title: Gut Hormone Suppression Increases Food Intake After Esophagectomy With Gastric Conduit Reconstruction.
abstract: OBJECTIVE
  To characterize the gut hormone profile and determine the effect of satiety gut hormone blockade on food intake in disease-free postesophagectomy patients.
  
  
  BACKGROUND
  Improved oncologic outcomes for esophageal cancer have resulted in increased survivorship and a focus on health-related quality of life. Anorexia and early satiety are common, but putative causative factors, in particular the gut-brain hormonal axis, have not been systematically studied.
  
  
  METHODS
  In a double-blind, placebo-controlled, randomized crossover study, disease-free patients at least 1 year postresection and gastric conduit reconstruction received either 1 mL 0.9% saline or 1 mL (100 μg) octreotide acetate subcutaneously followed by a standardized ad libitum meal on each of two assessments. Fasting and postprandial plasma glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and ghrelin immunoreactivity were measured. Gut hormone responses and calorie intake postsaline versus octreotide were compared between experimental and control groups.
  
  
  RESULTS
  Eighteen subjects [esophagectomy (ES), n = 10, 2.4 ± 0.75 years postresection; and unoperated control subjects, n = 8] were studied. ES demonstrated significant weight loss at 3, 6, 12, and 24 months postoperatively (all P < 0.05). Ghrelin levels were similar (P = 0.58) for both groups, but postprandial GLP-1 and PYY responses were significantly (P < 0.001) greater among ES as compared with controls. After octreotide, ad libitum calorie intake increased among ES (1.5 ± 0.2 fold-change, P = 0.02) but not controls (1.1 ± 0.1 fold-change, P = 0.30).
  
  
  CONCLUSIONS
  ES demonstrated an exaggerated postprandial satiety gut hormone response that was attenuated by octreotide, thus identifying a potential therapeutic target to modulate in the ES patient with early satiety.
authors.affiliation: *Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research, University College Dublin, Dublin, Ireland †Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland ‡Wellcome Trust and HRB Clinical Research Facility, St. James's Hospital, Dublin, Ireland §Gastrosurgical Laboratory, Sahlgrenska Academy, University of Gothenburg, Gothenberg, Sweden.
authors.forename: Jessie A
authors.initials: JA
authors.lastname: Elliott
authors.forename: Sabrina
authors.initials: S
authors.lastname: Jackson
authors.forename: Sinead
authors.initials: S
authors.lastname: King
authors.forename: Ruth
authors.initials: R
authors.lastname: McHugh
authors.forename: Neil G
authors.initials: NG
authors.lastname: Docherty
authors.forename: John V
authors.initials: JV
authors.lastname: Reynolds
authors.forename: Carel W
authors.initials: CW
authors.lastname: le Roux
mesh_terms: D015992:Body Mass Index; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004435:Eating / Q000187:drug effects*; D004938:Esophageal Neoplasms / Q000378:metabolism / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D005768:Gastrointestinal Hormones / Q000037:antagonists & inhibitors*; D015391:Gastroplasty; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage*; D011788:Quality of Life
chemical_list: D005765:Gastrointestinal Agents; D005768:Gastrointestinal Hormones; D015282:Octreotide