Effect Of Intestinal Resection Research Articles

Impact of drug therapy and surgery on quality of life in Crohn's disease: a systematic review.

Crohn's disease is associated with substantially impaired health-related quality of life (HRQoL). Even in the absence of active disease, patients with Crohn's disease report lower HRQoL, poorer function, and greater concerns, than those without disease. Achievement of disease remission in Crohn's disease, whether by pharmacological or surgical means, is associated with improved HRQoL, although the durability of the improvement seen after intestinal resection is uncertain because of the high rate of postoperative disease recurrence. This review focuses on the available literature on HRQoL in patients with Crohn's disease with an emphasis on the effects of intestinal resection and immunomodulatory therapy.

Effect of intestinal resection on quality of life in Crohn's disease.

Patients with Crohn's disease have poorer health-related quality of life [HRQoL] than healthy individuals, even when in remission. Although HRQoL improves in patients who achieve drug-induced or surgically induced remission, the effects of surgery overall have not been well characterised. In a randomised trial, patients undergoing intestinal resection of all macroscopically diseased bowel were treated with postoperative drug therapy to prevent disease recurrence. All patients were followed prospectively for 18 months. C-reactive protein [CRP], Crohn's Disease Activity Index [CDAI], and faecal calprotectin [FC] were measured preoperatively and at 6, 12, and 18 months. HRQoL was assessed with a general [SF36] and disease-specific [IBDQ] questionnaires at the same time points. A total of 174 patients were included. HRQoL was poor preoperatively but improved significantly [p < 0.001] at 6 months postoperatively. This improvement was sustained at 18 months. Females and smokers had a poorer HRQoL when compared with males and non-smokers, respectively. Persistent endoscopic remission, intensification of drug treatment at 6 months, and anti-tumour necrosis factor therapy were not associated with HRQoL outcomes different from those when these factors were not present. There was a significant inverse correlation between CDAI, [but not endoscopic recurrence, CRP, or FC] on HRQoL. Intestinal resection of all macroscopic Crohn's disease in patients treated with postoperative prophylactic drug therapy is associated with significant and sustained improvement in HRQoL irrespective of type of drug treatment or endoscopic recurrence. HRQoL is lower in female patients and smokers. A higher CDAI, but not direct measures of active disease or type of drug therapy, is associated with a lower HRQoL.

Effect of intestinal resection on hydrogen sulfide biosynthesis and the damage of Cajal interstitial cells

To investigate the effect of intestinal resection on hydrogen sulfide (H2S) biosynthesis and interstitial cells of Cajal(ICC) in mice. After intestinal resection mouse model was established, the activity of MPO in the proximal anastomosis intestinal tissue were detected. Sensitive sulphur electrode assay was applied to measure the H2S level. RT-PCR technique was employed to investigate the mRNA expression of the endogenous H2S biosynthesis enzymes, cystathionine-b-synthase (CBS) and cystathionine-c-lyase (CSE). Immunofluorescence staining was used to detect the expression of c-kit in order to calculate the area of ICC. The mRNA expression of CSE was detected in the small intestine tissue of mice, while no CBS mRNA was found. The mRNA expression of CSE in proximal anastomotic stoma increased in time-dependent manner in the model group. CSE mRNA expression began to increase 1 hour after operation, reached the peak at 6th hour, then decreased gradually, and was similar to the control group at postoperative 24th hour. Compared to the model group, in the intestinal tissues of proximal 3 cm to anastomotic stoma, the mRNA expression of CSE (1.16 ± 0.18 vs. 1.63 ± 0.13, P<0.05), the activity of MPO [(0.54 ± 0.07) U/g vs. (0.83 ± 0.09) U/g, P<0.05], the H2S level [(36.1 ± 6.1) nmol/mg vs. (5.3 ± 5.6) nmol/mg, P<0.05] were significantly reduced in the PPG group. Meanwhile, average percentage of positive ICC area in the PPG groups was significantly higher [(2.26 ± 0.19)% vs. (1.65 ± 0.24)%, P<0.05]. Inflammatory reaction in muscular layer induced by intestinal resection up-regulates the mRNA expression of CSE proximal to anastomotic stoma, generates excess H2S to damage ICC leading to intestinal motor dysfunction. Preoperative inhibition of endogenous H2S generation may protect the ICC.

Effects of Intestinal Resection on Growth Parameters in Children with Crohn's Disease

Effects of Intestinal Resection on Growth Parameters in Children with Crohn's Disease

Epidermal Growth Factor Receptor Signaling Regulates Bax and Bcl-w Expression and Apoptotic Responses During Intestinal Adaptation in Mice

Normal intestinal adaptation to massive small-bowel resection requires intact epidermal growth factor receptor signaling and consists of increased enterocyte proliferation and apoptosis. Although emphasis has been placed on understanding the regulation of proliferation, few studies have evaluated the mechanism and contribution of apoptosis to the adaptation response. We sought to test the hypothesis that epidermal growth factor receptor signaling regulates specific Bcl-2 family members (Bax and Bcl-w) to direct apoptosis and adaptation after massive small-bowel resection. Laser capture microdissection microscopy permitted measurement of Bax and Bcl-w messenger RNA expression in crypt and villus enterocytes in control conditions and under epidermal growth factor receptor-inhibited (waved-2 mice) or stimulated (epidermal growth factor transgenic mice) conditions after a 50% small-bowel resection or sham operation. Resection-induced adaptation was then studied in Bax-null and Bcl-w-null mice under control circumstances and after epidermal growth factor receptor stimulation. When compared with Bcl-w, the most significant expression changes were observed with Bax and took place within crypt enterocytes. Epidermal growth factor receptor stimulation resulted in a decreased ratio of Bax to Bcl-w expression and decreased rates of apoptosis. Bax-null mice had no apoptosis response to small-bowel resection and displayed an amplified adaptation response to the administration of epidermal growth factor. Bcl-w-null mice had poor survival and impaired adaptation to small-bowel resection, an effect that was rescued by crossbreeding these mice with epidermal growth factor transgenic mice. The crypt expression of Bax and Bcl-w is influenced by epidermal growth factor receptor signaling and is key for the regulation of apoptosis. Epidermal growth factor receptor stimulation, coupled with apoptosis inhibition, may provide a novel strategy to amplify adaptation responses in patients after massive intestinal loss.

Effects of intestinal resection on enterocyte apoptosis

Intestinal resection results in increased numbers of villus and crypt enterocytes. This adaptive response occurs secondary to increased crypt cell proliferation early after resection. Apoptosis also increases in both crypt and villus compartments early after resection. Our aim was to evaluate change in proliferation and apoptosis later during the adaptive period. Eighteen rabbits undergoing 50% proximal intestinal resection were killed 7, 14, or 21 days after resection. Intestine at the resection margin was evaluated before and after resection for morphometry, crypt cell production rate (CCPR), and in situ end labeling of DNA fragmentation. Apoptotic cells were identified by morphologic evaluation. Villus height (382 ± 51 μm vs. 505 ± 131 μm) and crypt depth (121 ± 10 μm vs. 163 ± 21 μm; P <0.05) were significantly increased at 21 days. CCPR was also increased compared to preoperative values (5.8 ± 1.2 cells/hr vs. 8.6 ± 0.3, 7.9 ± 0.3, and 8.3 ± 1.6 cells/hr at 7, 14, and 21 days; P <0.05). Apoptotic index (apoptotic cells per 100 cells) was significantly increased in cells at the tip of the villus at 21 days (32 ± 7% vs. 19 ± 7%; P <0.05) but not in the lateral villus or total villus. Total cells per villus (83 ± 6 vs. 65 ± 3) and apoptotic cells per villus (9.2 ± 1.6 vs. 4.5 ± 2.5; P <0.05) were also greater at 21 days. Mean DNA fragmentation scores were similar before and after resection. The crypt apoptotic index was increased only in the lateral crypt at 14 days. Total cells per crypt increased after resection, and the number of apoptotic cells per crypt was increased at 7 and 14 days (2.5 ± 1.7 and 2.3 ± 1.1 vs. 0.6 ± 0.6 days; P <0.05). Thus the following conclusions were reached: (1) Apoptosis of villus tip cells remains elevated late in postresection adaptation; (2) crypt cell apoptosis returns to preoperative levels during the time interval when crypt cell proliferation is still stimulated; and (3) apoptosis in the crypt and villus compartments appears to be regulated independently.

Effect of intestinal resection on human small bowel motility.

Few data are available on adaptive changes of human small bowel motility after intestinal resection. To characterise jejunal motility after extensive and limited distal intestinal resection. Seven patients with a short bowel syndrome after total ileal and partial jejunal resection (residual jejunal segments between 60 and 100 cm) and six patients with limited distal ileal resection (resected segment between 30 and 70 cm) underwent ambulatory 24 hour jejunal manometry 15 (6-24) months after the operation. Normal values were obtained from 50 healthy subjects. Fasting motility and the motor response to a 600 kcal solid meal were analysed visually and by a computer program. Limited ileal resection did not result in changed jejunal motility. After extensive distal resection, patients had a significantly shorter migrating motor complex (MMC) cycle and a significantly shorter duration of the postprandial motor response compared with controls (p < 0.005). Intestinal resection had no influence on jejunal contraction frequency and amplitude and did not lead to any abnormal motor pattern. Extensive distal resection of the small intestine produces distinct abnormalities of fasting and postprandial motility in the intestinal remnant. The shortening of digestive motility and the increased frequency of MMC cycling could contribute to malabsorption and diarrhoea in the short bowel syndrome.

Effect of intestinal resection and arginine-free diet on rat physiology

The small intestine has been presumed to release citrulline as a precursor for the endogenous arginine synthesis. We studied the effect of intestinal resection and arginine-free diet on rat physiology. We maintained rats with massively resected small intestine (R rats) and those with transected intestines (T rats) on either control or an arginine-free diet. After 4 wk, R rats fed deficient diet [R(-)] lost weight by a mean of 46 g, whereas R rats fed control diet [R(+)] and T rats fed control [T(+)] and deficient diet [T(-)] gained 30-96 g. Average nitrogen balance was 150, 60, 110, and -33 mg/day for T(+), T(-), R(+), and R(-), respectively. The concentrations of arginine in skeletal muscle were 654, 163, 230, and 84 nmol/g, respectively, and those in plasma were 133, 50, 103, and 54 microM, respectively. The concentrations of citrulline in R rats were halved compared with T rats irrespective of diet. We conclude that arginine is synthesized in a small intestine-dependent manner in the rat.

Effects of intestinal resection, cholecalciferol and ascorbic acid on iron metabolism in rats

The effect of dietary supplementation with ascorbic acid or cholecalciferol on Fe utilization was studied using the metabolic balance technique, in rats in which 50% of the distal small intestine was removed, or in which the mid small intestine was transected and reanastomosed (controls). Three different diets were used. The first (basal diet) contained (g/kg dry wt): protein (casein + 50 mg D,L-methionine/g) 120 and fat (medium-chain triacylglycerols, olive oil and sunflower oil, in equal parts) 40. The other diets were obtained by adding ascorbic acid (150 mg/kg diet) or cholecalciferol (0.4 mg/kg diet) to the basal diet. Apparent digestibility coefficient (ADC) and Fe retention were significantly lower in resected animals than in their respective control groups (transected rats). However, the addition of ascorbic acid or cholecalciferol to the basal diet increased the ADC and Fe retention in both transected and resected rats. Five weeks after surgery, resection also resulted in a reduced concentration of Fe in the sternum, but did not reduce the concentration of haemoglobin or serum Fe total Fe-binding capacity or the concentration of Fe in liver, testes, femur or muscle (longissimus dorsi). Supplementation with ascorbic acid increased serum Fe concentration, while the concentration of Fe in muscle was reduced by supplementation with both ascorbic acid and cholecalciferol. Neither supplementation had any effect on the Fe concentration in other tissues, on haemoglobin concentration or plasma total Fe-binding capacity. Thus, supplementation with ascorbic acid or with cholecalciferol increased Fe absorption and reduced the concentration of Fe in muscle.

Zinc metabolism in rats: Effects of intestinal resection, cholecalciferol and ascorbic acid

The metabolic balance technique was used to study the effect of dietary composition on zinc nutritive utilization in rats in which 50% of the distal small intestine (DSI) was removed, and in transected rats (controls). Six experiments with three different diets were done: the basal diet contained 12% protein (casein+5% D,L-methionine) and 4% lipid (medium chain triglycerides (MCT), olive oil and sunflower oil in equal parts); the other two diets were obtained by supplementing the basal diet with cholecalciferol (0.4 mg/kg diet) or adding ascorbic acid (150 mg/kg diet). Resection of 50% of the DSI markedly affected the digestive and metabolic utilization of zinc [apparent digestibility coefficient (ADC), and zinc balance] in rats fed on the basal diet alone or additioned with vitamin C. However, these parameters were not so markedly affected by the surgery in rats whose diet was supplemented with cholecalciferol. To investigate postresection zinc homeostasis we also measured the concentrations of this metal in blood, plasma and several organs (liver, femur, sternum, longissimus dorsi (LD) muscle and testes) one month after surgery. We found no alterations in the distribution of zinc in the organism under any of the experimental conditions. We conclude that the adaptive mechanisms that maintaining trace metal homeostasis are operative one month after intestinal resection.

Effect of Intestinal Resection on Phospholipid Class Distribution and Fatty Acid Composition of Mucosal Cells in the Rat Large Intestine

In this study we examined the effect of 50% distal small bowel resection (DSBR) on the lipid composition of rat colonic mucosa, including the fatty acid composition of major phospholipid classes, phosphatidylethanolamine (PE), phosphatidylcholine (PC), phosphatidylinositol (PI), lysophosphatidylcholine (LPC), and sphingomyelin (SM). Phospholipid, free cholesterol, triacylglycerols, diacylglycerols, and cholesterol ester levels were not affected by the surgical operation. PE together with PC accounted for more than 60% of total phospholipid, in both groups of animals. The relative percentages of PE, PC, PI, SM, and cardiolipin (CL) remained unaffected by DSBR. However, a decrease in the content of LPC was observed in 50%-resected animals. Different fatty acid composition changes in the colonic phospholipid classes were observed after resection. PC fraction contained the highest amounts of saturated fatty acids, but monounsaturated fatty acids were present in high levels in PI fraction, in both groups of animals. DSBR produces different changes in the levels of linoleic and arachidonic acids. These results suggest that the lipid composition and the fatty acid profile of the different phospholipid fractions change in the adaptive response of colon to intestinal resection.

Characterization of the lipid and fatty acid composition of rat caecal mucosa: effect of intestinal resection.

The lipid composition and the fatty acid profile of the lipid fraction (phospholipid, triacylglycerol, diacylglycerol and cholesterol ester) of the caecum were studies 6 weeks after both 50% and 75% distal small bowel resection (DSBR). Triacylglycerol (TG) and cholesterol ester (CE) levels were decreased after resection but the total phospholipid (PL), free cholesterol (FC), and diacylglycerol (DG) contents were not significantly modified after the operation. Different fatty acid changes in the caecum lipid fractions were found after the surgical operation, with the greatest differences after 75% DSBR. Saturated fatty acids were increased in PL, TG and CE fractions as a consequence of DSBR. Similarly, these fractions presented the lowest amounts of n-6 and polyunsaturated fatty acids after resection. On the contrary, the levels of saturated fatty acids was decreased and both n-6 and polyunsaturated fatty acid levels increased in the DG fraction of resected animals. These results are discussed in terms of adaptation to intestinal resection.

Role of rat large intestine in reducing diarrhea after 50% or 80% distal small bowel resection

The effects of intestinal resection on several intestinal parameters have been studied in the large intestine of rats one month after the surgical operation. The results show that both 50% and 80% distal small bowel resection increased net fluid absorption and mucosal permeability and caused expansion of the intercellular spaces of the large intestine. The increase in net fluid absorption was dependent upon the extent of the intestine removed. The cAMP and cGMP content of cecal and colonic mucosa were significantly reduced after jejunoilectomy. Changes in nucleotide levels were dependent on the length of the intestine resected. On the other hand, mucosa Na,K-ATPase specific activity was only increased in the cecum after 80% intestinal resection. The results are discussed in terms of adaptation to prevent diarrhea.

In vivo zinc transport by rat small intestine after extensive small bowel resection.

We studied the effects of intestinal resection on in vivo zinc transport and intestinal tissue zinc in remnant duodenum and ileum 4 wk after two-thirds small bowel enterectomy. In situ duodenal and ileal intestinal segments from resected and sham-operated control rats were perfused through the lumen with an isotonic solution containing 0.077 mM zinc with isotopic 65Zn as tracer. After resection there was significant mucosal growth in both segments, but segment transport specific activities (transport per gram mucosa) were unchanged. Therefore, increased segment transport capacities (transport per centimeter segment length) in both segments approximated increased mucosal mass. Comparisons with transport data from our earlier studies on other luminal substrates in rats after small bowel resection showed that adaptive transport mechanisms vary not only with the luminal substrate examined but may also differ in remaining proximal and distal small bowel. In the present study about 12% of the absorbed radiotracer zinc remained in the intestinal wall after perfusion of both duodenum and ileum of resected and control animals, and there were no effects of resection on tissue radiotracer 65Zn concentrations or specific activities in the mucosal fraction or underlying tissues. Calculations of mucosal entry and exit fluxes per centimeter segment length showed that the major effect of resection was to increase the zinc entry flux at the luminal surface of the mucosa. At the basal surface of the mucosa, both entry and exit fluxes increased.(ABSTRACT TRUNCATED AT 250 WORDS)

EFFECT OF INTESTINAL RESECTION ON BILE SALT ABSORPTION IN DOGS.

The efficiency of intestinal absorption of bile salts was evaluated by studying the rate of disappearance of radioactivity from the bile of dogs after the intravenous administration of sodium taurocholate-24-C14. Bile was sampled through an indwelling tube in the gall bladder. One day after a high-fat meal normal dogs retained 48% of the radioactivity; dogs with resection of the jejunum retained 48%, whereas those with resection of the ileum retained only 3% in the bile. This is consistent with previous observations that the ileum is the site of bile salt absorption in vitro and in anesthetized animals. Animals with resection of the ileum exhibited significant steatorrhea; however, three-fourths of the ingested fat was absorbed in spite of almost complete failure to absorb bile salts. This indicates that fat and bile salts are not normally absorbed together. Elimination of enterohepatic circulation of bile salts by resection of the ileum contributes to the observed steatorrhea.