The Influeces Of Gastrectomy To Esophageal Motility And Plasma Gastrointestinal Hormone Levels In Gastric Cancer Patients

Background/AimsGastric cancer is the most common digestive tract malignant neoplasm, which has the second highest prevalence in all kinds of malignancies in our country. Based on the latest epidemiological investigation, gastric cancer has a male dominance of about 2:1 and mainly afflicts people in middle-aged, however the prevalence becomes rejuvenation in recent years. At present, Surgical resection is still the most effective treatment for gastric cancer patients. Unfortunately, Post-operative patients often suffered for a series of clinical symptoms, such as nausea, vomiting, bellyache、abdominal distention, diarrhea, even reflux esophagitis and emaciation etc. These symptoms are often related with surgical procedures, the changes of plasma gastrointestinal hormone levels and gastrointestinal motility disorders, while the mechanisms are still unclear. The purpose of this study was to investigate the gastrectomy affects on motility and gastrointestinal hormones, such as Motilin、 Ghrelin、Leptin. And then discuss the possible relationship between esophageal motility and gastrointestinal hormones.Methods1. Data was collected from pre-operative and post-operative patients. Measurement of esophageal motility:Esophageal motility was measured by High-resolution manometry (HRM).2. Measurement of plasma gastrointestinal hormones:The plasma level of Motilin、Ghrelin、Leptin were determined by radioimmunoassay (RIA)Results1. Esophageal motilityThere was no significant difference of Esophageal motility between pre-operative patients and normal control (p>0.05), but pre-operative patients were in a decreasing trend. Compared with pre-operative patients and normal control, DCI、CFV、IRP and LES were significantly decreased in Post-operative patients (p<0.05)。2. Gastrointestinal hormones(1). Plasma levels of MTL in pre-operative patients were higher than that in normal controls (p<0.05), while they were lower than that in Post-operative patients (p<0.05). Plasma levels of MTL in Post-operative period raised gradually over time, but still lower than that in pre-operative patients.(2). Plasma levels of Ghrelin in pre-operative patients were lower than that in normal controls, but higher than that in Post-operative period (p<0.05)。Ghrelin levels in post-operative patients were turned to falling gradually over time (p< 0.05). Among three surgical procedures, patients with subtotal gastrectomy had a lowest levels of Ghrelin.(3). There were no significant difference between pre-operative patients and normal controls. However, levels of Leptin in Post-operative patients were lower than that in both pre-operative patients and normal controls. Meanwhile, levels of Leptin were not obviously changed over time. Patients with proximal gastrectomy had a lower level of plasma Leptin than that in subtotal gastrectomy patients.Conclusions1. HRM showed peristalsis impairment in esophageal body in addition with decreasing pressures of lower esophageal sphincter in Post-operative patients. These dynamic abnormalities lead to incompletely clearance of esophagus, sometimes even resulted in peristalsis absence.2. Plasma levels of Motilin、Ghrelin、Leptin in post-operative patients were significantly decreased compared to those in pre-operative patients.3. Esophageal dynamic abnormalities were partially associated with the decrease of plasma gastrointestinal hormones after gastrectomy, which might be one of the mechanisms involved in.