Entire Jejunum Research Articles

Ursodeoxycholic Acid Ameliorates Ibuprofen‐Induced Enteropathy in the Rat

ABSTRACTBackgroundThe objective of the study was to determine whether ursodeoxycholic acid (Ursodiol) is protective against ibuprofen (IBU)‐induced enteropathy.MethodsUsing the chronically catheterized rat model, IBU (60 mg/kg body weight per day) was infused via the gastric catheter twice daily. Pancreatic enzyme (PE; 10,000 U lipase/kg body weight per day) and Ursodiol (10 mg/kg body weight per day) in two doses were infused via the duodenal catheter. Rats were assigned to one of six treatment groups and were administered treatment for 20 days: control, IBU, PE, IBU + PE, IBU + Ursodiol, and IBU + PE + Ursodiol. The entire jejunum, ileum, cecum, and colon were available for histologic analysis using previously described techniques.ResultsAddition of Ursodiol to high‐dose IBU and normal doses of PE showed a significant reduction in the percentage of rats with ulcers (P < 0.05), total number of serositis events (P < 0.01), total number of severe ulcers (P < 0.001), and an absence of ulcers in the large intestine.ConclusionsUrsodiol, the drug of choice for the treatment of cystic fibrosis liver disease, may offer a safe method of using high‐dose IBU in these patients by ameliorating the enteropathy.

Jejunal glucose uptake and oxygen consumption in turkey poults selected for rapid growth

Two lines of turkey poults, one selected for rapid growth at 16 wk of age (F line) and the other a randombred control line (RBC2) were used to investigate the effect of selection for rapid growth on jejunal O2 consumption and glucose transport as well as whole-body O2 consumption. All trials used unsexed poults and were designed as a randomized complete block with day and line as independent variables. In Trial 1, 120 turkey poults, fed a standard starter ration (25.5% CP), were used to examine the effect of selection on feed intake, body weight gain, and efficiency from hatching (Day 0) to 13 d of age. At Day 14, 36 of 60 birds from each line were killed to measure intestinal length and weight and jejunal O2 consumption after 18 h of feed deprivation. Compared with the RBC2 line, the F line had relatively shorter but heavier small intestinal segments when adjusted by 18 h feed-deprived body weight (FBW; P < 0.001). The F line consumed more O2 over the entire jejunum adjusted to FBW than RBC2 line (43.8 vs 34.6 nmol O2/min.g FBW; P < 0.001). Jejunal ouabain- and cycloheximide-sensitive O2 consumption were greater (P < 0.05) in the F line. In Trial 2, 16 14-d-old poults from each line were used to measure in vitro jejunal glucose transport rate. There was no difference in glucose transport of the jejunum (nanomoles per minute per gram of FBW) between the lines. In Trial 3, 20 poults from each line were used to measure whole-body O2 consumption at 7 to 10 d of age. The F and RBC2 lines had similar whole-body O2 consumption rate per gram of FBW. These data suggest that selection of turkeys for rapid growth at 16 wk of age did not increase efficiency of jejunal glucose uptake in 14-d-old turkey poults.

TRANSPLANTATION OF SEGMENTAL RAT INTESTINAL GRAFTS INCLUDING THE ILEOCECAL VALVE AND THE ASCENDING COLON

Extrinsic denervation and lymphatic disruption impair nutrient absorption after small bowel transplantation. The present study was undertaken to determine whether adding the ileocecal valve with or without the ascending colon would improve the function of a segmental intestinal graft. Five groups of Lewis rats (n = 10/group) were studied. Group I had a sham laparotomy. Groups II, III, IV, and V had the native jejunum, ileum, and cecum replaced with a graft. Inbred Lewis rats were used as isogeneic donors for the transplants to avoid the confounding effect of graft rejection. Group II had the entire jejunum and ileum transplanted. Group III had 20 cm of terminal ileum transplanted. Group IV had 20 cm of the terminal ileum including the ileocecal valve transplanted. Group V had 20 cm of the terminal ileum, the ileocecal valve, and the ascending colon transplanted. The terminal ileum-transplanted and terminal ileum/ileocecal valve-transplanted groups lost more than 25% of their preoperative weight by the end of the second postoperative week; most of these animals were killed because of inanition. In contrast, the sham laparotomy, jejunum/ileum-transplanted, and ascending colon-transplanted groups remained healthy until completion of the study on the 28th postoperative day. The ascending colon-transplanted group had slower intestinal transit and less bacterial contamination of the terminal ileum compared with the terminal ileum-transplanted and terminal ileum/ileocecal valve-transplanted groups (P < 0.05). Transplantation of the ascending colon and the ileocecal valve significantly improves the function of segmental small bowel isografts in rats. These data suggest that adding a colonic segment may be a simple method to improve the function of short-segment cadaveric and living-related intestinal grafts in humans.

Use of fluorescein to predict survival of a free jejunal transfer after disruption of the arterial pedicle on postoperative day 12

The arterial pedicle to a free jejunal transfer was inadvertently disrupted on the 12th postoperative day. Intravenous fluorescein indicated viability of the entire jejunal transfer except for a 2 cm diameter area on the antimesenteric border midway between the upper and lower enteric anastomoses. The entire jejunum survived except for the small area which failed to fluoresce; this area was converted to a controlled pharyngocutaneous fistula. Neovascularisation from surrounding, unirradiated tissue can allow survival of a free vascularised jejunal transfer after disruption of arterial inflow as early as 12 days postoperatively.

Identification of Dopamine1A Receptors in the Rat Small Intestine

Dopamine receptors have been localized to several tissues outside the central nervous system including the kidney and mesenteric vessels. To determine if there are dopamine1 receptors within the small intestine, homogenates of the antimesenteric halves of the entire jejunum and ileum of adult rats were prepared and competitive inhibition studies and Scatchard analysis were performed at room temperature using 125I-SCH 23982 and SCH 23390. The specific binding of 125I-SCH 23982 to the intestinal tissue homogenates was rapid, saturable with ligand concentration, and reversible. Analysis of the Scatchard plots revealed a single class of receptors with an apparent dissociation constant of 10.77 ± 2.32 nM and maximum receptor density of 1.37 ± 0.34 fmole/mg protein. Emulsion autoradiography performed using 125I-SCH 23982 on antimesenteric sections of the rat small intestine revealed that the dopamine1 receptors are located on cells at the base of the intestinal crypts. Two dopamine1 subtypes (D1A and D1B) have been identified by molecular biological techniques. Using a ribonuclease protection assay we found expression of the D1A receptor gene in the small intestinal tissue. These studies are the first to identify, characterize, and localize receptors for the endogenous catecholamine, dopamine, within the rat small intestine and to confirm the expression of the D1A receptor gene.

Normal gestation after 5 years on home parenteral nutrition

A case of normal gestation after 5 years on HPN is reported. The patient had her entire jejunum and ileum and right colon resected because of gangrene and has subsisted normally on HPN ever since. From the second trimester on, her HPN formula was supplemented to meet the requirement for growth and development of the foetus. Anaemia, hypoalbuminaemia, low plasma zinc levels and jaundice became manifest in the final trimester. These responded readily to readjustment of her HPN formula. A normal baby weighing 2020 g was delivered by Caesarean section at 36 weeks. Long-term HPN, final trimester abnormalities and HPN formula adjustments are discussed.

Graft-versus-host disease after multiorgan transplantation

A rat model of multiorgan transplantation (MOTx) including the liver, pancreas, duodenum, and variable segments of small bowel (SB) was used to ascertain whether graft-versus-host disease (GVHD) could be produced by this procedure. Rats receiving an isogeneic multiorgan transplant (MOT) survived more than 150 days. MOTx was then performed in the Lewis to (Lewis X Brown Norway) LBNF 1 semiallogeneic combination, ensuring unidirectional GVHD. En bloc transplantation of the liver, pancreas, duodenum, and entire jejunum provoked lethal GVHD in all animals, and the mean time to recipient death (MT) was 16.5 ± 0.43. When only one-half of the jejunum was included in the MOT, lethal GVHD similarly occurred in 100% of animals and the MT was 18 ± 0.86. Finally, when only liver, pancreas, and duodenum were transplanted, the incidence of lethal GVHD was reduced to 50% ( P < 0.1). In those rats that died of GVHD, MT was 16 ± 0.33. Fifty percent of the rats in this group, however, recovered from a milder form of GVHD and survived more than 150 days. These results demonstrate that MOTx induces GVHD and that the lethality of this process correlates with the inclusion of the SB in the graft and thus, with the overall amount of transplanted lymphoid tissue.

Influence of the length of the small bowel graft on the severity of graft versus host disease

The influence of the length and origin of a small bowel graft on graft versus host disease (GVHD) was studied in 33 (Lewis x brown Norway) F1 hybrids transplanted with different types of Lewis small bowel grafts. Recipients of an entire small bowel graft (N = 9), a jejunal graft (N = 6), or an ileal graft (N = 6) displayed a similar acute lethal GVHD, with 100% mortality rate and equivalent survival time (15 +/- 0.7, 16.8 +/- 0.9, and 16 +/- 0.6 days, respectively) (P greater than 0.01). On the other hand, 80% of the recipients of a segmental jejunal graft (N = 10) recovered from a transitory form of GVHD and regained weight similarly to the isografted rats (N = 4). It was concluded that the entire small bowel, jejunum, and ileum can provoke an equivalent GVHD after transplantation, whereas a segment of jejunum decreases the intensity of GVHD, probably by reducing the amount of transplanted lymphoid tissue.

Posttranslational Regulation of Sucrase-Isomaltase Expression in Intestinal Crypt and Villus Cells

Expression and synthesis of sucrase-isomaltase (SI) were studied in human jejunum and in the colon tumor cell lines Caco-2 and HT-29. Twelve monoclonal antibodies produced against the adult human intestinal enzyme were shown to recognize specifically SI by immunoprecipitation of 14C-labeled membrane proteins, analysis of enzyme activities in the immunoprecipitates, and immunoblotting. These antibodies produced markedly different patterns of immunofluorescent staining of the intestinal mucosa. Three of them were specific for the absorptive villus cells, while the other nine also stained the luminal membrane of the proliferative crypt cells, with different intensities which paralleled their ability to recognize SI in immunoblots. Sequential immunoprecipitation of SI solubilized from purified brush borders or entire jejunum with four selected antibodies demonstrated the presence of different forms of the enzyme, expressed by either villus or crypt cells. Two immunologically distinct forms of high mannose precursor (hmP1 and hmP2) were also identified in both jejunal mucosa and colon tumor cells. They were present as monomers and their immunological differences were preserved under various ionic and pH conditions. Pulse-chase studies indicated that, in Caco-2 cells, hmP1 is converted into hmP2 within 30 min of chase, and hmP2 is then processed into the complex-glycosylated precursor destined for the brush border membrane. hmP1 was immunologically related to the mature SI present in crypt cells and lacked the epitopes specific for mature SI expressed by villus cells. These results demonstrated that sucrase-isomaltase is synthesized by both crypt and villus cells, but processing of the cotranslationally glycosylated high mannose precursor is dependent on the state of differentiation of the enterocytes. This may represent a general mechanism for the regulation of expression of differentiated cell products at the post-translational level.

D-Lactate-Associated Encephalopathy After Massive Small-Bowel Resection

D-Lactate-associated encephalopathy is a rare clinical syndrome characterized by dizziness, ataxia, confusion, headaches, memory loss, lethargy, and aggressiveness which may progress to frank but reversible coma. It occurs in patients with profound dysfunction of the short-bowel syndrome and is believed to result from massive carbohydrate malabsorption with resultant over-production of D-lactate and other organic anions by the colonic flora. Extremely elevated serum levels of D-lactate (but not L-lactate) confirm the diagnosis, but currently D-lactate is not clearly established as the putative neurotoxin. We describe a patient who repeatedly developed D-lactate encephalopathy after surgical removal of nearly the entire jejunum and ileum. Markedly elevated D-lactate serum levels were documented during an encephalopathic episode. Potential pathophysiologic mechanisms and the treatment rationale are discussed.

Importance of Collateral Circulation in the Vascularly Occluded Feline Intestine

The aim of this study was to assess the extent of collateral blood flow provided by the celiac and inferior mesenteric arteries to the intestines during total occlusion of the superior mesenteric artery (SMA). In anesthetized cats, blood flow to the pancreas, duodenum, jejunum, ileum, and colon was measured with radioactive micropheres (15 microns in diameter) before and during occlusion of the SMA. Superior mesenteric artery occlusion significantly decreased (by 63%) blood flow to the head of the pancreas. Flow to the neck and tail of the pancreas was not altered. Blood flow to the proximal and distal duodenum was significantly reduced by 35% and 61%, respectively. Along the entire jejunum and ileum, SMA occlusion markedly decreased blood flow by an average of 71%. In the proximal colon, blood flow decreased by 63%, whereas flow to the middle and distal colon was not affected by SMA occlusion. Reduction in total wall blood flow to the small and large intestines was largely due to a marked reduction in mucosa/submucosa blood flow; muscularis/serosa flow was not affected. The results of this study suggest that total occlusion of the SMA does not compromise blood flow to the neck and tail of the pancreas and middle and distal colon (tissues that are normally perfused with blood from either the celiac or inferior mesenteric arteries). Perfusion through collaterals maintains flow to the head of the pancreas and gut (from duodenum to proximal colon) to within 30%-65% of control (preocclusion) flow. An important new observation of this study is that collateral blood vessels are much more effective in preventing ischemia in the muscularis/serosa than in the mucosa/submucosa after SMA occlusion.

Origin of migrating myoelectric complex in sheep.

The electrical activity of the gastroduodenal junction was recorded in conscious sheep for 8 to 12 wk with chronically implanted electrodes. The flow of digesta was simultaneously recorded, and the duodenal bulb was isolated at the time of implantation. The mean slow-wave frequency of the antrum was 5.6 +/- 0.3/min with spike bursts randomly superimposed on about 60% of the slow waves. The activity of the duodenal bulb was characterized by an absence of slow-wave unpropagated spike bursts and by two types of propagated spike bursts. The first consisted of isolated bursts accompanied by a rapid movement of digesta through the entire duodenum and proximal jejunum. The second, an irregular series of 8-12 spike bursts was associated with total evacuation of the duodenal bulb, followed in turn by an inhibition of antral spiking activity and the development of a migrating myoelectric complex (MMC) in the distal duodenum. The results indicate that in sheep organization of the MMC is located at the duodenal level where the duodenal bulb has a reservoir function.

Accompanying gastro-enteric lesions in familial adenomatosis coli.

An effort was made to detect accompanying gastro‐enteric lesions in 26 patients with familial adenomatosis coli (FAG) belonging to 18 pedigrees. One or more types of various gastric lesions were found in 17 (65.4%) of the 26 patients, these gastric lesions consisting of adenoma in 11 cases, fundic gland polyposis in six, carcinoma in three and microcarcinoid in two. The fundic gland polyposis composed of simple hyperplasia of the fundic glands seems to be peculiar to FAC. Duodenal lesions were present in all of the 19 patients examined and consisted of “carcinoma in adenoma” in one case and adenoma in 18 cases in which one had a microcarcinoid in addition. Out of 16 cases investigated through the entire jejunum and ileum by endoscopy and/or at autopsy, eight (50%) showed small polyps limited to the proximal jejunum. Histologic study showed adenoma in five of them. In the remaining three, polyps did seem clearly to be adenoma on endoscopy. Only four (25%) cases revealed one or a few neoplastic lesions restricted to the distal ileum. Histologic study showed malignant lymphoma in one case, and adenoma in three. The present study strongly suggests that accompanying gastroenteric lesions are higher in incidence than previously considered, and special attention should be given to the stomach and small intestine as well as to the colon and rectum. ACTA PATH. JAP. 27: 823‐839, 1977.

Small bowel dilatation in Ehlers-Danlos syndrome--an unreported gastrointestinal manifestation.

Ehlers-Danlos syndrome is an interesting hereditary disease which involves the collagen fibres of connective tissue presumably at the molecular level (Beighton, Murdoch and Votteler, 1969; McKusick, 1966; Rubinstein and Cohen, 1964). It results in widespread systemic manifestations. These include involvement of the skin, blood vessel walls and the gastrointestinal tract (Beighton, Murdoch and Votteler, 1969; McKusick, 1966; Rubinstein and Cohen, 1964). Previous articles (Beighton et al., 1969; Brombart, Coupatez and Laurent, 1952; Hines and Davis, 1973; Mounier-Kuhn and Meyer. 1943; Rossi and Angst, 1964) have reported numerous gastrointestinal features such as the occurrence of visceromegaly, megaoesophagus, gastric atony, megaduodenum and megacolon. Other manifestations associate the Ehlers-Danlos syndrome with diverticula of the duodenum, small bowel and colon, and more severe complications such as spontaneous perforation of the gastrointestinal tract and gastrointestinal haemorrhage (Beighton et al., 1969). This paper presents a case of a patient with known Ehlers-Danlos syndrome who, although he had no symptoms referable to his gastrointestinal tract, was found to have dilatation of the entire jejunum and ileum. T.N., a 53-year-old Caucasian male has been known to suffer from Ehlers-Danlos syndrome since childhood characterized by elastic-rubbery skin and accompanied by easy bruising.

Intestinal transplantation: Laboratory experience and report of a clinical case

The experimental intestinal transplantation in our laboratory and elsewhere is briefly reviewed. Replantation of the entire jejunoileum is compatible with long-term survival of experimental animals. Lymphatic pathways severed during the procedure fully regenerated within a few weeks. Contrary to the implication of earlier studies on this subject, it is now believed that intestinal allografts are rejected in the same manner as other organs, and the rejection response is definitely mitigated by immunosuppressive drugs. There is no conclusive evidence of a graft versus host reaction despite the fact that transplantation of the entire jejunoileum represents a large antigenic mass and transplantation of many mesenteric lymph nodes. The time necessary for regeneration of lymphatic pathways after allotransplantation is different from that after replantation. In an eight year old boy with surgical removal of the entire jejunum and ileum, repeated problems with infection at catheter sites precluded intravenous feeding after four months. A 3 foot length of terminal ileum from his mother (a class B match) was transplanted, both ostia being opened as mucous fistulas to the abdominal wall. On the seventh day the recipient was explored because of the necrotic appearance of the stomas and a perforated duodenal ulcer. The allograft was precariously perfused and of questionable viability. It was removed to forestall possible further intraabdominal complications. Microscopic examination revealed extensive ischemic necrosis. The large vessels were open but the small vessels contained little blood. It was the opinion of the pathologist that the alterations found represented acute rejection, but we believe that limited arterial perfusion may have contributed substantially to the atrophic changes observed.

INFLUENCE OF BETA-MERCAPTOETHYLAMINE ON MUCOSAL UPTAKE OF 59FE BY INTESTINE-IRRADIATED RATS.

SummaryA perfusion technique was used for the study of mucosal uptake of iron by the irradiated small intestine. The entire exteriorized jejunum and ileum were exposed to 1400 r, 1800 r alone, or 1800 r preceded by MEA (100 mg/kg I.P.). The decreases in mucosal uptake of 59Fe were similar in the above categories for the first three days. The mucosal uptake after MEA and 1800 r was much higher at all times after day 3 than in animals given 1400 r alone, but on a histological basis, the intestines of both irradiated groups were similar throughout a 20-day period after irradiation. Thus there is a difference between the rate of histological and physiological recovery in the two groups. The sham-irradiated controls with MEA showed 16 per cent mucosal uptake of iron one day after surgery, but returned to the control level three days later. The sham-irradiated controls without MEA showed 17 per cent mucosal uptake of iron one day after surgery, but did not return to the control level until six days later. The a...

Loss of the entire jejunum and ileum, and the ascending colon. Management of a patient.

THE AMOUNT of small intestine required for survival is uncertain. Previous reports suggest that between 8 and 18 in. of small intestine below the ligament of Treitz is the minimal amount to support life, although we are aware of 3 exceptions. The purpose of this presentation is to describe the clinical course of a patient whose entire jejunum, ileum, and ascending colon were removed because of necrosis secondary to mid-gut volvulus. From the management of this patient, a systematic, stepwise nutritional program was evolved which may be useful in the care of other patients with major loss of small bowel function. Clinical History A 21-year-old single male was admitted to the Burbank Hospital, Fitchburg, Mass., because of the acute onset of abdominal pain, nausea, and vomiting. Since birth he had been subject to recurrent episodes of vomiting and abdominal cramps, but no diagnosis had been made. During adolescence he attained

A study of malabsorption after resection of the entire jejunum and the proximal half of the ileum.

Biochemical, haematological, and radiological investigations are reported in a young child in whom nearly 80% of the small intestine was resected. The prognosis in a child after such extensive resection is probably better than in an adult, as natural growth can still occur with the expectation of greater adaptability as well as of increased length of the remaining segments.

Experimental gastrojejunal ulcers produced by reversing the duodenum.

MANY SURGICAL and chemical methods for producing ulcers in animals have been developed, but all of these preparations have had certain disadvantages. 1 None has been entirely satisfactory for studying the peptic ulcer problem in man. All of the chemically produced ulcers, such as those caused by cinchophen and histamine in beeswax, are unsatisfactory for testing antiulcer preparations because of the theoretical drug antagonisms developing between the chemical producing the ulcer and the compound being tested. The surgically produced ulcers also have their drawbacks. Many of them do not occur in a sufficiently high percentage of cases to make the results derived from their use of any statistical value. The Mann-Williamson preparation, consisting of an internal duodenal fistula, allows only the terminal 12 in. (30.4 cm.) of ileum to act as an absorbing area for digested food, as the entire jejunum and ileum proximal to this receive no pancreatic juice

Regional Jejunitis

Of the cases of regional enteritis reported since the description of that new disease entity in 1934, the greater percentage have involved the ileum. Until 1939 only 18 examples of regional enteritis of the upper small bowel had appeared in the literature (1, 2). To that number, 6 cases have subsequently been added. Regional jejunitis would thus appear to be a rare disease, but the question arises: Is it merely unrecognized? Regional jejunitis is a serious illness. Six out of 9 patients in whom the condition was surgically proved were incapacitated or dead within two years, according to Pemberton and Brown (3). Chronic regional enteritis is a definite pathological entity. Its etiology at the present time is undetermined. It is characterized by a chronic inflammatory process involving all layers in particular areas of the small intestine. In the early stages varying degrees of mucosal ulceration and destruction occur, followed later by thickening of the intestinal wall and loss of normal elasticity. The final results are narrowing of the lumen and obstruction. Numerous enlarged lymph nodes are always associated with the condition. We present 3 cases of regional jejunitis, of which 2 were diagnosed preoperatively by roentgen examination. All were proved surgically and all were seen within a three-month period. Case I: J. L. S., male, aged 31, was admitted on March 12, 1946, complaining of loss of appetite, moderate nausea, abdominal pain , and loose stools. The symptoms were of several months’ duration. The patient appeared in good physical condition, with tenderness to palpation in the right lower and middle abdominal areas. Laboratory findings were within normal limits. Roentgen examination of the upper gastro-intestinal tract revealed the diagnosis. Roentgen Findings: Fluoroscopically, spasticity and irritability were observed along the distal greater curvature of the stomach, and near the duodenal-jejunal junction. Marked loss of normal mucosal pattern was noted throughout the duodenum and upper jejunum. This was due in part to increased motility of the barium meal through the involved areas, and in part to spasticity. There was associated tenderness' on palpation. A tentative diagnosis of regional enteritis involving the proximal jejunum was made. Operation on April 13, 1946, revealed jejunitis. The entire jejunum was thickened and rubbery, from duodenum to ileum. Associated esenteric nodes were inflamed. There was no evidence of obstruction. A posterior gastro-low jejunostomy was performed. Eleven days later symptoms of obstruction developed, and an entero-enterostomy was done, bypassing the obstructed jejunal area. The patient recovered after two months' stormy convalescence, but never returned to full duty. Post-operative upper gastro-intestinal roentgenographic studies showed a normally functioning gastro-ileostomy. No further follow-up studies are available.