Quantitative and Topographic Analysis by Immunohistochemical Expression of Ghrelin Gastric Cells in Patients with Morbid Obesity

PURPOSE: The cellular distribution of ghrelin positive cells is not well defined. The aim of the study is to quantify and determine the distribution of ghrelin cells in gastric mucosa in patients with morbid obesity and relate this finding to gender, comorbidities, gastritis, and plasmatic levels of acyl and desacylghrelin before and after laparoscopic sleeve gastrectomy. PATIENT AND METHODS: We performed a study on 61 patients with BMI≥50 kg/m(2) operated by laparoscopic sleeve gastrectomy. Three gastric regions were analyzed by histopathology and immunohistology. Blood sample was taken before surgery, and at 6 and 12 months post-surgery, to study the plasma levels of ghrelin isoforms. RESULTS: Ghrelin cells are present in all regions of the gastric mucosa, with a greater number in the body and the fundus. Difference was found in the antrum between male and female patients (p=0.018). Patients with arterial hypertension also showed a lower level of cells in antrum (p<0.05). Acylghrelin levels after surgery were significantly lower (32.83+5.6 pg/mL to 10.09+11.8 pg/mL, p<0.05). Values of desacylghrelin tended to decrease but no significant variation was observed (207.4+39.3 pg/mL to 188.84+52.3 pg/mL). CONCLUSION: Our patients show ghrelin cells in all areas of the stomach. Gender, comorbidities, and gastritis are determinant on gastric ghrelin-producing cells distribution.