Mo2087 Intravenous Ghrelin Accelerates Postoperative Gastric Emptying and Time to First Bowel Movement in Humans

Abstract

BACKGROUND & AIMS: Ghrelin has been shown to stimulate gastric emptying in normal humans and patients with retarded gastric emptying. The aim of this study was to assess the effect of ghrelin on gastric emptying on day 2 after open colorectal surgery. METHODS: We randomized 22 patients (mean age, 69.2 ± 1.4; body mass index, 25.8 ± 0.8 kg/m2) to either saline or ghrelin infusion (15 pmol/kg/min) during 3 hours before and on day 2 after open colorectal surgery. At the start of the infusion a liquid meal (480 kcal, 200 mL) was administered together with 1.5 g of acetaminophen. Plasma was obtained at regular intervals as was visual analog scale for hunger, satiety, and nausea. Acetaminophen was analyzed as a marker of gastric emptying. Concentrations of glucose, insulin, ghrelin (3‐36), glucagon‐like peptide (GLP)‐1, glucose inhibitory peptide (GIP), and peptide YY (PYY) were analyzed. RESULTS: Plasma acyl‐ghrelin was increased from 20 to 800 pg/mL for saline and ghrelin infusion, respectively. Area under the curve (AUC; 0‐180 minutes) for acetaminophen was significantly lower postoperatively during saline infusion (10,704 ± 1032 vs 7926 ± 1346; P = .02). There was no difference in the AUC acetaminophen during the pre‐ and postoperative ghrelin infusion (15,399 ± 1459 vs 14,980 ± 10,533), indicating rapid gastric emptying postsurgery with ghrelin. There was no difference in plasma glucose, insulin, GLP‐1, PYY, and GIP during saline infusion before or after surgery. During ghrelin infusion, plasma insulin was significantly lower after surgery. The subjects in the ghrelin group had a significantly shorter time to the first bowel movement after surgery compared with the saline group (2.2 ± 0.3 vs 3.5 ± 0.4 days; P = .03). CONCLUSION: Surgery resulted in delayed gastric emptying during saline infusion. A 3‐hour ghrelin infusion restored gastric emptying to that of preoperative conditions. There was little effect on glucose metabolism. There was a significantly faster time to first bowel movement during active acyl‐ghrelin infusion. Ghrelin/ghrelin receptor agonists have the potential to function against postoperative ileus.