Gut Hormone Suppression Increases Food Intake After Esophagectomy With Gastric Conduit Reconstruction

• 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.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Gastroenterologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Keyword

esophageal carcinoma

esophagectomy

esophagogastric junction

gastric conduit

ghrelin

glucagon-

quality-of-life

somatostatin receptor subtype-5

rat intestinal

cultures

glucagon-like peptide-1

serum ghrelin levels

body-weight

loss

cancer-surgery

tube reconstruction

sleeve gastrectomy

enteral

nutrition

Surgery

Publication and Content Type

ref (subject category)

art (subject category)