Effect of Glutamine on the Nucleic Acids Exchange during the Perioperative Period in Reconstructive Esophagus Surgery

Abstract

Purpose: To assess the homeostasis of nucleic acids and nutritional status in the operation of one-stage esophagoplasty among patients diagnosed with achalasia of the esophagus or scar narrowing of esophagus after chemical burn. Methods: The study included 37 patients from 20 to 65 years old, male and female with achalasia of the esophagus or scar narrowing of the esophagus after chemical burn. All patients underwent one-stage esophagectomy wuth the following plastic. In the first group, patients received standard preoperative preparation (preoperative and postoperative enteral nutritional support by izokaloric mixture). Enteral mixture with increased concentration of glutamine (6 g/100 ml) was added to a standard enteral mixture in patients of the second group (15) counting glutamine as 0.5 g/kg/day (during three days before and two days after the surgery). DNA concentration of blood plasma and uric acid concentration in urine were counted for the assessment of nucleic acids metabolism. General clinical indicators were examined to assess the nutritional status (total serum protein and albumin, transferrin, the absolute number of blood lymphocytes). Results: The initial alimentary nutritional deficiency is exacerbated in the postoperative period because of development of the catabolism syndrome. We examined DNA concentration of serum and excretion of uric acid in the urine to assess the severity of nutritional deficiency, as one of the markers of nucleic acid homeostasis. Analyzing the results of the first group of patients, we saw a deep serum oligonucleotides deficiency in all phases of the perioperative period. Application of enteral mixture with glutamine in patients of the second group significantly improves exchange of nucleic acids and nutritional status. Conclusion: There were revealed the dependence of the homeostasis state of nucleic acids and nutritional status. Patients in the first group had had two postoperative complications (9.1%), in the second group there were no complications.