RYGBP: 32.1 +/- 5.0; BPD: 31.7 +/- 6.1; P=NS) and decrease in percentage body fat (AGB: 10.0 +/- 1.5%; RYGBP: 14.2 +/- 2.8; BPD: 10.3 +/- 1.0; P=NS) induced by bariatric surgery exerted significantly different (P=0.004) effects on plasma ghrelin concentrations, depending on the surgical procedure applied (AGB: 480 +/- 78 pg/ml; RYGBP: 117 +/- 34; BPD: 406 +/- 86). Without significant differences in BMI, body fat, glucose, triglycerides, cholesterol, insulin and leptin levels, patients who had undergone the RYGBP exhibited statistically significant diminished circulating fasting plasma ghrelin concentrations compared with the other two bariatric techniques which conserve direct contact of the fundus with ingested food (P=0.003 vs AGB and P=0.020 vs BPD).
  
  
  CONCLUSIONS
  Fasting circulating ghrelin concentrations in patients undergoing diverse bariatric operations depend on the degree of dysfunctionality of the fundus.
authors.affiliation: Metabolic Research Laboratory, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain. gfruhbeck@unav.es
authors.forename: Gema
authors.initials: G
authors.lastname: Frühbeck
authors.forename: Alberto
authors.initials: A
authors.lastname: Diez-Caballero
authors.forename: M Jesús
authors.initials: MJ
authors.lastname: Gil
authors.forename: Inés
authors.initials: I
authors.lastname: Montero
authors.forename: Javier
authors.initials: J
authors.lastname: Gómez-Ambrosi
authors.forename: Javier
authors.initials: J
authors.lastname: Salvador
authors.forename: Javier A
authors.initials: JA
authors.lastname: Cienfuegos
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion; D001823:Body Composition; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty; D054439:Ghrelin; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery; D036361:Peptide Hormones / Q000097:blood*; D011184:Postoperative Period; D015431:Weight Loss
chemical_list: D054439:Ghrelin; D036361:Peptide Hormones