Tsikis, Savas T.;
Fligor, Scott C.;
Hirsch, Thomas I.;
Mitchell, Paul D.;
Pan, Amy;
Moskowitzova, Kamila;
Whitlock, Ashlyn E.;
Loring, Greta;
First, Eric;
Nedder, Arthur;
Gura, Kathleen M.;
Puder, Mark
A Digestive Cartridge Reduces Parenteral Nutrition Dependence and Increases Bowel Growth in a Piglet Short Bowel Model
Beschreibung:
<jats:sec>
<jats:title>Objective:</jats:title>
<jats:p>To determine whether the use of an immobilized lipase cartridge (ILC) to hydrolyze fats in enteral nutrition (EN) reduces parenteral nutrition (PN) dependence in a porcine model of short bowel syndrome with intestinal failure (SBS-IF).</jats:p>
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<jats:sec>
<jats:title>Background:</jats:title>
<jats:p>SBS-IF occurs after intestinal loss resulting in malabsorption and PN dependence. Limited therapeutic options are available for achieving enteral autonomy.</jats:p>
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<jats:sec>
<jats:title>Methods:</jats:title>
<jats:p>Eleven Yorkshire piglets underwent 75% jejunoileal resection and were randomized into control (n=6) and treatment (n = 5) groups. PN was initiated postoperatively and reduced as EN advanced if predefined clinical criteria were fulfilled. Animals were studied for 14 days and changes in PN/EN calories were assessed. Intestinal adaptation, absorption, and nutrition were evaluated at the end of the study (day 15). Comparisons between groups were performed using analysis of covariance adjusted for baseline.</jats:p>
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<jats:title>Results:</jats:title>
<jats:p>ILC animals demonstrated a 19% greater reduction in PN calories (<jats:italic toggle="yes">P</jats:italic> < 0.0001) and higher mean EN advancement (66% vs 47% of total calories, <jats:italic toggle="yes">P</jats:italic> < 0.0001) during the 14-day experiment. Treatment animals had increased intestinal length (19.5 vs 0.7%, <jats:italic toggle="yes">P</jats:italic>=0.03) and 1.9-fold higher crypt cell proliferation (<jats:italic toggle="yes">P</jats:italic>=0.02) compared with controls. By day 15, ILC treatment resulted in higher plasma concentrations of glucagon-like peptide-2 (<jats:italic toggle="yes">P</jats:italic> = 0.02), eicosapentaenoic acid (<jats:italic toggle="yes">P</jats:italic> < 0.0001), docosahexaenoic acid (<jats:italic toggle="yes">P</jats:italic> = 0.004), vitamin <jats:italic toggle="yes">A</jats:italic> (<jats:italic toggle="yes">P</jats:italic> = 0.02), low-density lipoprotein (<jats:italic toggle="yes">P</jats:italic> = 0.02), and high-density lipoprotein (<jats:italic toggle="yes">P</jats:italic> = 0.04). There were no differences in liver enzymes or total bilirubin between the two groups.</jats:p>
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<jats:title>Conclusions:</jats:title>
<jats:p>ILC use in conjunction with enteral feeding reduced PN dependence, improved nutrient absorption, and increased bowel growth in a porcine SBS-IF model. These results support a potential role for the ILC in clinical SBS-IF.</jats:p>
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