title: Clinical application of ghrelin administration for gastric cancer patients undergoing gastrectomy.
abstract: Loss of body weight is a common (and the most serious) sequela after gastrectomy. It impairs quality of life, increases various diseases including infection, and may affect long-term survival. Ghrelin, an intrinsic ligand of the growth hormone secretagogue receptor, was discovered in the stomach in 1999. In addition to growth hormone secretion, ghrelin has pleiotropic functions including appetite stimulation, increasing bowel movement and absorption, and anti-inflammatory reactions. In consequence, ghrelin comprehensively leads positive energy balance and weight gain. The fundic gland of the stomach produces the majority of ghrelin, and plasma ghrelin declines to 10-30 % of the preoperative level after total gastrectomy and 50-70 % after distal gastrectomy. Although plasma ghrelin is never restored after total gastrectomy, it gradually recovers to the preoperative level within a few years after distal gastrectomy. Chronic gastritis due to Helicobacter pylori infection and vagotomy are additional factors that perturb the ghrelin secretion of gastric cancer patients after gastrectomy. A randomized clinical trial that revealed that recombinant ghrelin administration successfully increased both food intake and appetite, and ameliorated weight loss after total gastrectomy. Ghrelin administration could thus be a promising strategy to transiently improve the nutritional status of patients who who have undergone gastrectomy, but its effect in the long term remains unclear. Further studies are warranted to elucidate the mechanism of ghrelin and to create and evaluate the analogs that could be administered orally or subcutaneously.
authors.affiliation: Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan, stakiguchi@gesurg.med.osaka-u.ac.jp.
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Takata
authors.forename: Kohei
authors.initials: K
authors.lastname: Murakami
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Yanagimoto
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kurokawa
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D005743:Gastrectomy / Q000009:adverse effects*; D054439:Ghrelin / Q000008:administration & dosage*; D006801:Humans; D011183:Postoperative Complications / Q000188:drug therapy*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000601:surgery*; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D054439:Ghrelin