Effects of Hyperosmolar Agents – Lactulose, Lactitol, Sodium Phosphate and Polyethylene Glycol – on Cecal Coliform Bacteria during Traditional Bowel Cleansing: An Experimental Study in Rats

Abstract

Mechanical bowel cleansing is considered to be necessary prior to colorectal surgery, some radiological or endoscopic procedures, and for fecal disimpaction. Traditional bowel cleansing (TBC) with cathartics and enemas is a method of mechanical bowel cleansing for patients who have restrictive factors for whole-bowel irrigation (WBI), such as excessive fecal impaction, cardiac, hepatic or renal disorders. In this experimental study, TBC with hyperosmolar agents was evaluated in terms of their effects on colonic flora and bacterial translocation (BT). Sprague-Dawley rats were divided into 6 groups. The animals, except controls, were not fed for 72 h but received tap water ad libitum. During this period, lactulose, lactitol, sodium phosphate (NaP), polyethylene glycol 3350 (PEG3350) and physiological saline gavages were administered to the rats in groups 1–5, respectively, once a day. All animals except controls (group 6) received enemas with 15 ml of warm saline twice a day. The cecum, mesenteric lymph nodes (MLNs) and portal vein blood were sampled for microbiological and histopathological analysis. The highest level of coliform bacterial overgrowth and BT to MLNs were observed in the lactulose group, although the others, except the saline and control groups, also caused some degree of BT. Portal vein cultures were negative for all groups. Histopathological damage was not associated with cecal bacterial count and BT. As a result of this study, PEG3350 seems to be safer and more effective than lactulose, lactitol and NaP during TBC.

Pediatric Intestinal Failure: Nutrition, Pharmacologic, and Surgical Approaches

“…Periodic flushes with oral polyethylene glycol electrolyte solutions or other cathartics have been used. 40 Probiotics, such as Lactobacillus rhamnosus GG, have been used, although additional studies are needed. 41,42…”

Effect of whole gut irrigation solutions on gastrointestinal smooth muscle activity

“…These studies evaluated not only the efficacy of solutions but also their choleretic effect with the alterations in gastrointestinal histopathologic condition and flora [3,10,11]. Although Condon et al [4] suggested that WGI in large solution volumes initiates gastrocolic reflex and causes colonic contractions, the information about the effect of WGI solutions on gastrointestinal motility is limited.…”

Perbandingan Gambaran Histopatologi Mukosa Kolon Tikus Putih (Rattus Norvegicus) Galur Wistar setelah Dilakukan Washout antara yang Menggunakan Nacl 0,9% dan Larutan Garam Meja 1%

“…Hal ini menyebabkan berbagai tingkat perubahan histologi saluran gastrointestinal seperti kongesti ede a dan in a asi aringan. 12,13 Jaringan yang engala i ongesti ede a dan in a asi e pu nyai efek yang merugikan pada penyembuhan anastomosis. Oleh karena itu, metode persiapan usus yang digunakan haruslah efektif dan tidak menyebabkan ede a aringan ongesti dan in a asi.…”

“…11 Namun Demirogullari dkk mendapatkan perubahan histopatologi yang ringan pada kelompok NaCl 0,9% dan secara statistik tidak ada perbedaan yang signifikan dengan kelompok kontrol. 13 Soyer dkk dalam penelitiannya tidak mendapatkan perbedaan yang signifikan antara beberapa jenis cairan yang digunakan sebagai irigasi usus dalam hal jumlah dan durasi. 2…”