Role of the duodenum in regulation of plasma ghrelin levels and body mass index after subtotal gastrectomy.
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.
Wang
Hai-Tao
HT
Department of Gastroenterology, 3rd Affiliated Hospital, Suzhou University, Changzhou 213003, Jiangsu Province, China. surgeonwht@163.com
Lu
Qi-Cheng
QC
Wang
Qing
Q
Wang
Rong-Chao
RC
Zhang
Yun
Y
Chen
Hai-Long
HL
Zhao
Hong
H
Qian
Hai-Xin
HX
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
D054439:Ghrelin