Published online Feb 15, 2001. doi: 10.3748/wjg.v7.i1.66
Revised: November 13, 2000
Accepted: November 20, 2000
Published online: February 15, 2001
AIM: To investigate the individual and the combined effects of glutamine, dietary fiber, and growth hormone on the structural adaptation of the remnant small bowel.
METHODS: Forty-two adult male Sprague-Dawley rats underwent 85% mid-small bowel resection and received total parenteral nutrition (TPN) support during the first three postoperational days. From the 4th postoperational day, animals were randomly assigned to receive 7 different treatments for 8 d: TPNcon group, receiving TPN and enteral 20 g·L-1 glycine perfusion; TPN + Gln group, receiving TPN and enteral 20 g·L-1 glutamine perfusion; ENcon group, receiving enteral nutrition (EN) fortified with 20 g·L-1 glycine; EN + Gln group, enteral nutrition fortified with 20 g·L-1 glutamine; EN + Fib group, enteral nutrition and 2 g·L-1 oral soybean fiber; EN + GH group, enteral nutrition and subcutaneous growth hormone (GH) (0.3IU) injection twice daily; and ENint group, glutamine-enriched EN, oral soybean fiber, and subcutaneous GH injection.
RESULTS: Enteral glutamine perfusion during TPN increased the small intestinal villus height (jejunal villus height 250 µm ± 29 µm in TPNcon vs 330 µm ± 54 µm in TPN + Gln, ileal villus height 260 µm ± 28 µm in TPNcon vs 330 µm ± 22 µm in TPN + Gln, P < 0.05) and mucosa thickness (jejunal mucosa thickness 360 µm ± 32 µm in TPNcon vs 460 µm ± 65 µm in TPN +Gln, ileal mucosa thickness 400 µm ± 25 µm in TPNcon vs 490 µm ± 11 µm in TPN + Gln, P < 0.05) in comparison with the TPNcon group. Either fiber supplementation or GH administration improved body mass gain (end body weight 270 g ± 3.6 g in EN + Fib, 265.7 g ± 3.3 g in EN + GH, vs 257 g ± 3.3 g in ENcon, P < 0.05), elevated plasma insulin-like growth factor (IGF-I) level (880 µg·L-1± 52 µg·L-1 in EN + Fib, 1200 µg·L-1± 96 µg·L-1 in EN ± GH, vs 620 µg·L-1± 43 µg·L-1 in ENcon, P < 0.05), and increased the villus height (jejunum 560 µm ± 44 µm in EN ± Fib, 530 µm ± 30 µm in EN ± GH, vs 450 µm ± 44 µm in ENcon, ileum 400 µm ± 30 µm in EN + Fib, 380 µm ± 49 µm in EN ± GH, vs 320 µm ± 16 µm in ENcon, P < 0.05) and the mucosa thickness (jejunum 740 µm ± 66 µm in EN ± Fib, 705 µm ± 27 µm in ENGH, vs 608 µm ± 58 µm in ENcon, ileum 570 µm ± 27 µm in EN ± Fib, 560 µm ± 56 µm in EN ± GH, vs 480 µm ± 40 µm in ENcon, P < 0.05) in remnant jejunum and ileum. Glutamine-enriched EN produced little effect in body mass, plasma IGF-I level, and remnant small bowel mucosal structure. The ENint group had greater body mass (280 g ± 2.2 g), plasma IGF-I level (1450 µg·L-1± 137 µg·L-1), and villus height (jejunum 620 µm ± 56 µm, ileum 450 µm ± 31 µm) and mucosal thickness (jejunum 800 µm ± 52 µm, ileum 633 µm ± 33 µm) than those in ENcon, EN + Gln (jejunum villus height and mucosa thickness 450 µm ± 47 µm and 610 µm ± 63 µm, ileum villus height and mucosa thickness 330 µm ± 39 µm and 500 µm ± 52 µm), EN + GH groups (P < 0.05), and than those in EN + Fib group although no statistical significance was attained.
CONCLUSION: Both dietary fiber and GH when used separately can enhance the postresectional small bowel structural adaptation. Simultaneous use of these two gut-trophic factors can produce synergistic effects on small bowel structural adaptation. Enteral glutamine perfusion is beneficial in preserving small bowel mucosal structure during TPN, but has little beneficial effect during EN.