Clinical application of ghrelin administration for gastric cancer patients undergoing gastrectomy

Abstract

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.

Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis

“…Solid tumours, including gastric cancers, are typically associated with a degree of anorexia as well as underlying metabolic alterations such as elevated energy expenditure, excess catabolism, and inflammation. In gastric cancers, these effects are worsened by the direct obstruction to the passage of food and combined effects of chemotherapy and major gastrectomy that results in a decline in nutritional intake [2,3].…”

Long‐term effects of an oral elemental nutritional supplement on post‐gastrectomy body weight loss in gastric cancer patients (KSES002)

“…Meanwhile, the ERAS protocol, which encompasses all types of perioperative management, has been recommended in gastric surgery for improving nitrogen balance under the condition of hypercatabolism associated with inflammatory reactions as a result of surgical stress, by shortening the fasting period as much as possible. Although ERAS is a reasonable management protocol, there remains a problem in that patients who undergo gastrectomy, in particular TG, are not able to consume a sufficient amount of food early after surgery because of loss of reservoir function and reduction in blood ghrelin levels …”

Clinical Impact of Sarcopenia on Gastric Cancer

“…In advanced gastric cancer, the majority of patients suffer from poor dietary intake, resulting in inadequate nutrition (18). Even in early gastric cancer, surgery reduces the capacity of the stomach to digest, which decreases meal intake and results in prominent weight loss (19). Therefore, we have to keep in mind that patients with gastric cancer have the potential to develop a sarcopenic state, emphasizing the importance of having sufficient knowledge and methodology for the management of gastric cancer.…”