Gastric Histopathological Findings and Ghrelin Expression in Morbid Obesity Morbid / Obezitede Gastrik Histopatolojik Bulgular ve Ghrelin Ekspresyonu

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Objective: Th e role of Ghrelin, also known as the appetite hormone, is not fully explained in the development of morbid obesity. Plasma Ghrelin level is low in obese and high in slim subjects. Ghrelin-expressing cells were investigated histopathologically in the stomach of morbid obese patients in this study. Tissue Ghrelin expression was also compared with various parameters such as the distribution of endocrine cells, age, gender, body mass index, preoperative plasma Ghrelin level and presence of accompanying diseases.

Material and Method: Th e study included 33 morbidly obese patients, and 8 non-obese control patients. Plasma Ghrelin levels were measured preoperatively. Sleeve gastrectomy resection materials of 33 cases were evaluated with histopathological and immunohistochemical (Ghrelin and Chromogranin-A) techniques. Th e results were statistically evaluated by nonparametric tests.

Results: Histopathological findings observed in sleeve gastrectomy resection materials were interstitial lymphocytic infiltration (63.6%), hyperplasia of lymphoid follicles in the lamina propria (60.7%) and microvesiculation / dilatation of parietal cells (57.6%). Th e number of Ghrelin immunopositive cells in the gastric mucosa in females was significantly higher compared to males (p=0,007). Additionally, the number of Ghrelin immunopositive cells was significantly higher at the fundus-proximal corpus compared to the distal corpus of the stomach (p=0.0001). No significant correlation was found between Ghrelin-chromogranin immunopositive endocrine cell distribution and preoperative plasma Ghrelin levels and endocrine cell hyperplasia.

Conclusion: Our study confirms that Ghrelin producing cells are most dense in the proximal stomach. Increased number of Ghrelin expressing cells in the gastric mucosa in females compared to males suggests that gender may also be a factor in determining the method for treatment of morbid obesity.

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  • 1. Bozbora A: Morbid Obezite ve Guncel Cerrahi Tedavi. Erguney S Cicek Y. (ed. cev.) 6. Baskı İstanbul Avrupa Tıp Kitapcılık 2001 105-109

  • 2. Kojima M Hosoda H Date Y Nakazato M Matsuo H KangawaK: Ghrelin is growth-hormone-releasing acylated peptide from stomach. Nature 1999 402:656-660

  • 3. Aydin S Ozkan Y Caylak E: Grelin and its biochemical functions. Turkiye Klinikleri J Med Sci 2006 26:272-283

  • 4. Brolin RE: Bariatric surgery and long-term control of morbid obesity. JAMA 2002 288:2793-2796

  • 5. Tanaka-Shintani M Watanabe M: Distribution of ghrelinimmunoreactive cells in human gastric mucosa: Comparison with that of parietal cells. J Gastroenterol 2005 40:345-349

  • 6. Sakata I Nakamura K Yamazaki M Hayashi Y Kangawa K: Ghrelin producing cell-exit as two of cells closed and opened types cells in the rat gastrointestinal tract. Peptides 2002 23: 531-536

  • 7. Stenstrom B Furnes MW Tommeras K Syversen U Zhao CMChen D: Mechanism of gastric bypass-induced body weight loss: One-year follow-up aft er micro-gastric bypass in rats. J Gastrointest Surg 2006 10:1384-1391

  • 8. Lee HM Wang G Englander EW Kojima M Greeley GH: Ghrelin a new gastrointestinal endocrine peptide that stimulates insulin secretion: Enteric distribution ontogeny influence of endocrine and dietary manipulations. Endocrinology 2002 143:185-190

  • 9. Ueno H Yamaguchi H Kangawa K Nakazato M: Ghrelin: A gastric peptide that regulates food intake and energy homeostasis. Regul Pept 2005 126:11-19

  • 10. Cummings DE: Ghrelin and the short- and long-term regulation of appetite and body weight. Physiology & Behavior 2006 89: 71-84

  • 11. Sönmez MF Ozan E: Determination of ghrelin immunoreactivity in the rat stomach aft er fasting and refeeding. Acta Histochem 2007 109:193-199

  • 12. Leite-Moreira AF Soares JB: Physiological pathological and potential therapeutic roles of ghrelin. Drug Discovery Today 2007 12:276-288

  • 13. Vrabie CD Cojocaru M Waller M Sindelaru R Copaescu C: Th e main histopathological gastric lesions in obese patients who underwent sleeve gastrectomy. Dicle Medical Journal 2010 37:97-103

  • 14. Wang Y Liu J: Plasma ghrelin modulation in gastric band operation and sleeve gastrectomy. Obes Surg 2009 19:357-362

  • 15. Purnell JQ Weigle DS Breen PACummings DE: Ghrelin levels correlate with insulin levels insulin resistance and high-density lipoprotein cholesterol but not with gender menopausal status or cortisol levels in humans. J Clin Endocrinol Metab 2003 88:5747-5752

  • 16. Zou CC Liang L Zhao ZY: Factors associated with fasting plasma ghrelin levels in children and adolescents. World J Gastroenterol 2008 14:790-794

  • 17. Chuang CH Sheu BS Yang HB Lee SC Kao AW Cheng HCChang WL Yao WJ: Gender diff erence of circulating ghrelin and leptin concentrations in chronic Helicobacter pylori infection. Helicobacter 2009 14:54-60

  • 18. Alonso N Granada ML Salinas I Reverter JL Flores LOjanguren I Martínez-Cáceres EM Sanmartí A: Plasma ghrelin concentrations in type 1 diabetic patients with autoimmune atrophic gastritis. Eur J Endocrinol 2007 157:763-769

  • 19. Corbetta S Peracchi M Cappiello V Lania A Lauri E Vago LBeck-Peccoz P Spada A: Circulating ghrelin levels in patients with pancreatic and gastrointestinal neuroendocrine tumors: Identification of on pancreatic ghrelinoma. J Clin Endocrinol Metab 2003 88:3117-3120

  • 20. Tsolakis AV Stridsberg M Grimelius L Portela-Gomes GMFalkmer SE Waldum HL Janson ET: Ghrelin immunoreactive cells in gastric endocrine tumors and their relation to plasma Ghrelin concentration. J Clin Gastroenterol 2008 42:381-388

  • 21. Maksud FA Alves JS Diniz MT Barbosa AJ: Density of Ghrelinproducing cells is higher in the gastric mucosa of morbidly obese patients. Eur J Endocrinol 2011 165:57-62

  • 22. Poykko SM Kellokoski E Horkko S Kauma H KesaniemiYA Ukkola O: Low plasma Ghrelin is associated with insulin resistance hypertension and the prevalence of type 2 diabetes. Diabetes 2003 52:2546-2553

  • 23. Bideci A Camurdan MO Cinaz P Demirel F: Grelin IGF-I and IGFBP-3 levels in children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2005 18:1433-1439

  • 24. Oner Iyidoğan Y Koçak H Gürdöl F Oner P Issever H Esin D: Circulating ghrelin levels in obese women: A possible association with hypertension. Scand J Clin Lab Invest 2007 67:568-576

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