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- Elliott, J. A., et al.
(författare)
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Gut Hormone Suppression Increases Food Intake After Esophagectomy With Gastric Conduit Reconstruction
- 2015
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Ingår i: Annals of Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 0003-4932. ; 262:5, s. 824-830
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: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 1mL 0.9% saline or 1mL (100g) 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, 2.40.75 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.
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| 170. |
- Elliott, J. A., et al.
(författare)
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Weight Loss, Satiety, and the Postprandial Gut Hormone Response After Esophagectomy A Prospective Study
- 2017
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Ingår i: Annals of Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 0003-4932. ; 266:1, s. 82-90
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To prospectively characterize changes in body weight, satiety, and postprandial gut hormone profiles following esophagectomy. Background: With improved oncologic outcomes in esophageal cancer, there is an increasing focus on functional status and health-related quality of life in survivorship. Early satiety and weight loss are common after esophagectomy, but the pathophysiology of these phenomena remains poorly understood. Methods: In this prospective study, consecutive patients undergoing esophagectomy with gastric conduit reconstruction were studied preoperatively and at 10 days, 6 weeks, and 3 months postoperatively. Glucagon-like peptide 1 (GLP-1) immunoreactivity of plasma collected immediately before and at 15, 30, 60, 90, 120, 150, and 180 minutes after a standardized 400-kcal mixed meal was determined. Gastrointestinal symptom scores were computed using European Organization for Research and Treatment of Cancer questionnaires. Results: Body weight loss at 6 weeks and 3 months postoperatively among 13 patients undergoing esophagectomy was 11.1 +/- 2.3% (P < 0.001) and 16.3 +/- 2.2% (P < 0.0001), respectively. Early satiety (P = 0.043), gastrointestinal pain and discomfort (P = 0.01), altered taste (P = 0.006), and diarrhea (P = 0.038) scores increased at 3 months postoperatively. Area under the curve for the satiety gut hormone GLP-1 was significantly increased from 10 days postoperatively (2.4 +/- 0.2-fold increase, P < 0.01), and GLP-1 peak increased 3.8 +/- 0.6-, 4.7 +/- 0.8-, and 4.4 +/- 0.5-fold at 10 days, 6 weeks, and 3 months postoperatively (all P < 0.0001). Three months postoperatively, GLP-1 area under the curve was associated with early satiety (P = 0.0002, R-2 = 0.74), eating symptoms (P = 0.007, R-2 = 0.54), and trouble enjoying meals (P = 0.0004, R-2 = 0.73). Conclusions: After esophagectomy, patients demonstrate an exaggerated postprandial satiety gut hormone response, which may mediate postoperative changes in satiety, body weight, and gastrointestinal quality of life.
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