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Submitted on December 23, 2004
Accepted on May 17, 2005
CLR, NMN, CJS, MAG and SRB - Department of Metabolic Medicine, Imperial College, UK; TJH, AM-I and NAT - Department of Surgery, Hammersmith Hospital Trust, UK
* To whom correspondence should be addressed. E-mail: s.bloom{at}imperial.ac.uk.
Context: Patients with gastric or esophageal surgery and transection of the vagus nerve may suffer from appetite and weight loss, but without dysphagia or mechanical obstruction to eating. The gastric hormone, ghrelin, stimulates food intake and growth hormone (GH) release in rodents and man. However rodents with vagotomy are not sensitive to the feeding effects of ghrelin.
Objective: To determine whether humans with vagotomy are sensitive to ghrelin.
Study design: Double-blind randomized placebo-controlled trial.
Setting: Hospital based study.
Patients: Six men and one woman who all had a previous complete truncal vagotomy with lower esophageal or gastric surgery entered and completed the study.
Intervention: Each patient received 120 min infusions of saline, ghrelin 1pmol/kg/min and ghrelin 5pmol/kg/min on three separate days. After 90 min a buffet meal was served.
Main outcome measure: Energy intake at the buffet meal.
Results: Ghrelin stimulated GH release in a dose dependent manner confirming bioactivity. However no change in energy intake was observed with either dose of ghrelin (energy intake (KJ): saline 2805 ± 812, ghrelin 1pmol/kg/min 2486 ± 767, ghrelin 5pmol/kg/min 2382 ± 543; P=NS).
Conclusions: Ghrelin is unlikely to be an effective appetite-stimulatory treatment for patients with vagotomy and esophageal or gastric surgery. Our results suggest that an intact vagus nerve may be required for exogenous ghrelin to increase appetite and food intake in man
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