Massive Resection Of Small Intestine Research Articles

Biliary-duodenal anastomosis using magnetic compression following massive resection of small intestine due to strangulated ileus after living donor liver transplantation: a case report

BackgroundDespite the improvements of surgical techniques and postoperative management of patients with liver transplantation, biliary complications are one of the most common and important adverse events. We present a first case of choledochoduodenostomy using magnetic compression following a massive resection of the small intestine due to strangulated ileus after living donor liver transplantation.Case presentationThe 54-year-old female patient had end-stage liver disease, secondary to liver cirrhosis, due to primary sclerosing cholangitis with ulcerative colitis. Five years earlier, she had received living donor liver transplantation using a left lobe graft, with resection of the extrahepatic bile duct and Roux-en-Y anastomosis. The patient experienced sudden onset of intense abdominal pain. An emergency surgery was performed, and the diagnosis was confirmed as strangulated ileus due to twisting of the mesentery. Resection of the massive small intestine, including choledochojejunostomy, was performed. Only 70 cm of the small intestine remained. She was transferred to our hospital with an external drainage tube from the biliary cavity and jejunostomy. We initiated total parenteral nutrition, and percutaneous transhepatic biliary drainage was established to treat the cholangitis. Computed tomography revealed that the biliary duct was close to the duodenum; hence, we planned magnetic compression anastomosis of the biliary duct and the duodenum. The daughter magnet was placed in the biliary drainage tube, and the parent magnet was positioned in the bulbus duodeni using a fiberscope. Anastomosis between the left hepatic duct and the duodenum was accomplished after 25 days, and the biliary drainage stent was placed over the anastomosis to prevent re-stenosis. Contributions to the successful withdrawal of parenteral nutrition were closure of the ileostomy in the adaptive period, preservation of the ileocecal valve, internal drainage of bile, and side-to-side anastomosis.ConclusionsCholedochoduodenostomy with magnet compression could be a less invasive and safer method for treatment of biliary stricture that cannot be accessed by conventional surgery.

簡便かつ機能的なopen abdominal management

簡便かつ機能的なopen abdominal management

Experimental study on the effects of massive bowel resection on liver function and hepatocyte apoptosis.

The effects of short-bowel syndrome on liver function and liver morphology independent of parenteral nutrition have not been thoroughly investigated. Our aim was to investigate the effects of massive bowel resection on hepatocyte apoptosis and liver function in rats. A total of 37 female Sprague-Dawley rats were randomly assigned to five groups: Control (no procedure); Sham 1 [laparotomy (LT)/enterotomy (ET); evaluated on postoperative day (POD) 1]; Sham 2 (LT/ET; evaluated on POD7; Group 1 (80% bowel resection after LT/ET; POD1); and Group 2 (80% bowel resection; POD7). Blood samples were obtained for measuring aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels. For assessing hepatocyte apoptosis, liver tissue samples from the median lobe were obtained and used for a terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick-end labeling assay. Aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels showed statistically significant differences among the five groups. Apoptotic hepatocyte counts there were statistically significant differences among groups for counts made in 20 consecutive high-power fields. However, liver sinusoidal cell apoptosis rates among groups showed statistically significant differences for counts made in 20 consecutive high-power fields, particularly on POD7 in rats undergoing massive bowel resection. Parenteral nutrition is not the only factor involved in liver dysfunction after massive bowel resection. Massive bowel resection alone can cause liver abnormalities. Rats undergoing massive small intestinal resection show significant temporal increases in liver sinusoidal cell apoptosis rates.

A Short Bowel (Small Intestine = 40 cm), No Ileocecal Valve, and Colonic Inertia Patient Works Well with Oral Intake Alone without Parenteral Nutrition.

We present a 50-year-old male who suffered from ischemic bowel disease, having undergone massive resection of small intestine and ileocecal valve. He had to cope with 40 cm proximal jejunum and 70 cm distal colon remaining. In the postoperative period parenteral nutrition (PN) was used immediately for nutrition support and electrolyte imbalance correction. We gave him home PN as regular recommendation for the short bowel status after discharge from hospital. This patient has tolerated regular oral intake 2 months later and did not develop significant short bowel syndrome. There were several episodes of venous access infection which troubled this patient and admitted him for treatment during home PN. Therefore, we changed home PN to cyclic tapering pattern. The patient could maintain his nutrition and hydration with oral intake alone after tapering home PN 15 months later. He has survived more than one year without PN support and still maintained 80% ideal body weight with average albumin of 3.5 ± 0.2 mg/dL. Although patient was hospitalized every two months to supplement nutrients, however, this has greatly improved the quality of life.

Intestinal lengthening in rats after massive small intestinal resection

Prior studies have demonstrated lengthening of normal small intestinal segments using mechanical expanders. The present study assesses the feasibility of intestinal lengthening in rats that have undergone extensive small intestinal resection. Female rats underwent small intestinal resection. After 6 weeks, the animals underwent the placement of a mechanical expander device with or without gradual mechanical lengthening. After 3 weeks, the intestinal segments were retrieved for analyses. Isolated intestinal segments without mechanical lengthening did not change in length, whereas isolated intestinal segments that were mechanically lengthened more than doubled their initial length. The total alkaline phosphatase activity was 2.4 mumol/min in the isolated intestinal segments and 4.9 mumol/min in the mechanically lengthened segments. The total lactase activity was 0.005 mumol/min in the isolated intestinal segments and 0.007 mumol/min in the mechanically lengthened segments. Smooth muscle thickness was 370 mum in the isolated intestinal segments and 530 mum in the mechanically lengthened segments. Mechanical small bowel lengthening was achieved in intestinal segments after extensive small intestinal resection. There was an increase in the total alkaline phosphatase activity and preservation of the total lactase activity. Mechanical lengthening may be a useful technique to increase intestinal length in patients with short bowel syndrome.

Peptide YY induces enterocyte proliferation in a rat model with total enteral nutrition after distal bowel resection

The main reason why enterocyte proliferative effects of peptide YY (PYY) have not been detected in rats undergoing massive small intestinal resection after feeding may have been the background activity of markedly increased endogenous PYY released from L cells in the distal gut in response to the intraluminal nutrients. The purpose of the present study was to evaluate the effects of PYY on enterocyte proliferation in a rat model of distal bowel resection (DBR) with total enteral nutrition (TEN). Male, adult Sprague-Dawley rats were assigned into three experimental groups: sham rats underwent bowel transection and reanastomosis, DBR rats underwent the resection of 40 cm distal small intestine and colon, and DBR-PYY rats underwent distal bowel resection as above, and were treated with PYY(1-36) from day 2 to day 14 postoperatively. During days 2-14 postoperatively, all animals received isocaloric TEN. At the endpoints, plasma PYY levels and parameters of enterocyte proliferation were determined. Compared with the sham group, DBR rats demonstrated a significant decrease in plasma PYY levels, and a significant increase in intestinal bowel and mucosal weight, mucosal DNA and protein content, villus height and crypt depth, and crypt cell proliferation index. Administration of PYY (DBR-PYY group) led to a significant increase in plasma PYY levels, intestinal bowel and mucosal weight, mucosal DNA and protein content, villus height and crypt depth, and crypt cell proliferation index in comparison with the DBR untreated group. We conclude that administration of PYY increases the plasma PYY levels, and PYY induces enterocyte proliferation with TEN after distal bowel resection.

Efficacy and Safety of Teduglutide in Parenteral Nutrition (PN)-Dependent SBS Subjects: Update of a Current Multinational Trial

Purpose: Massive small intestinal resection creates malnutrition, diarrhea, and dehydration as a consequence of reduced intestinal capacity to absorb nutrients, and this can lead to dependence on parenteral nutrition (PN) therapy. Unfortunately use of PN is also associated with serious complications, however, it is vital for many short bowel syndrome (SBS) patients. Teduglutide, an analog of glucagon-like peptide-2 (GLP-2), is being evaluated for safety, tolerability, and efficacy in reducing PN dependency in SBS patients. We present the design and baseline characteristics of this multinational trial. Methods: Eligibility criteria included: 18 years and older; SBS resulting from major intestinal resection; PN dependency for at least 12 months; PN required at least 3 times weekly; and preserved renal and hepatic function. Subjects then entered into an intensive stabilization period to optimize PN volume before being randomized to placebo or 0.05 or 0.1 mg/kg/day of teduglutide for a 24-week treatment, with follow-up 4 weeks post-treatment. Reduction in PN usage at 24 weeks of therapy was the primary endpoint, calculated as an ordered categorical response. Additional assessments included plasma citrulline, 72-hour balance studies, villous height, crypt depth, bone density, and quality of life. Results: A total of 139 subjects were screened and 84 randomized (37 male), with 13 withdrawing. Up to 71 patients are expected to complete the study. Forty percent of subjects were recruited from the US and Canada, 60% from the EU. Subjects developed SBS due to surgical resections for: CD (37%); vascular accidents (30%); trauma (11%); and volvulus (13%). Sixty seven percent of subjects had a colon in continuity and 35% had a stoma. The average remaining length of small bowel was 66 cm and 69 cm of colon. Of the 20% of subjects with a distal/terminal ileum, 53% had an ileocecal valve. The DSMB reviewed safety throughout the study and found no specific concerns. Conclusion: The target of randomizing at least 80 PN-dependent SBS patients in the teduglutide study was achieved, making this the largest clinical trial to evaluate a treatment to decrease PN requirements in SBS patients. The ability to reduce PN by enhancing enteral function, the therapeutic goal of teduglutide, has the potential to lead to improved quality of life in the SBS population.

P-136A Arginine effect on the absorption and motor functions of the residual ileum after massive small intestinal resection(Gastrointestinal 8, the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-136A Arginine effect on the absorption and motor functions of the residual ileum after massive small intestinal resection(Gastrointestinal 8, the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)

Retrograde electrical pacing of the small intestine--a new treatment for the short bowel syndrome?

Retrograde electrical pacing has been shown to increase absorption of sodium, glucose and water from a continuously perfused jejunal segment in dogs. Under similar circumstances, absorption of xylose, magnesium, calcium and chloride was also increased by pacing compared with before and after its use (P less than 0.005). Following massive distal small intestinal resection, dogs undergoing post-cibal retrograde pacing showed an increase in body weight (P less than 0.005) and a decrease in faecal fat (P less than 0.005) and nitrogen (P less than 0.01) losses during the test period, compared with similarly prepared dogs who did not undergo pacing. These results suggest that pot-cibal retrograde electrical pacing of the small intestine may have a place in the management of patients with the short bowel syndrome.

The outlook after massive resection of small intestine, with a report of two cases.

Journal Article The outlook after massive resection of small intestine, with a report of two cases Get access H S Trafford H S Trafford North Staffordshire Royal Infirmary, Stoke-on-Trent Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 44, Issue 183, July 1956, Pages 10–13, https://doi.org/10.1002/bjs.18004418304 Published: 06 December 2005

Practical Guide to Intestinal Rehabilitation for Postresection Intestinal Failure: A Case Study

After massive small-intestinal resection or combined small-intestinal and colonic resection, diarrhea with resulting dehydration, electrolyte abnormalities, and malnutrition occur. Many patients become dependent on IV fluids and nutrition. An adaptation process manifested clinically by decreased diarrhea and improved nutrient absorption according to decreased parenteral nutrition and fluid requirements has been noted to occur over time. In some patients, adaptation is inadequate and may require special techniques to enhance and augment this process. This is a case of a 52-year-old woman who experienced increased stoma output 1 week after major intestinal resection, resulting in dehydration. She required IV fluids in order to maintain hydration. After the initiation of an intestinal rehabilitation program, which included modified diet, soluble fiber, oral rehydration solution (ORS), and medications, IV fluids were successfully weaned off in 3 months. She continues not to receive IV fluids and continues to follow the intestinal rehabilitation plan.

Comparative Effects of Glucagon‐Like Peptide‐2 (GLP‐2), Growth Hormone (GH), and Keratinocyte Growth Factor (KGF) on Markers of Gut Adaptation After Massive Small Bowel Resection in Rats

Administration of specific growth factors exert gut-trophic effects in animal models of massive small bowel resection (SBR); however, little comparative data are available. Our aim was to compare effects of a human glucagon-like peptide-2 (GLP-2) analog, recombinant growth hormone (GH) and recombinant keratinocyte growth factor (KGF) on jejunal, ileal, and colonic growth and functional indices after 80% SBR in rats. Thirty-seven male rats underwent small bowel transection (sham operation) with s.c. saline administration (control; Tx-S; n = 7) or 80% midjejuno-ileal resection (Rx) and treatment with either s.c. saline (Rx-S, n = 7), GLP-2 at 0.2 mg/kg/d (Rx-GLP-2; n = 8), GH at 3.0 mg/kg/d (Rx-GH; n = 8), or KGF at 3.0 mg/kg/d (Rx-KGF; n = 7) for 7 days. All groups were pair-fed to intake of Rx-S rats. Gut mucosal cell growth indices (wet weight, DNA and protein content, villus height, crypt depth, and total mucosal height) were measured. Expression of the cytoprotective trefoil peptide TFF3 was determined by Western blot. Gut mucosal concentrations of the tripeptide glutathione (L-glutamyl-L-cysteinyl-glycine) and glutathione disulfide (GSSG) were measured by high-performance liquid chromatography and the glutathione/GSSG ratio calculated. SBR increased adaptive growth indices in jejunal, ileal, and colonic mucosa. GLP-2 treatment increased jejunal villus height and jejunal total mucosal height compared with effects of resection alone or resection with GH or KGF treatment. Both GH and KGF modestly increased colonic crypt depth after SBR. SBR did not affect small bowel or colonic goblet cell number or TFF3 expression; however, goblet cell number and TFF3 expression in both small bowel and colon were markedly up-regulated by KGF treatment and unaffected by GLP-2 and GH. SBR oxidized the ileal and colonic mucosal glutathione/GSSG redox pools. GLP-2 treatment after SBR increased the glutathione/GSSG ratio in jejunum, whereas KGF had an intermediate effect. In addition, GLP-2 (but not GH or KGF) prevented the SBR-induced oxidation of the glutathione/GSSG pools in both ileum and colon. GLP-2 exerts superior trophic effects on jejunal growth and also improves mucosal glutathione redox status throughout the bowel after massive SBR in rats. Both GH and KGF increase colonic mucosal growth in this model. KGF alone potently increases gut mucosal goblet cell number and expression of the cytoprotective trefoil peptide TFF3. The differential effects of GLP-2, GH and KGF administration in this model of short bowel syndrome suggest that individual therapy with these growth factors may not be an adequate strategy to maximally improve adaptive gut mucosal growth and cytoprotection after massive small intestinal resection. Future research should address the use of these agents in combination in short bowel syndrome.

Plasma GLP-2 Levels and Intestinal Markers in the Juvenile Pig During Intestinal Adaptation: Effects of Different Diet Regimens

Adaptation of the residual small bowel following resection is dependent on luminal and humoral factors. We aimed to establish if circulating levels of glucagon-like peptide (GLP-2) change under different dietary regimens following resection and to determine if there is a relationship between plasma GLP-2 levels and markers of intestinal adaptation. Four-week-old piglets underwent a 75% proximal small bowel resection (n = 31) or transection (n = 14). Postoperatively they received either pig chow (n = 14), nonpolymeric (elemental) infant formula (n = 7), or polymeric infant formula alone (n = 8) or supplemented either with fiber (n = 6) or with bovine colostrum protein concentrate (CPC; n = 10) for 8 weeks until sacrifice. Plasma GLP-2 levels were measured at weeks 0, 2, 4, and 8 postoperatively. In addition, end-stage parameters were studied at week 8 including weight gain, ileal villus height, crypt depth, and disaccharidase levels. Plasma GLP-2 levels were higher in resected animals compared to transected animals fed the same diet. Plasma GLP-2 levels were significantly increased in the colostrum protein isolate-supplemented animals following resection compared to all other diet groups. The increase in plasma GLP-2 (pM) was greatest in the first 2 weeks postresection (week 0, 15.5; week 2, 30.9), followed by a plateau at weeks 2 to 4 and a decrease in GLP-2 levels from week 4 to week 8. At week 8, no relationships were found between the plasma GLP-2 levels and the measurements of weight gain, villus height, lactase, sucrase, maltase, crypt depth, or villus/crypt ratio. Plasma GLP-2 levels increase in the first weeks following massive small intestinal resection. The increase in plasma GLP-2 levels was enhanced by supplementation of the diet with CPC. The changes in GLP-2 levels observed in this study may suggest that GLP-2 plays a role in the adaptive response in the intestine following resection in this preclinical model.

Enteral alanyl-glutamine supplement promotes intestinal adaptation in rats

Although parental administration of glutamine promotes intestinal adaptation, it is controversial whether enteral glutamine is effective after small bowel resection. To further evaluate the benefits of enteral supplementation, peptide and amino acid peptide transporter function must be considered. We evaluated the effect of enteral alanyl-glutamine based on the alteration of peptide and amino acid transporter expressions after massive small intestinal resection. Rats underwent 80% proximal intestinal resection. Expression of the glutaminase (GA), amino acid transporter B0 and peptide transporter PepT1 mRNA in the residual intestinal cells was initially examined by Northern blot analysis. Rats with a small bowel received a bolus supplement of glutamine (2.0 g/kg/day) + alanine (1.22 g/kg/day) mixture, alanyl-glutamine (2.972/kg/day) or saline for 3 days from one day before operation. On the 3rd postoperative day (POD) and the 7th POD, residual intestinal tissue was removed, and mucosal parameters were measured. The GA activity and GA mRNA significantly increased on the 1st POD. Although the levels of B0 mRNA gradually decreased, the PepT1 mRNA increased after surgery, and reached 150% of the initial level on the 5th POD. In the rats administered alanyl-glutamine, mucosal wet weight and protein content similarly increased with increasing villus height on the 7th POD. Enteral supplementation with alanyl-glutamine but not glutamine + alanine mixture promotes intestinal adaptation as evidenced by increased peptide transport after intestinal resection.

The role of growth hormone in adaptation to massive small intestinal resection in rats.

The residual small bowel undergoes profound adaptive alterations after surgical resection. GH is considered to have a role in regulation of these adaptive changes, but its precise role is unknown. We investigated the role of GH by studying the response to intestinal resection in rats with isolated GH deficiency. Spontaneous dwarf rats, a strain of rats with congenital isolated GH deficiency, underwent 60% resection of the small intestine and parameters of the response of the intestinal remnant were compared with age-matched GH-deficient rats undergoing transection, GH-normal rats undergoing 60% resection, and nonmanipulated GH-normal rats. Deficiency of GH did not inhibit hyperplasia of the mucosal mass of the intestinal remnant, indicating that GH is not required for regulation of this aspect of the adaptive response. However, GH deficiency resulted in lack of accumulation of mucosal protein, including lack of accumulation of digestive hydrolases. In addition, GH deficiency resulted in alterations in processing of digestive hydrolases of the distal intestine, indicating that GH may have region-specific effects on small intestinal function. We conclude that GH is required for the normal expression of specific components of the adaptive response to massive small intestinal resection, but not for all aspects. The aspects that require GH appear to involve protein synthesis and processing.

Effects of insulin-like growth factor-1 on massive resection of small intestine with or without ileocecal resection in rats

Effects of insulin-like growth factor-1 on massive resection of small intestine with or without ileocecal resection in rats

Growth hormone (GH) and glutamine (GLN) therapy in children with refractory short bowel syndrome (SBS) who underwent intestinal lenghening procedures (ILP)

INTRODUCTION: SBS in children is characterized by severe malabsorption following massive small intestinal resection. ILP has been performed in children who fail to wean from Parenteral Nutrition (PN). Although ILP is associated with increased intestinal tolerance, most patients remain PN-dependent. Intestinal absorption has improved in adults with refractory SBS utilizing GH and the gut-trophic amino acid GLN. Some adults have discontinued PN with this therapy. GH may act via insulin-like growth factorI(IGF-I) to stimulate morphologic and functional adaptation. GLN is the primary fuel for small intestinal cells and may become depleted in catabolic states. GLN supplementation attenuates PN-induced mucosal atrophy in rats. PURPOSE: This feasibility study assessed whether the combination of GH and GLN modifies nutrient absorption in children who underwent intestinal resections in infancy followed by ILP. PATIENTS AND METHODS: Pt#1 was an 8yo with SBS secondary to gastroschisis and volvulus. He had 30 cm of residual duodenum following ILP. He required PN daily for normal growth despite gastrostomy-tube feedings of 1440 calories/day. Pt#2 was a 7 yo who had SBS secondary to multiple atresias. She had ajejuno-ileal segment of 80 cm. following ILP. She had been PN-dependent, but the central line was removed following an episode of candidal sepsis 4 months prior to enrollment. G-tube was placed for enteral feedings. Baseline absorption studies were obtained at entry. Children were then treated with GH (0.1 mg/kg/day sc) and GLN (0.5 gm/kg/day enterally) for 3 months. Enteral feedings were not modified. Absorption studies were repeated at 1 and 3 months after initiating therapy. Laboratory evaluation included fat and protein absorption, and plasma IGF-I levels. Body composition was measured by DEXA. RESULTS: The percent of fat absorption was 90% in Pt#1 and 80% in Pt#2 prior to treatment. This decreased to 78% in Pt#1 and was maintained at 84% in Pt#2 following treatment. The percent of intestinal nitrogen absorption did not improve in Pt #1 whereas Pt#2 demonstrated a gradual improvement during the treatment period (0-time=34%, I-month=45%, and 3-months=49%). Treatment resulted in an increase in proportion of lean body mass from 70 to 86% in pt#1 and 92 to 94% in pt#2. Additionally, serum IGF-I levels increased 3-fold in pt#1 and 10-fold in pt#2. CONCLUSION: Combined GH and GLN treatment was well tolerated in children with SBS. Variable effects on gut nutrient absorption and body composition may be a function of the length and type of residual bowel and/or IGF-I response to treatment. Further studies using this treatment in children are suggested. This research was funded by Genentech Foundation for Growth and Development, Charlottesville, VA.

Gut adaptation and the insulin-like growth factor system: regulation by glutamine and IGF-I administration.

Intestinal adaptation after extensive small bowel resection in rats is augmented by the provision of diets supplemented with the amino acid glutamine (Gln) or by administration of insulin-like growth factor-I (IGF-I). The goal of this study was to investigate potential synergistic effects of Gln and IGF-I on postresection ileal hyperplasia. Rats underwent 80% small bowel resection (SBR) and then were fed low-Gln or L-Gln-enriched diets and subcutaneously given recombinant human IGF-I or vehicle for 7 days. Gln and IGF-I each significantly enhanced adaptive ileal hyperplasia (DNA content) compared with rats receiving vehicle and low-Gln diet. Ileal DNA content was highest when IGF-I was administered together with Gln supplementation. Combined IGF-I plus Gln synergistically increased ileal weight and protein content. This was associated with higher plasma concentrations of IGF-I and Gln than observed when IGF-I or Gln was given individually. Ileal IGF-I mRNA expression rose nearly twofold during gut adaptation after SBR; this response was augmented with IGF-I administration but was unaltered by Gln feeding. In contrast, dietary Gln, but not IGF-I therapy, prevented a decrease in hepatic IGF-I mRNA induced by SBR. We conclude that parenteral IGF-I and enteral Gln have both individual and synergistic effects on ileal adaptation after massive small intestinal resection. These findings support the concept that specific gut-trophic nutrients and growth factors may be combined to enhance intestinal adaptation and possibly reduce the severity of short bowel syndrome after intestinal resection.

Effect of Glutamine-Supplemented Elemental Diet on Mucosal Adaptation following Bowel Resection in Rats

Glutamine is the major fuel for enterocytes and prevents mucosal atrophy in certain animal models. Previous studies in our laboratory have failed to show a trophic effect of glutamine on the small-bowel mucosa following massive resection when added to a chow diet. However, the complexity of the chow diet might potentially interfere with the adequate evaluation of the trophic effect of a single agent such as glutamine. This study was therefore designed to determine whether the addition of glutamine to an elemental diet would augment mucosal adaptation following massive small intestinal resection in a rat model. Male Sprague-Dawley rats were divided into two dietary groups, one receiving an amino acid-based pediatric elemental diet supplemented with 2% glutamine, and the other receiving the diet supplemented with 2% glucose. One half of the animals in each dietary group received 80% jejunoileal resection, and the remainder were sham operated. Fifteen days postsurgery, mucosal weight, DNA, protein, and sucrase activities were determined in both the proximal and the distal small intestine. While both groups of resected animals developed marked increases in all parameters of adaptation, the glutamine-supplemented group did not differ from the control diet group in any parameter. The addition of glutamine to an elemental diet had no enhancing effect on intestinal adaptation after bowel resection. These results are similar to those previously observed in our laboratory when glutamine was added to chow diet. The addition of glutamine to an elemental diet cannot be justified on the basis of its trophic effect in animals.

Effect of Glutamine‐Supplemented Elemental Diet on Mucosal Adaptation following Bowel Resection in Rats

Summary: Glutamine is the major fuel for enterocytes and prevents mucosal atrophy in certain animal models. Previous studies in our laboratory have failed to show a trophic effect of glutamine on the small‐bowel mucosa following massive resection when added to a chow diet. However, the complexity of the chow diet might potentially interfere with the adequate evaluation of the trophic effect of a single agent such as glutamine. This study was therefore designed to determine whether the addition of glutamine to an elemental diet would augment mucosal adaptation following massive small intestinal resection in a rat model. Male Sprague‐Dawley rats were divided into two dietary groups, one receiving an amino acid‐based pediatric elemental diet supplemented with 2% glutamine, and the other receiving the diet supplemented with 2% glucose. One half of the animals in each dietary group received 80% jejunoileal resection, and the remainder were sham operated. Fifteen days postsurgery, mucosal weight, DNA, protein, and sucrase activities were determined in both the proximal and the distal small intestine. While both groups of resected animals developed marked increases in all parameters of adaptation, the glutamine‐supplemented group did not differ from the control diet group in any parameter. The addition of glutamine to an elemental diet had no enhancing effect on intestinal adaptation after bowel resection. These results are similar to those previously observed in our laboratory when glutamine was added to chow diet. The addition of glutamine to an elemental diet cannot be justified on the basis of its trophic effect in animals.