Effect of early intrajejunal nutrition on pancreatic pathological features and gut barrier function in dogs with acute pancreatitis

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2002-12, Vol.21 (6), p.469-473
• Main Authors: QIN, H.-L., SU, Z.-D., HU, L.-G., DING, Z.-X., LIN, Q.-TI
• Format: Article
• Language: English
• Subjects: Acute Disease; acute pancreatitis pathological features; Amylases - blood; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; bacterial translocation; Bacterial Translocation - physiology; Biological and medical sciences; Blood Glucose - analysis; Calcium - blood; Colon - microbiology; Colon - pathology; Disease Models, Animal; DNA - metabolism; Dogs; early intrajejunal nutrition; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Endotoxins - blood; Enteral Nutrition - methods; Gastroenterology. Liver. Pancreas. Abdomen; Ileum - microbiology; Ileum - pathology; Intensive care medicine; Jejunostomy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Other diseases. Semiology; Pancreas - pathology; Pancreatitis - microbiology; Pancreatitis - pathology; Pancreatitis - therapy; parenteral nutrition; Parenteral Nutrition, Total; Random Allocation; Safety; Treatment Outcome
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1054/clnu.2002.0574

Background: In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Traditionally, it was believed that early intrajejunal nutrition (EIN) in severe acute pancreatitis (SAP) may exacerbate the clinical pathological features, lead to recurrence of symptoms and delay complications. Objective: To compare the effect of EIN vs TPN on the pancreatic pathological features and gut barrier function in dogs with acute pancreatitis (AP). Methods: Fifteen dogs (surviving over 7 days, the death rate being 32%, 7/22) were divided into parenteral nutrition (PN) group ( n=7) and EIN group ( n=8). SAP model was induced by injecting 1 ml/kg of combined solution of 2.5% sodium taurocholate and 8000–10,000 BAEE units trypsin/ml into the pancreas via the pancreatic duct. Nutrients were delivered to the EIN group by catheter via a jejunostomy feeding 24 h postoperatively. The two groups were isocaloric and isonitrogenous. Systemic blood samples were obtained before and 1, 4, 7 d following AP, and cultured by aerobic as well as anaerobic bacterial growth. Systemic plasma and portal vein endotoxin levels were quantified by the chromogenic limulus amebocyte lysate (LAL) technique. Portal vein blood and specimens of tissue from mesenteriolum and mesocolon lymph nodes, lung, pulmonary portal lymph nodes and pancreas were adopted before the experiment was finished. Aliquots of the homogenata were cultured as blood mentioned above. Serum glucose, calcium, amylase and lysosomal enzymes were determined. All dogs were injected with 50 μCi 125I-BSA 4 h at the 7th day before being sacrificed. The 125I-BSA indexes of the pancreas/muscle and pancreas/blood were measured, and pancreatitic pathological scores (PPSs) of the different partial pancreas were observed. The content of mucosa protein, DNA and the villi, the thickness of mucosa and the whole bowel wall of the ileum and transverse colon were measured. Results: The study showed that serum glucose in the PN group was higher than in the EIN group after SAP 3 d; the levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and systemic blood and distant organ reduced significantly in the EIN group P0.05; the 125I-BSA index of pancreas