title: Postoperative weight loss does not resolve after esophagectomy despite normal serum ghrelin levels.
abstract: BACKGROUND
  Esophagectomy after gastric reconstruction leads to significant weight loss. Ghrelin is known to stimulate appetite and cause weight increase. The objective of this study is to examine the relationship of serum ghrelin levels and weight loss in patients after esophagectomy for cancer.
  
  
  METHODS
  Twenty-two patients underwent esophagectomy including gastric reconstruction. Serum ghrelin levels and weight were measured preoperatively and then postoperatively for 12 months in all patients. A questionnaire assessed appetite, amount of food eaten, satisfaction, and frequency of eating.
  
  
  RESULTS
  Preoperatively, the mean serum ghrelin level was 67.9 ± 42.6 (fmol/mL ± SD), and at 1, 3, 6, and 12 months after surgery were 43.4 ± 28.1, 51.5 ± 32.2, 67.1 ± 50.9, and 84.9 ± 43.1, respectively. Compared with preoperative values, the mean body mass index decreased by 1.9 ± 1.5, 2.3 ± 1.8, 2.1 ± 2.3, 2.4 ± 2.7 at 1, 3, 6, and 12 months after surgery. While appetite score showed a decrease at 1 month (1.6 ± 0.92), appetite increased by 12 months postoperatively (2.7 ± 1.0) and showed a strong positive correlation (r = 0.743) with serum ghrelin levels. There were no significant differences in ghrelin levels when patients were stratified by disease stage, recurrence, or administration of adjuvant chemotherapy.
  
  
  CONCLUSIONS
  Esophagectomy resulted in temporary reduction of ghrelin levels, but while levels returned to normal 3 months later, weight loss persisted at 12 months. Further study is needed to elucidate the mechanisms of persistent weight loss and design therapeutic interventions to recover the weight lost.
authors: Department of Surgery, Jichi Medical University School of Medicine, Tochigi, Japan. mkoizumi@jichi.ac.jp
authors: Masaru
authors: M
authors: Koizumi
authors: Yoshinori
authors: Y
authors: Hosoya
authors: Katsuya
authors: K
authors: Dezaki
authors: Toshihiko
authors: T
authors: Yada
authors: Hiroshi
authors: H
authors: Hosoda
authors: Kenji
authors: K
authors: Kangawa
authors: Hideo
authors: H
authors: Nagai
authors: Alan T
authors: AT
authors: Lefor
authors: Naohiro
authors: N
authors: Sata
authors: Yoshikazu
authors: Y
authors: Yasuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D015431:Weight Loss
chemical_list: D054439:Ghrelin