Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5551
Peer-review started: December 10, 2021
First decision: January 8, 2022
Revised: January 20, 2022
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: June 16, 2022
The basic assumption of this study is based on the observation from everyday clinical practice that obstructive jaundice has a negative effect on the nutritional status of patients regardless of the obstruction etiology. Nutritional parameters play an important role in the treatment outcome of these patients.
Given the conflicting results of a very small number of studies determining the concentrations of appetite-regulating hormones in patients with biliary obstruction and their changes after cholestasis resolution, we considered that it is of scientific interest to investigate key mediators regulating the appetite and nutritional status of patients before and after biliary obstruction resolution.
The research objectives were to determine the levels of ghrelin, cholecystokinin and inflammatory markers in patients with obstructive jaundice, and to analyze their effect on appetite and nutritional status; to investigate the influence of the severity, duration and etiology of biliary obstruction, Helicobacter pylori infection and general characteristics of patients on the concentrations of hormones and inflammatory markers and the impact of endoscopic internal biliary drainage on the investigated parameters.
This was a prospective case control study performed in a tertiary center in Zagreb, Croatia. Fifty-five patients (34 with benign and 21 with malignant disease) with biliary obstruction undergoing internal biliary drainage, along with 40 healthy controls, were enrolled. Appetite, nutritional status, serum ghrelin, cholecystokinin (CCK), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α) were determined at admission, 48 h and 28 d after internal biliary drainage. Chi square test was used for categorical variables. Continuous variables were analyzed for normality by Kolmogorov–Smirnov test and relevant non-parametric (Mann-Whitney, Kruskal-Wallis, and Friedman) or parametric (t-test and ANOVA) tests were used.
Plasma ghrelin, IL-6, TNF-α, and C-reactive protein (CRP) were significantly higher in patients with obstructive jaundice. An increase in CCK was observed only in malnourished patients with obstructive jaundice. TNF-α was a predictive factor for malnutrition in obstructive jaundice. After internal biliary drainage, a significant improvement of nutritional status was observed in spite of the fact that concentrations of ghrelin, CCK, IL-6, and TNF-α remained significantly elevated even 28 d after procedure. We have not established any correlation between appetite and serum levels of ghrelin, CCK, IL-6, and TNF-α before and after biliary drainage. Malnutrition, lower appetite, lower serum CRP and higher TNF-α in patients with obstructive jaundice were associated with long-term mortality.
The efficacy of ghrelin and CCK signaling depends on their mutual balance. Disruption of that balance, such as it that be able to be seen in patients with biliary obstruction, can lead to dysfunction in appetite regulation which, according to our results, can be restored, but through some other mechanisms. This shows that changes in concentrations of appetite regulating hormones and inflammatory factors play only a small part in feeding regulation.
Changes in the concentration of appetite-regulating hormones and inflammatory markers are only a part of the feeding regulation process, which will certainly continue to be the subject of numerous future studies due to its complexity.