Glutamine Decreases the Duration of Postoperative Ileus After Abdominal Surgery: An Experimental Study of Conscious Dogs

Abstract

Postoperative ileus (POI) is a transient bowel dysmotility that occurs following many types of operations and is one of the most common complications of gastrointestinal surgery. We hypothesized that enteral supplementation of glutamine after abdominal surgery would restore fuel to the small intestine, suppress oxidative stress, and lead to improvement in POI. Twelve dogs underwent distal gastrectomy and were each randomly assigned to one of two groups based on postoperative treatment: the water injection (control) group and the glutamine injection group. Water (40 ml) or L(+)-glutamine (1 g/40 ml water) was injected into the residual stomach through the gastric tube every 12 h after surgery for 7 days. Changes in the plasma and intestinal intracellular concentration of glutamine and in gastrointestinal motility were measured. The plasma and intracellular glutamine levels decreased after the operation in both groups, although the decreased intracellular glutamine levels were not significantly different than preoperative levels. The glutamine group showed a significantly smaller decrease of the plasma glutamine level compared with the control group (P < 0.05). All the dogs showed gastrointestinal dysmotility after the operation. The mean length of time between the operation and the appearance of interdigestive migrating contractions in the glutamine group was significantly shorter than in the control group (22.4 +/- 3.1 h versus 37.8 +/- 4.0 h, respectively; P < 0.05). In conclusion, glutamine could act as a motility-recovery agent after abdominal surgery and thereby decrease the duration of POI.

Effects of Glutamine on Gastrointestinal Motor Activity in Patients following Gastric Surgery

“…Furthermore, we first reported the effect of glutamine on gastrointestinal motor activity after gastrectomy in humans. The present study shows that plasma glutamine levels decrease after surgery, a finding that is in agreement with previous reports [11,13]. The glutamine group in this study showed a smaller decrease in mean plasma glutamine level and higher gastrointestinal motor activity after gastrectomy than the control group.…”

“…Gut glutamine requirements are increased during critical illness; a number of studies suggest that glutamine may be essential for the maintenance of gut metabolism, structure, and function [4,6]. We previously reported that glutamine improved gastrointestinal motor activity after gastrectomy and decreased the duration of postoperative ileus in the dog [11].…”

Preoperative short-term parenteral administration of polyunsaturated fatty acids ameliorates intestinal inflammation and postoperative ileus in rodents

“…Critically ill patients were shown to profit from systemic antioxidants [44], and some studies suggest a detrimental role for oxidative stress in intestinal postoperative or septic intestinal dysfunction [37,45,46]. However, the results within our ex vivo endotoxemia model demonstrate that the antiinflammatory effect of Omegaven occurs also in the absence of vitamin E during the inflammatory stimulus.…”

Postoperative parenteral glutamine supplementation improves the short-term outcomes in patients undergoing colorectal cancer surgery: A propensity score matching study

“…Glutamine supplementation has been shown to prevent chemotherapy-induced diarrhea ( 23 ). Using animal experiments with dogs, Ohno et al reported that glutamine improved intestinal obstruction after abdominal surgery ( 24 ). Additionally, Ohno et al ( 25 ) reported that glutamine supplementation improved the decrease in plasma glutamine levels and gastrointestinal motility after gastrectomy.…”