Changes in appetite hormone (ghrelin) levels of saliva and serum in acute appendicitis cases before and after operation

Effect of Ghrelin Hormone as a Diagnostic Factor on Appendicitis

Background

Appendicitis is the most common cause of surgery in people under 50. In America, it causes 250,000 cases per year and about 1 million days of hospitalization.

Methods

This cross-sectional study was performed on 20 patients under appendectomy with diagnosis of acute appendicitis. The statistical population was divided into two groups, proven appendicitis in pathology and rejection of appendicitis in pathology. Then, 10 patients were assigned into each group.

Results

A total of 20 patients were enrolled in this study, 9 of whom were female (45%) and 11 male (55%). The most common symptom was anorexia. However, there was no statistical difference between the two groups. The lowest level of serum ghrelin was 0.95 and the highest was 16.00 in the study group, which was the mean in people with appendicitis and nonappendicitis 6.24 ± 4.09 and 5.12 ± 4.85, respectively. These values were not significantly different between the two groups (T = 0.45, df = 18, p = 0.65).

Conclusion

This conclusion may be due to the small number of cases introduced into the study, which suggests that further investigation is warranted with a larger sample size.

Plasma ghrelin suppression as an early predictor for postoperative complications after pancreatoduodenectomy

BACKGROUND/OBJECTIVES

The gut peptide hormone ghrelin induces appetite and exhibits an anti-inflammatory effect. Serial perioperative changes in ghrelin have been examined in several surgical procedures, but few in pancreatectomy. The present study analyzed perioperative changes in plasma ghrelin levels after pancreaduodenectomy (PD).

METHODS

The study included 24 patients undergoing PD between May 2015 and January 2016 at Osaka University Hospital. Plasma ghrelin and interleukin-6 (IL-6) levels, as well as white blood cells (WBCs) and C-reactive protein (CRP), were measured preoperatively and on postoperative day (POD) 1, 3, 7, and 14 by enzyme-linked immunosorbent assay. The relationship between the individual ghrelin ratio relative to preoperative value (IGR) and the development of grade IIIa-V Clavien-Dindo (CD) complications was examined.

RESULTS

Twelve patients (50%) developed grade IIIa CD complications (n = 6 [25%] pancreatic fistula, n = 7 [29%] intraabdominal abscess, n = 3 [13%] post-pancreatectomy hemorrhage, n = 5 [21%] wound infection, and n = 1 [4%] lymphorrhea). The IGR on POD 1 was significantly lower (p = 0.014) in patients who developed the complications compared to those who did not, but no significant differences were found in terms of WBC, CRP, or IL-6 on POD 1. When the IGR cut-off was set to 82% by receiver operative curve analysis, the sensitivity was 83%, specificity 75% and area under the curve 0.80. The lower IGR group (≤82%) had more postoperative complications and longer hospital stay.

CONCLUSIONS

The IGR on POD 1 after PD is a useful marker for predicting postoperative complications.

Acute one-cigarette smoking decreases ghrelin hormone in saliva: a pilot study

Cigarette smoking is commonly associated with weight loss and mechanisms for these weight changes are still elusive. Ghrelin is a peptide hormone that works in a neuroendocrine fashion to stimulate hunger and the desire for food intake. Ghrelin is also secreted in saliva, probably to enhance food taste. In the current study, we tested the direct impact of acute cigarette smoking on total ghrelin found in saliva. Methods. Blood and saliva samples were collected from 30 healthy nonsmoker male volunteers before and after one-cigarette smoke. Total ghrelin in serum and saliva was measured by ELISA based method. Results. Data showed a statistically significant reduction in salivary ghrelin after smoking (P < 0.0001). In serum, total ghrelin levels were not affected before and after smoking (P = 0.1362). Additionally, positive correlation was observed between serum and salivary ghrelin before smoking (r = 0.4143 and P = 0.0158); however, this correlation was lost after smoking (r = 0.1147 and P = 0.5461). Conclusion. Acute one-cigarette smoking can negatively affect ghrelin levels in saliva that might contribute to the dull food taste in smokers.

Agreement between paper and pen visual analogue scales and a wristwatch-based electronic appetite rating system (PRO-Diary©), for continuous monitoring of free-living subjective appetite sensations in 7-10 year old children

Electronic capture of free-living subjective appetite data can provide a more reliable alternative to traditional pen and paper visual analogue scales (P&P VAS), whilst reducing researcher workload. Consequently, the aim of this study was to explore the agreement between P&P VAS and a wristwatch-based electronic appetite rating system known as the PRO-Diary© technique, for monitoring free-living appetite sensations in 7-10 year old children. On one occasion, using a within-subject design, the 12 children (n=6 boys; n=6 girls) recorded their subjective appetite (hunger, prospective food consumption, and fullness), at two time points before lunch (11:30 and 12:00) and every 60 min thereafter until 21:00. The agreement between the P&P VAS and PRO-Diary© technique was explored using 95% limits of agreement and 95% confidence intervals (95% CI) calculated using the Bland and Altman (1986) technique. For hunger, prospective food consumption and fullness, the 95% limits of agreement were -1±25 mm (95% CI: lower limit -8mm; upper limit +6mm), 0±21 mm (95% CI: lower limit -6mm; upper limit +6mm) and -6±24 mm (95% CI: lower limit -14 mm; upper limit +1mm), respectively. Given the advantages associated with electronic data capture (inexpensive; integrated alarm; data easily downloaded), we conclude that the PRO-Diary© technique is an equivalent method to employ when continuously monitoring free-living appetite sensations in 7-10 year old children, but should not be used interchangeably with P&P VAS.

Effect of Acute Surgical Stress on Serum Ghrelin Levels

BACKGROUND

Ghrelin is an appetite hormone that influences the gastrointestinal function and regulates energy metabolism. Growing evidence also suggests that this hormone plays a central role in immune modulation. Each surgical operation is followed by a series of inflammatory and metabolic changes that constitute the stress response. The aim of our study is to evaluate the effect of stress during different types of abdominal surgery in ghrelin serum levels.

METHODS

An overall of 25 patients were prospectively allocated in two groups based on the type of surgical operation. Group A (n = 10) patients were scheduled to undergo cholecystectomy, whereas Group B (n = 15) patients underwent colectomy. Serum ghrelin concentrations were evaluated in each patient preoperatively, after the induction of general anesthesia and tracheal intubation, one and five hours after the beginning of surgery and the morning of the first and second postoperative day.

RESULTS

In both groups serum ghrelin concentrations reached their peak level at 24 hr (Group A: 8.4 ± 3.4 ng/mL; Group B: 7.4 ± 1.8 ng/mL) and these values were significantly higher than those in the preoperative period (Group A: 5.0 ±1.5 ng/mL; Group B: 4.8 ± 0.6 ng/mL) (P < 0.05). Forty eight hours after surgery the levels of ghrelin returned to their preoperative status. Patients' gender, age, ASA score and type of surgical procedure did not influence the serum ghrelin levels.

CONCLUSIONS

Serum ghrelin concentration appears to elevate in response to surgical stress. Future studies are needed to improve comprehension of the mechanisms underlying responses of this hormone to acute surgical stress and to evaluate their possible clinical implications.

Comparison of serum and salivary ghrelin in healthy adults, morbidly obese, and patients with metastatic carcinoma

BACKGROUND

Ghrelin, a known orexigenic hormone, has been demonstrated to be produced and released by salivary glands. Obtaining saliva for metabolism studies would be preferable for patients since the procedure is non-invasive.

METHODS

The present study examined serum and salivary ghrelin levels in 41 morbidly obese subjects, 45 healthy controls, and 17 patients with metastatic carcinoma by using a commercial radioimmunoassay.

RESULTS

When comparing serum and salivary levels under fasting conditions, ghrelin levels were significantly higher in saliva for morbidly obese and healthy subjects. A significant correlation between salivary and serum ghrelin could only be demonstrated for healthy subjects. Fasting serum ghrelin concentrations in morbidly obese patients were significantly lower compared with healthy controls and cancer patients, however the levels in whole saliva did not differ significantly between all groups. There was only a highly significant inverse correlation between BMI and serum ghrelin. Serum ghrelin correlated positively with age in morbidly obese. There was no significant difference in serum and saliva ghrelin concentrations between men and women. Following the standardized meal, no significant suppression of serum ghrelin levels in morbidly obese was observed, however salivary ghrelin concentrations were significantly decreased.

CONCLUSIONS

The results of the present study support the hypothesis that there is an autonomous production of ghrelin in the salivary glands. Further research should focus on factors involved in the regulation of salivary ghrelin. Until the mechanism of regulation is fully understood, the testing of ghrelin levels in saliva is too limited to recommend a switch from serum testing.

Weight loss and changes in salivary ghrelin and adiponectin: comparison between sleeve gastrectomy and Roux-en-Y gastric bypass and gastric banding

BACKGROUND

Weight loss is associated with increased levels of adiponectin with a greater increase observed following Roux-en-Y gastric bypass (RYGB) compared to restrictive procedures. However, currently there are no data on changes in adiponectin following laparoscopic sleeve gastrectomy (LSG). Ghrelin was reported to be also produced by the salivary glands. There are also no data available regarding its changes following bariatric surgery.

METHODS

The present study examined weight loss, and salivary ghrelin and HMW adiponectin levels in 43 morbidly obese subjects undergoing three different types of bariatric surgery.

RESULTS

We found that weight loss following LSG is superior to laparoscopic adjustable gastric banding (LAGB) and comparable to RYGB at 12 months after surgery. Although blood glucose decreased similarly following all three procedures, fasting insulin continuously declined only in LSG and RYGB patients. Changes in both fasting and postprandial salivary ghrelin greatly varied between all three procedures with no similarities to changes in serum ghrelin reported in the literature. HMW adiponectin significantly increased following LSG, and this increase was more marked than in LAGB patients and almost identical compared to RYGB.

CONCLUSIONS

Weight loss following LSG is comparable to RYGB in the short term. Changes in HMW adiponectin are comparable following LSG and RYGB which may further contribute to the successful results after LSG. Furthermore, the results of the present study support the hypothesis that there is an autonomous production of ghrelin in salivary glands irrespective of nutritional status and weight loss.

Expression of ghrelin in human salivary glands and its levels in saliva and serum in Chinese obese children and adolescents

OBJECTIVE

The aim of the present study was to reveal the expression characteristics of ghrelin in human three major salivary glands and to investigate saliva and serum ghrelin level and the relation with weight and lipid indices in Chinese children.

DESIGN

Expression and distribution of ghrelin in parotid, submandibular, and sublingual glands were measured by reverse transcription-polymerase chain reaction and immunohistochemistry. Saliva and serum samples were collected from 194 Chinese children and adolescents (mean age 12.98 years). Ghrelin levels were tested by enzyme-linked immunosorbent assay. Significant differences were estimated by one-way ANOVA.

RESULTS

Ghrelin mRNA was expressed in parotid and submandibular glands, but was not detectable in sublingual glands. Ghrelin proteins were widespread in the cytoplasm of striated, intercalated and excretory ducts, as well as in serous acini of parotid and submandibular glands, but not in mucous acinar cells of sublingual glands. Saliva and serum ghrelin levels were increased along with BMI. There was positive correlation between saliva and serum ghrelin levels (r=0.534, P<0.01). Serum and saliva ghrelin levels were both significantly correlated with BMI (r=0.523, r=0.374, P<0.01, respectively), but not with blood lipid levels.

CONCLUSIONS

Parotid and submandibular glands were primary sources of ghrelin produced and released in saliva. Although whether salivary ghrelin could be useful in the diagnosis of obesity remains to be determined, salivary ghrelin might be a possible alternative to serum ghrelin for predicting obesity.