title: Role of the duodenum in regulation of plasma ghrelin levels and body mass index after subtotal gastrectomy.
abstract: OBJECTIVE
  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 fell by 3.3% and 6.4%, respectively. The linear regression correlations were revealed in both groups between decrease of ghrelin level and BMI (R1(2) = 0.297, P = 0.007; R2(2) = 0.559, P < 0.001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology, 3rd Affiliated Hospital, Suzhou University, Changzhou 213003, Jiangsu Province, China. surgeonwht@163.com
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Wang
authors.forename: Qi-Cheng
authors.initials: QC
authors.lastname: Lu
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.forename: Rong-Chao
authors.initials: RC
authors.lastname: Wang
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Hai-Long
authors.initials: HL
authors.lastname: Chen
authors.forename: Hong
authors.initials: H
authors.lastname: Zhao
authors.forename: Hai-Xin
authors.initials: HX
authors.lastname: Qian
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D015992:Body Mass Index; D004386:Duodenum / Q000378:metabolism / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000378:metabolism; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011863:Radioimmunoassay; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000378:metabolism / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D054439:Ghrelin