Circulating ghrelin level is increased in coeliac disease as in functional dyspepsia and reverts to normal during gluten-free diet

Background. It is controversial whether serum ghrelin concentration is altered in celiac disease, and whether this alteration is related to nutritional impairment or to inflammatory changes of duodenal mucosa.
Aim. We investigated clinical and histopathologic variables affecting circulating ghrelin in celiac patients by comparison with dyspeptic patients and with healthy controls.
Methods. We measured serum ghrelin and obtained gastric and duodenal biopsies in 44 celiacs before and after 1-year gluten-free diet, in 39 dyspeptic patients and 53 healthy controls.
Results. Serum ghrelin concentration was significantly higher in celiac (531+29 pg/mL,p<0.05) and in dyspeptic patients (526+14 pg/mL,p<0.01) than in healthy controls (451+8 pg/mL), and body mass index was significantly lower in celiac (20+1) and in dyspeptic patients (20+1) than in healthy controls (22+1,p<0.05). In celiac patients serum ghrelin concentration was not related to the severity of duodenal lesions. Serum ghrelin reverted to normal (399+30 pg/mL) and body mass index increased significantly (0.6+0.1 Kg/m2 increase, p<0.05) during gluten free diet despite persistent duodenal lymphocytic infiltration.
Conclusions. Ghrelin concentration is increased and BMI is decreased in celiac and in dyspeptic patients irrespective of presence and of severity of duodenal inflammation. Nutritional impairment is a key factor in elevating plasma ghrelin levels in celiac disease.