BACKGROUND: Ghrelin is secreted mainly in the stomach and plays a role in food 
intake regulation. Morbidly obese (MO) individuals report a decline in appetite 
after sleeve gastrectomy (SG), presumably due, in part, to ghrelin cell removal. 
Ghrelin cell distribution and expression were determined in three areas of 
resected stomach specimens from MO patients subjected to SG.
METHODS: Resected stomach specimens from 20 MO patients undergoing SG were 
analyzed. Real-time polymerase chain reaction of ghrelin mRNA and 
immunohistostaining for ghrelin cells in three stomach regions (fundus, body, 
and pre-antral areas) were performed. Body mass index (BMI) and total plasma 
ghrelin levels were obtained before and 3 months postoperatively.
RESULTS: Ghrelin mRNA was detected throughout the stomach, its expression 
decreasing from the fundus towards the antrum. The relative quantification for 
ghrelin mRNA expression was 0.043, 0.026, and 0.015 at the fundus, body, and 
pre-antral region, respectively (P = 0.05, fundus vs. pre-antral region). 
Average ghrelin cell counts declined from 60 ± 40 to 45 ± 20 and 39 ± 13 
cells/high power fields in the fundus, body, and pre-antral region, 
respectively. Three months after surgery, total plasma ghrelin levels decreased 
from 1,676 ± 470 to 1,179 ± 188 pg/ml (P < 0.00001) and BMI dropped from 46 ± 6 
to 38 ± 5 kg/m2 (P < 0.00001).
CONCLUSIONS: Distribution and expression of ghrelin-secreting cells throughout 
the stomach were defined, emphasizing the importance of meticulous resection of 
the fundus during SG for maximal ghrelin cell removal.