Subject(s)
Community Health Services/trends , Efficiency, Organizational/trends , Emergency Medical Services/trends , Hospitals/trends , Community Health Services/organization & administration , Cost Control , Emergency Medical Services/organization & administration , Female , Health Planning Guidelines , Health Priorities , Hospital Administration , Humans , Male , Practice Guidelines as TopicSubject(s)
Primary Health Care , Secondary Care , State Medicine , Continuity of Patient Care/organization & administration , Delivery of Health Care , Emergency Service, Hospital/organization & administration , Female , Humans , Male , Outcome and Process Assessment, Health Care , Practice Patterns, Physicians' , Primary Health Care/organization & administration , Primary Health Care/trends , Secondary Care/organization & administration , Secondary Care/trends , State Medicine/organization & administration , State Medicine/trends , United KingdomABSTRACT
BACKGROUND: Ghrelin is an orexigenic gut peptide produced predominantly by the stomach. Gastric mucosal ghrelin production could be compromised by an infiltrating adenocarcinoma. AIMS: To assess the expression of ghrelin mRNA and peptide in oesophagogastric adenocarcinomas and adjacent non-neoplastic mucosa. METHODS: 10 gastric and 22 oesophageal adenocarcinoma archival samples were randomly selected from a database. The presence of ghrelin-positive cells was assessed in cancer and corresponding non-neoplastic mucosa by immunohistochemistry. Quantitative reverse transcriptase polymerase chain reaction (PCR) for ghrelin mRNA was also performed on 24 gastric and 8 oesophageal adenocarcinoma specimens and adjacent non-neoplastic mucosa. RESULTS: Immunohistochemistry and reverse transcriptase PCR confirm a negligible expression of ghrelin in adenocarcinoma specimens. By contrast, non-neoplastic gastric mucosa was rich in ghrelin-positive cells and ghrelin mRNA. The number (median and range) of ghrelin-positive cells per 2 mm section of non-neoplastic mucosa was 73 (45-215) in the corpus; this was significantly higher than in cardia mucosa (9 (0-64), p<0.001) and antral mucosa (5 (0-14), p<0.001). CONCLUSIONS: Gastric and oesophageal adenocarcinomas have no ghrelin-producing cells. The highest level of ghrelin expression was noted in the non-neoplastic mucosa of the gastric corpus. Disruption of the gastric ghrelin-producing mechanism may occur during oesophagogastric malignancy.
