RESUMO
BACKGROUND: Alterations in gastrointestinal tract physiology after gastrectomy may affect appetite and energy balance. OBJECTIVE: The objective of this study was to examine energy balance, appetite, and gastrointestinal transit in subjects with gastrectomy. DESIGN: Seven subjects with total gastrectomy (TG) and 14 subjects with partial gastrectomy (PG), who were free from signs of recurrent disease, and 10 healthy control subjects were studied. Resting energy expenditure (REE) was measured by indirect calorimetry and compared with REE predicted by the Harris-Benedict equation (mREE/pREE%). Gastrointestinal transit was measured by scintigraphy. Habitual food intake was assessed, and appetite was measured during scintigraphy after ingestion of a test meal (361 kcal). RESULTS: Body mass index was not different among the groups. mREE/pREE% was higher in patients with PG (P < 0.01) than in control subjects. The TG group showed higher energy intake (P < 0.05) than the PG group and control subjects. Gastric emptying was faster in the PG group than in control subjects, and gastrointestinal transit was accelerated in both PG and TG groups. An intense, precocious postprandial fullness and a relatively early recovery of hunger and prospective consumption sensations were seen in these patients. CONCLUSIONS: Patients with PG or TG have higher than predicted energy expenditure, which in TG seems to be compensated for by increased energy intake. These patients have preserved postprandial appetite responses and precocious postprandial fullness, which seem to be associated with disturbances in gastrointestinal transit of the ingested meal and are likely to be independent of vagal fiber integrity or stomach-released ghrelin.
Assuntos
Apetite/fisiologia , Metabolismo Basal/fisiologia , Ingestão de Energia/fisiologia , Metabolismo Energético/fisiologia , Gastrectomia , Trânsito Gastrointestinal/fisiologia , Adulto , Anastomose em-Y de Roux , Índice de Massa Corporal , Calorimetria Indireta , Estudos de Casos e Controles , Feminino , Esvaziamento Gástrico/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/cirurgia , Úlcera Gástrica/cirurgiaRESUMO
PURPOSE OF REVIEW: The purpose of this review is to summarize recent studies that investigated the role of ghrelin and ghrelin analogs in wasting conditions. RECENT FINDINGS: Numerous studies have demonstrated potential beneficial effects exerted by ghrelin in a number of diseases associated with wasting. Besides ghrelin's orexigenic effect, anabolic as well as anti-inflammatory activity mediated by ghrelin have been investigated in wasting conditions such as cancer, diabetes mellitus, malabsorptive diseases, chronic obstructive pulmonary disease, anorexia nervosa, renal failure, liver failure, and chronic heart failure. Encouraging results have been obtained from experimental studies and a few clinical trials using subcutaneous administration of ghrelin and ghrelin agonists in cachexia. In-vitro studies have shown ghrelin and des-acyl ghrelin biological activities on proliferation of tumor cells and abnormal tissues. SUMMARY: The recent studies support the possible positive effects of ghrelin in therapeutic approaches and adjunct treatment of a number of diseases associated with wasting. Utilization of agonists of the ghrelin receptor growth hormone secretagogue-1a is a promising approach for clinical use. Randomized and placebo-controlled studies, including large number of patients are further required.
Assuntos
Caquexia/tratamento farmacológico , Ingestão de Energia/efeitos dos fármacos , Grelina/fisiologia , Grelina/uso terapêutico , Síndrome de Emaciação/tratamento farmacológico , Doença Crônica , Metabolismo Energético/efeitos dos fármacos , Grelina/análogos & derivados , HumanosRESUMO
Despite years of experience with Helicobacter pylori treatment, the ideal regimen for treating the infection has not been found. The most effective eradication treatment is the combination of a proton pump inhibitor with antibiotics, but 10-20% of the patients fail to obtain eradication of the infection. Antibiotic resistance is a major factor affecting the outcome of treatment. Non-antibiotic therapies, including phytomedicines, probiotics, and antioxidants, have been increasingly investigated as potential alternatives for the treatment of H. pylori. In this article, we review the non-antibiotic therapies for H. pylori infection.