Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan,
Gastric Cancer. 2014 Apr;17(2):200-5. doi: 10.1007/s10120-013-0300-8. Epub 2013 Sep 20.
Loss of body weight is a common (and the most serious) sequela after gastrectomy. It impairs quality of life, increases various diseases including infection, and may affect long-term survival. Ghrelin, an intrinsic ligand of the growth hormone secretagogue receptor, was discovered in the stomach in 1999. In addition to growth hormone secretion, ghrelin has pleiotropic functions including appetite stimulation, increasing bowel movement and absorption, and anti-inflammatory reactions. In consequence, ghrelin comprehensively leads positive energy balance and weight gain. The fundic gland of the stomach produces the majority of ghrelin, and plasma ghrelin declines to 10-30 % of the preoperative level after total gastrectomy and 50-70 % after distal gastrectomy. Although plasma ghrelin is never restored after total gastrectomy, it gradually recovers to the preoperative level within a few years after distal gastrectomy. Chronic gastritis due to Helicobacter pylori infection and vagotomy are additional factors that perturb the ghrelin secretion of gastric cancer patients after gastrectomy. A randomized clinical trial that revealed that recombinant ghrelin administration successfully increased both food intake and appetite, and ameliorated weight loss after total gastrectomy. Ghrelin administration could thus be a promising strategy to transiently improve the nutritional status of patients who who have undergone gastrectomy, but its effect in the long term remains unclear. Further studies are warranted to elucidate the mechanism of ghrelin and to create and evaluate the analogs that could be administered orally or subcutaneously.
体重减轻是胃切除术后的常见（也是最严重的）后遗症。它会降低生活质量，增加包括感染在内的各种疾病，并可能影响长期生存。Ghrelin 是生长激素促分泌素受体的内源性配体，于 1999 年在胃中被发现。除了促进生长激素分泌外，Ghrelin 还具有多种功能，包括刺激食欲、增加肠蠕动和吸收以及抗炎反应。因此，Ghrelin 全面促进正能平衡和体重增加。胃底腺产生大部分 Ghrelin，全胃切除术后血浆 Ghrelin 下降至术前水平的 10-30%，远端胃切除术后下降至 50-70%。虽然全胃切除术后血浆 Ghrelin 从未恢复，但在远端胃切除术后几年内逐渐恢复到术前水平。幽门螺杆菌感染和迷走神经切断术引起的慢性胃炎是另外两个会扰乱胃癌患者胃切除术后 Ghrelin 分泌的因素。一项随机临床试验表明，重组 Ghrelin 给药成功增加了食物摄入和食欲，并改善了全胃切除术后的体重减轻。因此，Ghrelin 给药可能是一种有前途的策略，可以暂时改善接受胃切除术的患者的营养状况，但长期效果尚不清楚。需要进一步的研究来阐明 Ghrelin 的机制，并创建和评估可口服或皮下给药的类似物。
