Enteral feeding induces profound early intestinal adaptation in a neonatal piglet model of short bowel syndrome

Abstract

Our objective was to characterize small intestinal (SI) adaptation in a novel piglet model. Piglets (n = 32, 12–13 d old) were randomized to 1) 80% SI resection with total parenteral nutrition (TPN) feeding (R‐TPN), 2) 80% SI resection with TPN + enteral feeding (R‐EN) or 3) sham SI transection with TPN + enteral feeding (Sham‐EN). In R pigs, the distal 100 cm of ileum (residual SI) and 30 cm of proximal SI was left intact. All pigs received TPN after surgery. R‐EN and Sham‐EN piglets also received continuous gastric infusions of elemental diet starting on d 3 (40:60 TPN:EN). Piglets were killed 4, 6 or 10 d post‐surgery. Cell proliferation in residual SI, assessed by incorporation of 5‐bromo‐2′‐deoxyuridine (BrdU) was significantly greater in R‐EN animals (29.5 ± 4.7 %) compared to Sham‐EN (13.63 ± 5.7 %) and R‐TPN (12.97 ± 8.9 %) animals at d 4 (P<0.05). R‐EN at d 4 also had higher rates of mucosal protein synthesis than Sham‐EN (P<0.001) and R‐TPN animals (P<0.05), (87.2 ± 3.2 vs 53.2 ± 2.1 and 59.7 ± 9.7 %/d, respectively). Villous height and crypt depth were greater in R‐EN animals compared to Sham‐EN animals at d 6 and 10 (p<0.05). Less than 24 h of enteral feeding increased rates of cell proliferation and protein synthesis; this translated into greater villous height and crypt depth only 2 d later. This piglet model will be very useful in assessing the efficacy of nutritional interventions targeting SI adaptation. (SickKids Foundation)