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World J Gastroenterol. Apr 21, 2008; 14(15): 2425-2429
Published online Apr 21, 2008. doi: 10.3748/wjg.14.2425
Role of the duodenum in regulation of plasma ghrelin levels and body mass index after subtotal gastrectomy
Hai-Tao Wang, Qi-Cheng Lu, Qing Wang, Rong-Chao Wang, Yun Zhang, Hai-Long Chen, Hong Zhao, Hai-Xin Qian
Hai-Tao Wang, Qi-Cheng Lu, Qing Wang, Rong-Chao Wang, Department of Gastroenterology, 3rd Affiliated Hospital, Suzhou University, Changzhou 213003, Jiangsu Province, China
Yun Zhang, Hai-Long Chen, Department of Nuclear Medicine, 3rd Affiliated Hospital, Suzhou University, Changzhou 213003, Jiangsu Province, China
Hong Zhao, Hai-Xin Qian, Department of Gastroenterology, First Affiliated Hospital, Suzhou University, Suzhou 215006, Jiangsu Province, China
Author contributions: Qian HX, Zhao H and Wang RC designed the research; Zhang Y and Chen HL performed the research; Wang HT, Lu QC and Wang Q collected clinical data and wrote the paper.
Correspondence to: Hai-Tao Wang, Department of Gastroen-terology, 3rd Affiliated Hospital, Suzhou University, Changzhou 213003, Jiangsu Province, China. surgeonwht@163.com
Telephone: +86-519-86180072
Fax: +86-519-86621235
Received: December 21, 2007
Revised: February 25, 2008
Published online: April 21, 2008
Abstract

AIM: 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 (R12 = 0.297, P = 0.007; R22 = 0.559, P < 0.001).

CONCLUSION: 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.

Keywords: Duodenum, Ghrelin, Body mass index, Subtotal gastrectomy, Digestive reconstruction