Abstract
Introduction: The appetite-modulating hormone ghrelin may have a role in the etiology of anorexia which is a serious concern in patients with primary biliary cirrhosis (PBC). This study aims to assess the difference in ghrelin level between cases of PBC and healthy controls matched for age and gender, and to evaluate the level of ghrelin in relation to clinical and laboratory findings among cases.Methods: Twenty patients with primary biliary cirrhosis and 30 healthy controls matched by gender and age were recruited. The severity of liver disease was determined using the Child-Pugh grading system. Clinical comorbidities such as a history of ascites, gastrointestinal bleeding, and encephalopathy were evaluated. A commercial enzyme-linked immunosorbent assay was used to measure total ghrelin. Results: PBC cases had a significantly higher average level of ghrelin (2305.3 ± 639.4) pg/mL compared to controls (682 ± 197.3) pg/mL. Furthermore, the minimum reported level in cases was 1258 pg/mL compared to 326 pg/mL in controls, while the maximum level nearly tripled the control’s maximum level. In PBC patients, plasma levels of total ghrelin showed a weak positive correlation with age, an inverse correlation with body mass index, and were not associated with gender. The level was significantly higher than those in the controls. Ghrelin was associated with the severity of cirrhosis. Levels of serum ghrelin were higher in patients with associated comorbidities such as a history of ascites, gastrointestinal bleeding, and encephalopathy.Conclusions: Our study demonstrated elevated serum ghrelin levels in patients with primary biliary cirrhosis. Serum ghrelin was associated with the degree of severity and the presence of related comorbidities. Patients with primary biliary cirrhosis remain anorexic and catabolic despite elevated ghrelin levels, suggesting tissue resistance to this anabolic peptide which could be crucial to understanding anorexia and cachexia in primary biliary cirrhosis.
Highlights
The appetite-modulating hormone ghrelin may have a role in the etiology of anorexia which is a serious concern in patients with primary biliary cirrhosis (PBC)
History of ascites was confirmed in 80% of PBC cases (n=16), encephalopathy in 65% (n=13), and GI bleeding was verified in 55% of cases (11 patients) (Table 1)
This result was reported by previous studies [16,17,25]. This denotes that serum ghrelin level depends on the nutritional status and can be used as a marker to help with anorexia and enhance dietary supplements for patients with liver cirrhosis
Summary
The appetite-modulating hormone ghrelin may have a role in the etiology of anorexia which is a serious concern in patients with primary biliary cirrhosis (PBC). Its concentration rises pre-prandially, helping to initiate meals [5] It has a diabetogenic effect, inhibiting insulin release and stimulating glucose output by hepatocytes, as well as strong growth hormone (GH) releasing activity. It has lipogenic and antilipolytic properties and antiinflammatory effects [6,7]. Fasting ghrelin concentrations are higher in anorexia and cachexia in patients suffering from chronic illnesses but lower in obesity indicating a compensatory mechanism. The orexigenic properties of ghrelin and its potential clinical usage to enhance appetite to compensate for anorexia-cachexia seen in patients with chronic illnesses have been investigated [9,10,11]. Ghrelin increases appetite in the short term by targeting the melanocortin system in the hypothalamic arcuate nucleus and increases adiposity in peripheral tissues in the long term [12]
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