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Weight Loss, Satiety, and the Postprandial Gut Hormone Response After Esophagectomy A Prospective Study

Journal article
Authors J. A. Elliott
N. G. Docherty
H. G. Eckhardt
S. L. Doyle
E. M. Guinan
N. Ravi
J. V. Reynolds
Carel W le Roux
Published in Annals of Surgery
Volume 266
Issue 1
Pages 82-90
ISSN 0003-4932
Publication year 2017
Published at Institute of Clinical Sciences, Section for Surgery and Gastrosurgical Research and Education, Department of Gastrosurgical Research and Education
Pages 82-90
Language English
Links doi.org/10.1097/sla.000000000000191...
Keywords appetite, body weight, dumping syndrome, enteroendocrine cell, esophageal cancer, esophagectomy, gastrointestinal symptoms, GLP-1, glucagon-like peptide 1, glucose, gut hormones, gut peptides, health-related quality of life, hunger, insulin, L-cell, mal, glucagon-like peptide-1, gastric bypass, intestinal transit, total, gastrectomy, symptoms, glucose, Surgery, holic j, 1991, digestive diseases and sciences, v36, p1361, holic j, 1993, digestion, v54, p73
Subject categories Endocrinology and Diabetes

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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