Massive Small-Bowel Resections

Leonard, Arnold S.; Levine, Arthur S.; Wittner, Richard; Buchwald, Hēnry; Varco, Richard L.

doi:10.1001/archsurg.1967.01330150105014

Cited by 25 publications

(3 citation statements)

References 17 publications

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“…As mentioned above, the PEG data (Table 2) suggest that more fluid was secreted into the lumen of the proximal intestine in response to ingestion of the hypertonic amino acid meal than the relatively hypotonic peptide meal. If the functional integrity of the small intestinal mucosa with respect to fluid and electrolyte absorption is impaired, as for example in untreated adult coeliac disease (Fordtran et al, 1967;Russell et al, 1972;Silk et al, 1974b), after massive intestinal resection (Leonard et al, 1967), or in patients who have had jejunoileal bypass operations for morbid obesity (Gazet et al, 1974;Geiss et al, 1976), then it might be advantageous to achieve satisfactory assimilation of orally administered nitrogen at the cost of as little intestinal secretion of fluid and electrolytes as possible. This being so, we suggest that consideration could be given to choosing a diet that contains peptides rather than free amino acids as the nitrogen source.…”

Section: Discussionmentioning

confidence: 99%

Comparison of oral feeding of peptide and amino acid meals to normal human subjects

Silk¹,

Chung²,

Berger³

et al. 1979

Gut

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SUMMARY Intestinal perfusion studies performed in man have suggested that amino acid nitrogen may be absorbed more rapidly from peptides than free amino acids. The aim of the present study was to compare the effects of the oral administration of peptides and free amino acids. Two isonitrogenous liquid test meals, one containing 50 g of a partial enzymic hydrolysate of fish protein in which approximately 80 % of the nitrogen content was present as small peptides (peptide meal), and the other a mixture of free amino acids (amino acid meal) the composition and molar pattern of which simulated that of the peptide meal, were administered on separate occasions to six normal subjects intubated with a triple lumen tube. Both meals contained the reference marker polyethylene glycol. Fractional absorption of amino acid residues one and two hours after ingestion of the two meals was similar at three intestinal locations situated 120, 160, and 200 cm from the mouth of each subject, and at two hours 73-8 % and 72-0% of the amino acid residues had been absorbed respectively by the time the contents of the peptide and amino acid meals reached the middle sampling port of the tube. The total sum of individual amino acid increments in plasma was significantly greater 30 minutes (p < 0 025) and one hour (p < 005) after ingestion of the peptide than amino acid meals. By three hours the total area under the two plasma curves was similar. Normal human subjects thus appeared to be capable of assimilating orally administered mixtures of peptides and free amino acids with equal efficiency. Secretion of fluid into the lumen of the upper small intestine, assessed by reference to dilution of the polyethylene glycol, was less after ingestion of the peptide meal. In clinical situations characterised by fluid and electrolyte malabsorption consideration might be given to using small peptides rather than free amino acids as the nitrogen source in nutritional diets.The processes involved in the absorption of the final products of luminal proteolysis in the human small intestine are complex. Amino acids on release into free solution are absorbed by at least four group specific carrier-mediated active transport systems (Saunders and Isselbacher, 1966;Gray and Cooper, 1971). In addition to these transport systems, a separate system capable of mediating the transport of unhydrolysed dipeptides and tripeptides across the microvillous membrane into the mucosal cell has

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Section: Discussionmentioning

confidence: 99%

Comparison of oral feeding of peptide and amino acid meals to normal human subjects

Silk¹,

Chung²,

Berger³

et al. 1979

Gut

View full text Add to dashboard Cite

show abstract

“…The preferred source of dietary carbohydrate is starch which is less likely to lead to D-lactic acid formation than glucose or oligo-saccharides [47]. Even prior to the research highlighting the advantages of prescribing a low fat/high carbohydrate diet to patients with short bowel syndrome with intact segments of colon [36], it had become common clinical practice to treat patients in this way as it was believed that normal or high fat intakes, when administered to short bowel syndrome patients, had deleterious effects on fluid, electrolytes and mineral absorption [49][50][51][52][53]. Two carefully performed metabolic balance studies, however, do not support the restriction of dietary fat intake in patients with short bowel syndrome with end jejunostomies [35,54].…”

Section: Carbohydratementioning

confidence: 99%

“…This operation has largely been abandoned because of the many post-operative problems including the difficulty in achieving diabetic control. However, when the major disease as determined by ERCP is limited to the body and tail of the gland a distal 50% pancreatectomy has been shown to be effective in relieving pain in the highly selective group of patients with chronic pancreatitis [8,52]. When considering dietary management following pancreatic resection the seminal physiological studies of Di Magno et al [68] from the Mayo Clinic must be remembered.…”

Section: Dietary Management Following Pancreatic Resectionmentioning

confidence: 99%