Growth In Ileum Research Articles

Surgical Management of Intestinal Tuberculosis in Preoperatively Unsuspected Cases at a Tertiary Care Hospital in Dhaka City

Background: Surgical management of intestinal tuberculosis is a crucial task in preoperatively unsuspected cases. Objective: The present study was undertaken to see the different surgical management of intestinal tuberculosis in preoperatively unsuspected cases. Methodology: This clinical trial was conducted in different units of the Department of Surgery at Dhaka Medical College Hospital, Dhaka from March 2002 to March 2004 for a period of two (2) years. Purposive sampling technique was applied to collect the study population. Patients with no suspicion about pulmonary as well as intestinal tuberculosis, history of cough & hemoptysis, no history of antitubercular drug taken, diagnosed as other than tuberculosis, per operative suspicion raised by any one or more of followings, enlarge lymph nodes in mesentery, omental masses, ileocaecal masses, suspicious growth in ileum, omental thickening, perforation suspected by tuberculosis were selected as study population. Biopsy was taken from suspicious lesions. Histopathology was confirmed the granulomatous lesion. Results: A total number of 300 patients were undergone surgical intervention of which 38(12.7%) cases. Maximum affected age group was 21 to 30 years which was 16(42%) cases. Granulomatous inflammation was found in 12(31.6%) cases. Maximum mode of presentation was in the form of emergency which was 36(94.7%) cases. Tissue was taken for biopsy from mesenteric lymph node in 16(42.10%) cases. Procedures done during laparotomy were resection of ileum and ileoileal anastomosis and proximal ileostomy which was performed in 6(23.07%) cases, resection of ileum and ileostomy in 5(19.23%) cases and resection of ileum with ileoileal anastomosis in 3(11.53%) cases. Conclusion: In conclusion surgical management is performed by resection of jejunum with jejunojejunal anastomosis, hemicolectomy with ileotrasverse anastomosis and resection of ileum with ileostomy.

Clinico-Demographic Characteristics of Intestinal Tuberculosis in Pre-Operative Unsuspected Laparotomy as Incidental Findings in Bangladesh

Background: Clinical presentation of intestinal tuberculosis is varied. It is also essential to know the clinical and demographic characteristics of incidentally detected intestinal tuberculosis patient. Objective: The purpose of the present study was to find out the clinic-demographic characteristics of intestinal tuberculosis in clinically and preoperatively unsuspected laparotomies. Methodology: This cross-sectional study was carried out in the Department of Surgery at Dhaka Medical College Hospital, Dhaka from March 2002 to March 2004 for a period of two (2) years. All the patients underwent laparotomy presented without any suspicion of pulmonary or intestinal tuberculosis were included as study population. Patients who were without the history of cough, haemoptysis, antitubercular drug therapy were included. Per operative suspicion was raised due to enlarged lymph nodes in mesentery, omental masses, ileocaecal masses, suspicious growth in ileum, omental thickening, perforation suspected by tuberculosis. Biopsy was taken from suspicious lesions. Histopathology was confirmed the tubercular lesion. Results: A total number of 300 patients under laparotomy were recruited for this study of which 38 positive cases were found in the study with a percentage of 12.7%. Maximum affected age group was 21 to 30 years which was 16 (42%) cases. Male was predominant to female which was 28 (73.7%) cases and 10 (26.3%) cases respectively. Low socioeconomic people are affected more (76.3%). Most common presentation in positive cases was acute and sub-acute intestinal obstruction 20 (52.6%) followed by intestinal perforation (26.31%). Conclusion: In conclusion young age male patient is the most commonly affected intestinal tuberculosis which is frequently presented with sub-acute intestinal obstruction among the preoperatively unsuspected laparotomy patients.

T1290 Enteral Feeding in Acute Pancreatitis: A Meta-Analysis of Randomized Controlled Trials

Glucagon-like peptide-2 (GLP-2) is a nutrient-dependent, intestinotrophic hormone derived from post-translational processing of proglucagon in the distal bowel. Parenterally-fed rats showed a synergistic intestinal growth response to combination treatment with enteral nutrients (EN) and a low-dose of intravenous GLP-2 (Am J Physiol 295:R1794, 2008). Evidence suggest that whey protein may inhibit dipeptidyl peptidase-IV (DPP-IV) and prolong the half life of GLP-2. The objective of this study was to determine what enteral protein component is responsible for the synergistic intestinal growth induced by treatment with EN + GLP-2. Rats were randomized to 7 treatment groups (n=6) maintained with parenteral nutrition (PN) and continuous intravenous infusion of GLP-2 (100 μg/kg bw/day) for 7 days. The control group received only PN+GLP-2. Six treatment groups received PN+GLP2 from days 1-3 and partial PN+GLP-2 plus EN from a semi-elemental liquid diet from days 4-7 (n=6). Enteral protein was provided from different sources as follows: Casein, Soy, and 4 groups receiving different combinations of whey protein, whey protein concentrate (WPC), hydrolyzed WPC, WPC + hydrolyzed WPC, and soy + WPC + hydrolyzed WPC. The 4 groups receiving whey protein showed significantly increased mucosa growth in ileum for dry mass, protein, and DNA by approximately 20%, 22% and 30%-49% compared to Casein, Soy or the PN+GLP-2 control, respectively. All groups that received EN showed significantly greater jejunal sucrase segmental activity and gain of body weight after 7 days of PN compared to the PN+GLP-2 control. This suggests that during PN, any form of a supplemental complete enteral diet improves digestive capacity and gain in body weight irrespective of protein source. There was a significant 35% greater concentration of plasma bioactive GLP-2 in 5 out of the 6 groups that received EN, compared to the PN+GLP-2 control. All groups that received EN showed greater proglucagon mRNA expression in ileum compared to the PN+GLP-2 control. Increased proglucagon mRNA and plasma bioactive GLP-2 are consistent with nutrient regulation of GLP-2. The 3 groups receiving hydrolyzed WPC showed significantly lower plasma DPP-IV activity compared to Casein or Soy. In addition, the 4 groups receiving EN that included whey protein showed significantly decreased DPP-IV specific activity in ileum and colon compared to Casein or Soy. In conclusion, the synergistic ileal mucosa growth due to combination treatment with EN+GLP2 in rats with PN-induced mucosal atrophy is associated with intake of whey protein which may mediate this effect through decreasing DPP-IV activity.

T1289 Whey Protein Potentiates the Intestinotrophic Action of Glucagon-Like Peptide-2 in Association with Reduced Dipeptidyl Peptidase-IV Activity in Parenterally-Fed Rats

Glucagon-like peptide-2 (GLP-2) is a nutrient-dependent, intestinotrophic hormone derived from post-translational processing of proglucagon in the distal bowel. Parenterally-fed rats showed a synergistic intestinal growth response to combination treatment with enteral nutrients (EN) and a low-dose of intravenous GLP-2 (Am J Physiol 295:R1794, 2008). Evidence suggest that whey protein may inhibit dipeptidyl peptidase-IV (DPP-IV) and prolong the half life of GLP-2. The objective of this study was to determine what enteral protein component is responsible for the synergistic intestinal growth induced by treatment with EN + GLP-2. Rats were randomized to 7 treatment groups (n=6) maintained with parenteral nutrition (PN) and continuous intravenous infusion of GLP-2 (100 μg/kg bw/day) for 7 days. The control group received only PN+GLP-2. Six treatment groups received PN+GLP2 from days 1-3 and partial PN+GLP-2 plus EN from a semi-elemental liquid diet from days 4-7 (n=6). Enteral protein was provided from different sources as follows: Casein, Soy, and 4 groups receiving different combinations of whey protein, whey protein concentrate (WPC), hydrolyzed WPC, WPC + hydrolyzed WPC, and soy + WPC + hydrolyzed WPC. The 4 groups receiving whey protein showed significantly increased mucosa growth in ileum for dry mass, protein, and DNA by approximately 20%, 22% and 30%-49% compared to Casein, Soy or the PN+GLP-2 control, respectively. All groups that received EN showed significantly greater jejunal sucrase segmental activity and gain of body weight after 7 days of PN compared to the PN+GLP-2 control. This suggests that during PN, any form of a supplemental complete enteral diet improves digestive capacity and gain in body weight irrespective of protein source. There was a significant 35% greater concentration of plasma bioactive GLP-2 in 5 out of the 6 groups that received EN, compared to the PN+GLP-2 control. All groups that received EN showed greater proglucagon mRNA expression in ileum compared to the PN+GLP-2 control. Increased proglucagon mRNA and plasma bioactive GLP-2 are consistent with nutrient regulation of GLP-2. The 3 groups receiving hydrolyzed WPC showed significantly lower plasma DPP-IV activity compared to Casein or Soy. In addition, the 4 groups receiving EN that included whey protein showed significantly decreased DPP-IV specific activity in ileum and colon compared to Casein or Soy. In conclusion, the synergistic ileal mucosa growth due to combination treatment with EN+GLP2 in rats with PN-induced mucosal atrophy is associated with intake of whey protein which may mediate this effect through decreasing DPP-IV activity.

Enteral nutrients potentiate the intestinotrophic action of glucagon-like peptide-2 in association with increased insulin-like growth factor-I responses in rats

Glucagon-like peptide-2 (GLP-2) is a nutrient-dependent, intestinotrophic hormone derived from posttranslational processing of proglucagon in the distal bowel. GLP-2 is thought to act through indirect mediators, such as IGF-I. We investigated whether intestinal expression of GLP-2 and IGF-I system components are increased with the mucosal growth induced by enteral nutrient (EN) and/or a low dose of GLP-2 in parenterally fed rats. Rats were randomized to four treatment groups using a 2 x 2 design and maintained with parenteral nutrition (PN) for 7 days: PN alone, EN, GLP-2, and EN+GLP-2; n = 7-9. The two main treatment effects are +/-GLP-2 (100 microg.kg body wt(-1).day(-1)) and +/-EN (43% of energy needs, days 4-6). Combination treatment with EN+GLP-2 induced synergistic intestinal growth in ileum, resulting in greater mucosal cellularity, sucrase segmental activity, and gain of body weight (ENxGLP-2, P < 0.04). In addition, EN+GLP-2 induced a significant 28% increase in plasma concentration of bioactive GLP-2, a significant 102% increase in ileal proglucagon mRNA with no change in ileal dipeptidyl peptidase-IV (DPP-IV) specific activity, and significantly reduced plasma DPP-IV activity compared with GLP-2. This indicates that EN potentiates the intestinotrophic action of GLP-2. Proliferation of enterocytes due to GLP-2 infusion was associated with greater expression of ileal proglucagon, GLP-2 receptor, IGF-I, IGF binding protein-3 mRNAs, and greater IGF-I peptide concentration in ileum (P < 0.032). Ileal IGF-I mRNA was positively correlated with expression of proglucagon, GLP-2R, and IGFBP-5 mRNAs (R2 = 0.43-0.56, P < 0.0001). Our findings support the hypothesis that IGF-I is one of the downstream mediators of GLP-2 action in a physiological model of intestinal growth.

Intestinal adaptation after extensive small bowel resection: differential changes in growth and insulin-like growth factor system messenger ribonucleic acids in jejunum and ileum.

The distal small bowel exhibits greater adaptive growth than proximal segments after partial small intestine resection. To explore this process, we evaluated adaptive cellularity, intestinal insulin-like growth factor (IGF) system messenger RNA (mRNA) transcripts, and effects of recombinant IGF-I treatment in jejunum and ileum of adult rats. Gastrostomy-fed animals underwent 80% jejuno-ileal resection or intestinal transection and reanastomosis without resection, followed by infusion of human recombinant IGF-I (2.4 mg/kgXday) or vehicle. After 7 days, resected rats demonstrated modest adaptive growth in jejunum and marked cell proliferation in ileum. Resection increased IGF-I mRNA in both jejunum (183%) and ileum (249%) and up-regulated IGFBP-4 mRNA levels in both tissues. IGFBP-3 mRNA fell significantly in ileum after resection. IGF-I infusion modestly increased ileal cellularity after resection, but had no effect in jejunum. IGF-I markedly increased IGFBP-3 mRNA levels in jejunum after both transection and resection. These data confirm that bowel resection induces greater adaptive growth in ileum than jejunum. IGF-I administration modestly increases ileal, but not jejunal, growth after resection. Increased levels of intestinal IGF-I and IGFBP-4 mRNA suggest roles for IGF-I and IGFBP-4 in mediating small bowel adaptation. Higher levels of jejunal IGFBP-3 mRNA may be related to limited jejunal vs. ileal growth after extensive jejuno-ileal resection.