Nutritional Aspects of Gastrointestinal Wound Healing

Abstract

Significance: Although the wound healing cascade is similar in many tissues, in the gastrointestinal tract mucosal healing is critical for processes such as inflammatory bowel disease and ulcers and healing of the mucosa, submucosa, and serosal layers is needed for surgical anastomoses and for enterocutaneous fistula. Failure of wound healing can result in complications including infection, prolonged hospitalization, critical illness, organ failure, readmission, new or worsening enterocutaneous fistula, and even death. Recent Advances: Recent advances are relevant for the role of specific micronutrients, such as vitamin D, trace elements, and the interplay between molecules with pro-and antioxidant properties. Our understanding of the role of other small molecules, genes, proteins, and macronutrients is also rapidly changing. Recent work has elucidated relationships between oxidative stress, nutritional supplementation, and glucose metabolism. Thresholds have also been established to define adequate preoperative nutritional status. Critical Issues: Further work is needed to establish standards and definitions for measuring the extent of wound healing, particularly for inflammatory bowel disease and ulcers. In addition, a mounting body of evidence has determined the need for adequate preoperative nutritional supplementation for elective surgical procedures. Future Directions: A large portion of current work is restricted to model systems in rodents. Therefore, additional clinical and translational research is needed in this area to promote gastrointestinal wound healing in humans, particularly those suffering from critical illness, patients with enterocutaneous fistula, inflammatory bowel disease, and ulcers, and those undergoing surgical procedures.

Perspectives on Wound Healing

“…Factors general to the body (systemic) which would affect any wound that was made would include old age, malnutrition, vitamin deficiency especially vitamin C, trace metal deficiency especially zinc, anemia, uremia jaundice, diabetes mellitus, generalized infection, shock leading to poor tissue perfusion, cytotoxic drugs, steroids and AIDS.) [25,26]. From all available evidence, old age, malnutrition, vitamin deficiency, anaemia and malignancy are doubtful factors that delay wound healing.…”

“…The elderly are a heterogenous group and it is important to distinguish chronological from physiological age. Malnutrition has to be severe before healing is affected because the wound has high priority when competing with unwounded tissue for body resources [26]. Anaemia per se does not impair healing if normovolaemic and normal O 2 tension.…”

“…The incidence is about 8% and the causes are (1) infection which may even be low grade, (2) poor sutures e.g. absorbable (vicryl) used instead of non-absorbable (nylon) for abdominal wound closure especially with the lesser collagen synthesis in Caucasians than in negroes [25,26,29].…”

“…Healing problems can be anticipated when recent weight loss is greater than 20% of original weight [26,27]. Ascorbic acid (vitamin C) is essential for proline hydroxylation and collagen synthesis, although the number of fibroblasts is not reduced in scorbutic states (scurvy).…”

“…Zinc is a component of enzymes involved in the healing process and its deficiency retards healing. However, supplements of ascorbic acid and zinc are effective when these factors are deficient but do not improve healing in normal subjects [26,30,31].…”