Intestinal adaptation following gut resection

Česká verzia

Authors: Jarmila Křížová; Pavel Trachta; Eva Kotrlíková
Authors place of work: III. interní klinika 1. LF UK a VFN v Praze
Published in the journal: Vnitř Lék 2017; 63(10): 703-706
Category: Reviews

Summary

Gut resection is followed by wide changes in the gastrointestinal tract. The goal is to increase nutrient, water and mineral absorption in the remnant intestine. These changes are going on for several months. They affect gut mucosa structure, intestine peristaltic activity and enterocytes function. The crucial role is ileum preserving. Ileum has higher adaptation ability comparing to jejunum and inhibits peristaltic function of proximal parts of GIT. A lot of factors involved in intestinal adaptation were identified, hormones, growth factors, regulating peptides, intracellular signalizing cascades, cytokines and tissue factors. The most important seems to be GLP2 (glucagon like peptide 2) which has positive trophic influence on gut mucosa. Early enteral nutrition after gut resection enhances its adaptation. Recombinant analogueGLP2 teduglutide was introduced to be used in the short bowel syndrome treatment. It inhibits stomach evacuation and hypersecretion, increases intestine perfusion and enhances intestinal adaptation. Its long-term application accelerates the parenteral nutrition weaning.

Key words:
enteral nutrition – enterocytes – GLP2 – gut resection – intestinal adaptation

Zdroje

1. Jeppesen PB. Gut hormones in the treatment of short-bowel syndrome and intestinal failure. Curr Opin Endocrinol Diabetes Obes 2015; 22(1): 14–20. Dostupné z DOI: <http://dx.doi.org/10.1097/MED.0000000000000120>.

2. Tappenden KA. Intestinal adaptation following resection. JPEN J Parenter Enteral Nutr 2014; 38(1 Suppl): S23-S31. Dostupné z DOI: <http://dx.doi.org/10.1177/0148607114525210>.

3. Seetharam P, Rodrigues G. Short bowel syndrome: a review of management options. Saudi J Gastroenterol 2011; 17(4): 229–235. Dostupné z DOI: <http://dx.doi.org/10.4103/1319–3767.82573>.

4. Fjermestad H, Hvistendahl M, Jeppesen PB. Fasting and Postprandial Plasma Citrulline and the Correlation to Intestinal Function Evaluated by 72-Hour Metabolic Balance Studies in Short Bowel Jejunostomy Patients With Intestinal Failure. JPEN J Parenter Enteral Nutr 2017: 148607116687497. Dostupné z DOI: <http://dx.doi.org/10.1177/0148607116687497>.

5. Dekaney CM, Fong JJ, Rigby RJ et al. Expansion of intestinal stem cells associated with long-term adaptation following ileocecal resection in mice. Am J Physiol Gastrointest Liver Physiol 2007; 293(5): G1013-G1022.

6. Helmrath MA, Fong JJ, Dekaney CM et al. Rapid expansion of intestinal secretory lineages following a massive small bowel resection in mice. Am J Physiol Gastrointest Liver Physiol 2007; 292(1): G215-G222.

7. Tang Y, Swartz-Basile DA, Swietlicki EA et al. Bax is required for resection-induced changes in apoptosis, proliferation, and members of the extrinsic cell death pathways. Gastroenterology 2004; 126(1): 220–230.

8. Uchiyama M, Iwafuchi M, Matsuda Y et al. Intestinal motility after massive small bowel resection in conscious canines: comparison of acute and chronic phases. J Pediatr Gastroenterol Nutr 1996; 23(3): 217–223.

9. O‘Connor TP, Lam MM, Diamond J. Magnitude of functional adaptation after intestinal resection. Am J Physiol 1999; 276(5 Pt 2): R1265-R1275.

10. Musch MW, Bookstein C, Rocha F et al. Region-specific adaptation of apical Na/H exchangers after extensive proximal small bowel resection. Am J Physiol Gastrointest Liver Physiol 2002; 283(4): G975-G985.

11. Rubin DC, Levin MS. Mechanisms of intestinal adaptation. Best Pract Res Clin Gastroenterol 2016; 30(2): 237–248. Dostupné z DOI: <http://dx.doi.org/10.1016/j.bpg.2016.03.007>.

12. Gillard L, Billiauws L, Stan-Iuga B et al. Enhanced Ghrelin Levels and Hypothalamic Orexigenic AgRP and NPY Neuropeptide Expression in Models of Jejuno-Colonic Short Bowel Syndrome. Sci Rep 2016; 6: 28345. Dostupné z DOI: <http://dx.doi.org/10.1038/srep28345>.

13. DiBaise JK, Young RJ, Vanderhoof JA. Intestinal rehabilitation and short bowel syndrome: Part 2. Am J Gastroenterol 2004; 99(9): 1823–1832.

14. Nightingale JM, Kamm MA, van der Sijp JR et al. Disturbed gastric emptying in the short bowel syndrome. Evidence for a ‚colonic brake‘. Gut 1993; 34(9): 1171–1176.

15. Fuller PJ, Beveridge DJ, Taylor RG. Ileal proglucagon gene expression in the rat: characterization in intestinal adaptation using in situ hybridization. Gastroenterology 1993; 104(2): 459–466.

16. Dowling RH. Polyamines in intestinal adaptation and disease. Digestion 1990; 46(Suppl 2): S331-S344.

17. Bjerknes M, Cheng H. Modulation of specific intestinal epithelial progenitors by enteric neurons. Proc Natl Acad Sci USA 2001; 98(22): 12497–12502.

18. Gianino S, Grider JR, Cresswell J et al. GDNF availability determines enteric neuron number by controlling precursor proliferation. Development 2003; 130(10): 2187–2198.

19. Drucker DJ, Ehrlich P, Asa SL et al. Induction of intestinal epithelial proliferation by glucagon-like peptide 2. Proc Natl Acad Sci USA 1996; 93(15): 7911–7916.

20. Madsen KB, Askov-Hansen C, Naimi RM et al. Acute effects of continuous infusions of glucagon-like peptide (GLP)-1, GLP-2 and the combination (GLP-1+GLP-2) on intestinal absorption in short bowel syndrome (SBS) patients. A placebo-controlled study. Regul Pept 2013; 184: 30–39. Dostupné z DOI: <http://dx.doi.org/10.1016/j.regpep.2013.03.025>.

21. Rowland KJ, McMellen ME, Wakeman D et al. Enterocyte expression of epidermal growth factor receptor is not required for intestinal adaptation in response to massive small bowel resection. J Pediatr Surg 2012; 47(9): 1748–1753. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jpedsurg.2012.03.089>.

22. Choi P, Guo J, Erwin CR et al. IGF-2 mediates intestinal mucosal hyperplasia in retinoblastoma protein (Rb)-deficient mice. J Pediatr Surg 2013; 48(6): 1340–1347. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jpedsurg.2013.03.042>.

23. Garcia SB, Kawasaky MC, Silva JC et al. Intrinsic myenteric denervation: a new model to increase the intestinal absorptive surface in short-bowel syndrome. J Surg Res 1999; 85(2): 200–203.

24. Wefer H, Nystrom N, Finkel Y et al. Intestinal dysbiosis in children with short bowel syndrome is associated with impaired outcome. Microbiome 2015; 3: 18. Dostupné z DOI: <http://dx.doi.org/10.1186/s40168–015–0084–7>.

25. Till H, Castellani C, Moissl-Eichinger C et al. Disruptions of the intestinal microbiome in necrotizing enterocolitis, short bowel syndrome, and Hirschsprung‘s associated enterocolitis. Front Microbiol 2015; 6: 1154. Dostupné z DOI: <http://dx.doi.org/10.3389/fmicb.2015.01154>.

26. Lapthorne S, Pereira-Fantini PM, Fouhy F et al. Gut microbial diversity is reduced and is associated with colonic inflammation in a piglet model of short bowel syndrome. Gut Microbes 2013; 4(3): 212–221. Dostupné z DOI: <http://dx.doi.org/10.4161/gmic.24372>.

27. Wales PW, Nasr A, de Silva N et al. Human growth hormone and glutamine for patients with short bowel syndrome. Cochrane Database Syst Rev 2010; (6): CD006321. Dostupné z DOI: <http://dx.doi.org/10.1002/14651858.CD006321.pub2>.

28. Pironi L, Arends J, Bozzetti F et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr 2016; 35(2): 247–307. Dostupné z DOI: <http://dx.doi.org/10.1016/j.clnu.2016.01.020>.