[Changes in intestinal motility after massive small bowel resection with a reversed jejunal segment]

Restoring gut physiology in short bowel patients: from bench to clinical application of autologous intestinal reconstructive procedures

Introduction: Short bowel syndrome represents the leading etiology that causes intestinal failure both in children and adults. Total parenteral nutrition support has dramatically improved the prognosis for these patients but, if related irreversible complications occur, the alternative is represented by surgery and/or transplantation. Areas covered: Autologous gastrointestinal reconstructive procedures are a feasible, alternative approach with good long-term outcome data inexperienced surgical centers. Expert opinion: Ongoing innovative efforts have driven the surgical options for successful autologous reconstructive surgery: bowel elongation/tapering techniques (LILT, STEP, and the new SILT) together with the 'reversed bowel segment' procedure are now recognized procedures and all must be tailored to the individual patient needs to obtain the optimal result in terms of enteral autonomy. Background laboratory experimentation with new procedures e.g. options for bowel dilation techniques and distraction-induced enterogenesis, may provide additional management and treatment modalities.

Oral antibiotics attenuate bowel segment reversal-induced systemic inflammatory response and body weight loss in massively bowel-resected rats

BACKGROUND

Using a massively bowel-resected rat model, our previous study demonstrated that small bowel segment reversal stimulates jejunal hyperplasia but may also increase the possibility of bacterial translocation and the elevation of circulating white blood cells and serum interleukin-6 that may reduce the whole-body anabolism. The aim of this study is to investigate whether oral antibiotics might attenuate the inflammatory responses and might therefore facilitate the beneficial effects of bowel segment reversal.

METHODS

Male Wistar rats (approximately 270 g) underwent a 70% small bowel resection with (REV group) or without (CON group) a 3-cm small bowel segment reversal, or underwent a sham operation (SHAM group). After surgeries, half of the animals in the REV group were given oral clindamycin plus amoxicillin (50 plus 50 mg/kg/d, ANT group) for 3 weeks.

RESULTS

Oral antibiotics administration significantly attenuated the decreases in feeding efficiency (g of body weight/100 kcal diet) and increases in the circulation of white blood cells, serum nitric oxide, and interleukin-6 (1-way ANOVA, p < .05), which are associated with bowel segment reversal. In addition, antibiotics significantly increased serum concentrations of insulin-like growth factor-I, significantly decreased the total numbers of bacteria in the intestine, and tended to reduce the extent of jejunal hyperplasia in rats with bowel segment reversal.

CONCLUSIONS

Our results suggest that oral antibiotics may be used as an adjuvant to attenuate the inflammatory responses and to enhance the anabolic responses in massively bowel-resected patients with bowel segment reversal.

Small bowel segment reversal induces intestinal hyperplasia but reduces whole-body growth in massive bowel resected rats

BACKGROUND

Surgical reversal of a small bowel segment has been proposed as a means to improve nutritional status in individuals with extensive bowel resection. However, clinical experience remains controversial. The aim of this study was to determine the effects of bowel segment reversal on intestinal adaptation and whole-body anabolism.

METHODS

Male Wistar rats underwent a 70% small bowel resection with (REV) or without (CON) reversal of a 5-cm small bowel segment (5 cm distal to resected segment), or sham-operation (SHAM). After surgery (day 0), rats were fed with powdered diet from day 2 to day 12. Body weight, nitrogen balance, carcass compositions, and serum concentrations of albumin and insulin-like growth factor (IGF)-1 were determined to assess whole-body anabolism. The composition and architecture of the small intestine were measured to assess the intestinal growth response. Serum concentrations of tumor-necrosis factor (TNF)-alpha and interleukin (IL)-6 were measured to assess the response of postoperative cytokines.

RESULTS

Surgical reversal significantly increased the intestinal protein and DNA contents in the proximal segment compared with surgical resection. REV rats had a significantly slower rate of weight gain and lower serum levels of albumin and IGF-1, and had significantly greater levels of circulating white blood cells, blood urea nitrogen, and IL-6 compared with CON and SHAM rats. There were no significant differences in serum concentrations of TNF-alpha and carcass percentages of water, protein, and fat among groups.

CONCLUSIONS

Small bowel segment reversal stimulates jejunal hyperplasia but the surgical reversal induced-elevation in serum IL-6 may eliminate the whole-body anabolism in massive bowel-resected rats.