Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10440
Peer-review started: August 1, 2016
First decision: August 22, 2016
Revised: October 18, 2016
Accepted: November 13, 2016
Article in press: November 13, 2016
Published online: December 21, 2016
To investigate the relationship between plasma ghrelin level, Helicobacter pylori (H. pylori) infection status and the severity of atrophy in hemodialysis patients.
One hundred eights patients who received hemodialysis and 13 non-hemodialysis H. pylori-negative controls underwent gastroduodenoscopy to evaluate the severity of gastric atrophy. Serum levels of pepsinogen (PG) were measured as serum markers of gastric atrophy. H. pylori infection was evaluated by anti-H. pylori IgG antibody, rapid urease test and culture test. We classified H. pylori infection status as non-infection, present infection and past infection. In addition, plasma acyl-ghrelin and desacyl-ghrelin levels were measured by enzyme-linked immunosorbent assay.
Infection rate of H. pylori was 45.4% (49/108). Acyl-ghrelin level in the non-infection group (39.4 ± 23.0 fmol/mL) was significantly higher than in the past (23.4 ± 19.9 fmol/mL, P = 0.005) and present infection groups (19.5 ± 14.0 fmol/mL, P < 0.001). Furthermore, desacyl-ghrelin level in the non-infection group (353.2 ± 190.2 fmol/mL) was significantly higher than those in the past (234.9 ± 137.5 fmol/mL, P = 0.008) and present infection groups (211.8 ± 124.2 fmol/mL, P < 0.001). Acyl-ghrelin was positively correlated with the PG I level and PG I/II ratio (|R| = 0.484, P < 0.001 and |R| = 0.403, P < 0.001, respectively). Both ghrelins were significantly decreased in accordance with the progress of endoscopic atrophy (both P < 0.001) and acyl-ghrelin was significantly lower in patients with mild, moderate and severe atrophy (24.5 ± 23.1 fmol/mL, 20.2 ± 14.9 fmol/mL and 18.3 ± 11.8 fmol/mL) than in those with non-atrophy (39.4 ± 22.2 fmol/mL, P = 0.039, P = 0.002 and P < 0.001, respectively).
In hemodialysis patients, plasma ghrelin level was associated with the endoscopic and serological severity of atrophy related to H. pylori infection.
Core tip: Ghrelin enhances the orexigenic effect, protein anabolism, anti-inflammatory actions and cardiovascular protection in hemodialysis patients. Helicobacter pylori (H. pylori) infection and gastric mucosal atrophy affect ghrelin level in subjects with normal renal function. However, it is unclear whether ghrelin in hemodialysis patients relates to H. pylori status or gastric mucosal atrophy. This study demonstrated that plasma ghrelin level was associated with endoscopic and serological severity of atrophy related with H. pylori infection in hemodalysis patients. Therefore, eradication therapy of H. pylori before the progression of atrophy might improve ghrelin level associated with nutrition status, such as protein-energy wasting.