Gut Hormones after Oesophagectomy and Gastrointestinal Symptoms

• Research type

  Research Study

• Full title

  Gut Hormones after Oesophagectomy and Symptoms of the Gastrointestinal Tract (FLIGHT)

• IRAS ID

  184808

• Contact name

  George Hanna

• Contact email

  g.hanna@imperial.ac.uk

• Sponsor organisation

  Imperial College London

• Duration of Study in the UK

  2 years, 1 months, 1 days

• Research summary

  Summary of Research
  Background:
  Previous studies have reported a range of complications after oesophagectomy (surgery to remove the oesophagus/gullet) which can have a significant impact upon patient’s long-term quality of life (QOL). Whilst the surgical reconfiguration of the upper gastrointestinal tract (stomach and oesophagus) is thought to contribute in part to these symptoms, a role for gut hormones (small molecules produced by gut which regulate digestion) is hypothesised. Understanding the effects of this surgery on gut hormone levels may offer a new opportunity to improve the QOL of patients following oesophagectomy.

  Primary aim
  i. To evaluate postoperative changes in gut hormones in response to a standard test meal after oesophagectomy

  Secondary aims
  i. To correlate gut hormone levels with gastrointestinal symptoms, appetite and quality of life following oesophagectomy
  ii. To correlate gut hormone levels with the results of studies to assess the speed of stomach emptying following oesophagectomy
  iii. To determine changes in gut bacteria levels and their relationship to gut hormone levels and gastrointestinal symptoms
  iv. To compared breath markers of metabolism with gut hormone levels

  Study design:
  Phase 1: study evaluating variation in symptoms, QOL and gut hormone levels in a group of fifteen patients undergoing oesophagectomy. Subjects will be followed up during the pre-operative period and for 9 months postoperatively. At each study time point subjects QOL and gastrointestinal symptoms will be assessed. Gut hormone response to a standard meal will be measured. The speed of emptying of the remaining stomach after surgery will be assessed as will the levels of breath metabolites (small molecules produced within the body) and native bacteria within the gut.

  Phase 2: study of patients with existing adverse gastrointestinal symptoms following oesophagectomy. Patient symptoms and the results of gut hormone studies will be correlated to studies investigating the speed of stomach emptying, breath metabolite levels and native bacteria within the gut

  Summary of Results
  Background: Esophagectomy has been associated with poor quality of life and unpleasant postoperative intestinal symptoms. The aim of this study was to investigate long-term quality of life in patients after oesophagectomy (surgery to remove the gullet)

  Methods: The study population was identified from two expert centres for the management of esophageal cancer. Patients completed quality of life and symptom questionnaires. Patients were divided into three groups based on the time that had passed since their surgery: <1 year; 1–5 years, and; >5 years after surgery.

  Results: In total 171 of 222 patients of eligible patients completed the questionnaires, corresponding to a response rate of 77%. Median age was 66.2 years, and median time from operation to survey was 5.6 years (range 0.3–23.1).

  Feeling full soon after eating was the most commonly reported symptom in all patients irrespective of time since surgery (87.4%; range 82%–92%). Difficulty swallowing was seen to decrease over time (58% at <2 years; 28% at 2–5 years; 20% at >5 years; P = 0.013). All other symptom scores including heartburn, regurgitation, respiratory symptoms, and pain scores remained constant over time. Average quality of life scores did not improve from levels 1 year after surgery compared to patients up to 23 years after surgery.

  Conclusion: With the exception of difficulty swallowing, which improved over time, esophagectomy was associated with decreased quality of life and lasting intestinal symptoms up to 20 years after surgery. Importantly however long-term survivors after oesophagectomy demonstrated comparable to improved quality of life compared to the general population.

• REC name

  London - Chelsea Research Ethics Committee

• REC reference

  15/LO/1668

• Date of REC Opinion

  25 Nov 2015

• REC opinion

  Further Information Favourable Opinion