Plasma Ghrelin Levels and Weight Regain After Roux-en-Y Gastric Bypass Surgery

Ghrelin is a gut hormone that induces hunger, gastric acid secretion, and gastrointestinal motility. A number of studies have previously demonstrated a possible correlation between a decrease in ghrelin level and weight loss after Roux-en-Y gastric bypass (RYGB). This study aimed to assess if there was a relationship between ghrelin level and weight regain after RYGB nadir weight had been achieved.

Sixty-three consecutive RYGB patients who were referred for an upper endoscopy were enrolled. Weight and responses to the 21-item Three-Factor Eating Questionnaire (TFEQ-R21) were collected. Ghrelin levels were measured. Upper endoscopy was performed to evaluate pouch length and stoma diameter. Multivariate linear regression was performed to assess an association between ghrelin level, TFEQ-R21 score, pouch length, stoma diameter, and percentage of weight regained.

Subjects were 47 ± 10 years old and had a BMI of 38 ± 7.7 kg/m². Out of 63 patients, 76 % had weight regain (gaining of ≥20 % of maximal weight lost after the RYGB) and 24 % did not. Average pouch length was 44 ± 13 mm, stoma diameter 20 ± 6.6 mm, and ghrelin levels 125 ± 99 ng/ml. Ghrelin level was not associated with weight regain (β = 0.17, p = 0.2). GJ stoma diameter was associated with weight regain (β = 0.39, p < 0.01) and the uncontrolled eating domain of the TFEQ-R21 (β = 0.45, p < 0.01).

Ghrelin levels do not appear to correlate with weight change after RYGB nadir weight has been achieved. A dilated GJ stoma diameter is a risk factor for weight regain and uncontrolled eating behavior after RYGB.