Morphologic and Cytoproliferative Patterns of Duodenal Mucosa in Two Patients After Long‐term Total Parenteral Nutrition: Changes With Oral Refeeding and Relation to Intestinal Resection

Abstract

The morphologic and cytoproliferative patterns of the duodenal mucosa of two adult patients, one of whom had a short bowel, were evaluated after more than 2 months of postoperative total parenteral nutrition and 2 and 12 months after the resumption of oral alimentation. Morphometric analysis was performed on routinely processed duodenal biopsies. Cell proliferation was evaluated by means of in vitro bromodeoxyuridine uptake. The results were compared with those obtained in five healthy controls. After parenteral nutrition, patients showed significantly lower villus height and crypt depth than those of controls and a normal bromodeoxyuridine labeling index. After 2 months of refeeding, villus and crypt returned to normal, and the labeling index was increased. After 12 months of oral refeeding, labeling index, villus height, and crypt depth were similar to those of controls. The patient with the short bowel showed a number of cells per unit length of villus and crypt significantly greater than those of the controls and of the patient who underwent shorter intestinal resection. In human duodenal mucosa, (1) hypoplasia develops after long-term total parenteral nutrition; (2) mucosal recovery occurs through an increased cell proliferation after oral refeeding; and (3) extensive small bowel resection determines the development of relative hyperplasia.

Glutamine preserves protein synthesis and paracellular permeability in Caco-2 cells submitted to ”luminal fasting“

“…BOTH SEVERE ILLNESS AND TOTAL parenteral nutrition have been shown to alter gut barrier function in animal models (39,46). Intestinal frailty, in turn, may increase the risk of bacterial translocation and produce sepsis, which results in protein wasting, and may condition survival.…”

Short Bowel Syndrome: clinical management

“…Successivamente alla resezione, l'intestino residuo va incontro a un fenomeno di adattamento che consente il parziale o totale recupero delle funzioni intestinali perse [12,16]. L'adattamento intestinale è rappresentato da una iperplasia della mucosa con aumento delle capacità assorbitive del tenue e da un aumento dell'assorbimento di acqua e sali, ma anche di energia, da parte del colon residuo.…”

Organisation, regulations, preparation and logistics of parenteral nutrition in hospitals and homes; the role of the nutrition support team – Guidelines on Parenteral Nutrition, Chapter 8

“…Some studies have associated PN with altered morphology and intestinal function, for example with reduced mucosa thickness, a reduced number of villi in the small intestine and increased intestinal permeability [27], [28], [29], [30], while other trials do not show such alterations [31], [32]. If such effects occur, they depend on the duration of PN and are usually reversible.…”