Fundus Functionality and Ghrelin Concentrations after Bariatric Surgery

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Abstract
Circulating ghrelin concentrations have been reported to be suppressed in morbidly obese patients after Roux-en-Y gastric bypass surgery,1 whereas no significant changes have been observed after adjustable gastric banding.2 The placement of an adjustable gastric band is a purely restrictive technique, producing an approximately 30-ml stomach pouch with functional conservation of the fundus. In contrast, gastric bypass surgery leaves a 15-ml pouch near the esophagogastric junction and excludes the major curvature, thus isolating the fundus — the richest source of ghrelin production3 — from direct contact with food. We hypothesized that circulating ghrelin concentrations in patients undergoing bariatric surgery depend on the degree to which the procedure excludes the fundus and the subsequent isolation of ghrelin-producing cells from direct stimuli. To avoid the potential confounding effect of long-term weight loss, we focused on the changes occurring 24 hours after the intervention.