Burning the stomach lining reduces the ‘hunger hormone’ and cuts weight 

An experimental weight loss procedure cranks up the heat to dial down hunger. 

Blasting a patch of patients’ stomach lining with thermal energy curbed hunger and cut pounds, researchers reported in a small pilot study to be presented at the annual Digestive Disease Week meeting on May 19 in Washington, D.C. 

Called gastric fundus mucosal ablation, the procedure relies on an endoscope, a thin tube that can be threaded down the throat. It takes less than an hour and doesn’t require hospitalization. “The advantage of this is that it’s a relatively straightforward procedure,” says Cleveland Clinic surgical endoscopist Matthew Kroh, who was not involved with the work. Side effects, which included mild nausea and cramping, are minimal, one study author said in a news conference on May 8. 

That’s a big difference from bariatric surgery, considered the gold standard treatment for obesity, which includes many techniques to restrict stomach size or affect food absorption. Patients can be hospitalized for days and take weeks to recover. Obese people often avoid these treatments because they don’t want to endure surgery, Kroh says.

The new procedure could one day offer an easier option — if the results hold up in larger groups of patients. “There’s potential,” Kroh says, “but I think we have to be cautious.” 

The trial included 10 women, so the method is still at the proof-of-concept stage. On average, the women lost nearly 8 percent of their body weight, some 19 pounds, over six months. That’s less than patients typically see from bariatric surgery or pharmaceutical treatments like the anti-obesity drug Wegovy (SN 12/13/23).

But it’s enough to make a difference in people’s lives, says Margaret Keane, a bariatric endoscopist at the Johns Hopkins Hospital, who wasn’t part of the study. Even at that level of weight loss, she says, people can experience improvements in conditions that accompany obesity, like high blood pressure, high cholesterol and diabetes.

The study’s authors pinned participants’ weight loss on reduction of a hunger hormone called ghrelin. The hormone acts like a dinner bell for the brain, sending the message that it’s time to eat. Less ghrelin means fewer hungry feelings. There isn’t a drug available to lower the hormone’s level in the blood, but doctors can directly target the tissue that makes ghrelin. Cells lining the upper portion of the stomach pump out most of the hormone. Burning these cells away should lead to weight loss, reasoned study coauthor Christopher McGowan, a gastroenterologist at True You Weight Loss, a clinic in Cary, N.C. 

The idea isn’t without precedent. Bariatric surgeries that remove or bypass this portion of the stomach can also reduce ghrelin. Though results varied in the new study, participants’ ghrelin levels dropped by about 45 percent, from roughly 460 picograms per milliliter at baseline to about 250 at six months post procedure. That’s probably because they had roughly half as many ghrelin-producing cells after the procedure, McGowan said at the news conference. 

Because the study followed patients for just six months, it’s unclear how long the procedure’s results will last — and whether ghrelin-producing cells will grow back. But McGowan noted another effect that could also affect hunger. Scar tissue forms as the burned tissue heals, making the scorched stomach area “less stretchy, less expandable, and stiffer,” he said. “So patients feel full with less food.” 

McGowan sees the technique as a potential stand-alone treatment for obesity. It could perhaps be used for patients transitioning off Wegovy or similar drugs, who often gain weight back after they stop taking the medications. 

But Keane is most excited about the potential of combining the ablation treatment with, for example, an endoscopic sleeve gastroplasty, which makes the stomach smaller by stitching its walls together. Both procedures are nonsurgical and rely on an endoscope. 

It’s still too early to say for sure, Keane says, but such a dual treatment could possibly get patients up to “surgical levels of weight loss without the longer recovery time.”