Basic Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2018; 24(5): 583-592
Published online Feb 7, 2018. doi: 10.3748/wjg.v24.i5.583
Enteral nutrition combined with glutamine promotes recovery after ileal pouch-anal anastomosis in rats
Yan-Yan Xu, An-Qi He, Gang Liu, Kai-Yu Li, Jian Liu, Tong Liu
Yan-Yan Xu, An-Qi He, Gang Liu, Kai-Yu Li, Jian Liu, Tong Liu, Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
Author contributions: Xu YY and He AQ collected the data; Liu G conceived and designed the study; Li KY and He AQ contributed to the data analysis; Xu YY contributed to the interpretation of the data; Liu G participated in streamlining the study protocol; Xu YY, He AQ, Li KY, Liu J and Liu T proofread the study protocol; Li KY supervised the data collection process; Xu YY, He AQ, Liu G, Li KY, Liu J and Liu T contributed to drafting the manuscript; all authors contributed to the revision of the manuscript and approved the final version.
Supported by Li Jie-Shou Gut Barrier Foundation, No. LJS_201008.
Institutional review board statement: The study was reviewed and approved by Tianjin Medical University General Hospital Institutional Review Board.
Institutional animal care and use committee statement: Animal care and experiments were conducted according to the international guidelines on animal research and ethics.
Conflict-of-interest statement: The authors have no financial or other conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gang Liu, MD, PhD, Professor, Surgeon, Department of General Surgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China. landmark1059@163.com
Telephone: +86-22-60362365 Fax: +86-22-60362365
Received: November 15, 2017
Peer-review started: November 15, 2017
First decision: December 3, 2017
Revised: December 10, 2017
Accepted: December 26, 2017
Article in press: December 26, 2017
Published online: February 7, 2018
ARTICLE HIGHLIGHTS
Research background

Glutamine is a nutrient active in the immune system, and may influence recovery after surgery. However, clinical research into nutritional support for ulcerative colitis (UC) patients after ileal pouch-anal anastomosis (IPAA) is currently lacking. Therefore, it is important to explore appropriate postoperative nutritional support to address the issue of postoperative malnutrition.

Research motivation

The purpose of this study was to investigate the effects of enteral nutrition (EN) supplemented with different nutrients on recovery, nutritional status, and mucosal barrier function of the ileal pouch in IPAA rats. These results will provide an experimental basis for nutritional treatment of ulcerative colitis (UC) patients after IPAA.

Research objectives

To assess the effect of EN supplemented with glutamine on recovery after IPAA in rats, to provide an experimental basis for nutritional support in patients with UC after IPAA.

Research methods

Male Sprague-Dawley (SD) rats were randomly divided into three groups (n = 8) after IPAA operation using a microsurgical technique. From the third day postoperatively, rats in the control group, EN group, and immune nutrition (IN) group were fed standard rat chow, short peptide EN, and short peptide EN combined with glutamine ad libitum, respectively. The rats’ general condition was observed throughout the study. Serum levels of total protein, albumin, prealbumin, and transferrin were detected on the 30th day postoperatively, using an automatic biochemical analyzer. The ileal pouch mucosa was stained with hematoxylin and eosin, and occludin protein levels were detected by immunohistochemistry.

Research results

The body weight of rats in the EN group was significantly higher than that in the control group (P < 0.05) and lower than that in the IN group (P < 0.05) on the 30th day postoperatively. The levels of serum TP, ALB, PA, and TF in the EN group were significantly higher than those in the control group (P < 0.01 for all) and lower than those in the IN group (P < 0.05 for all). Histopathological scores and expression levels of occludin protein were significantly lower in the control group compared with the EN and IN groups (P < 0.05 for all), but there were no significant differences between the latter two groups (P > 0.05 for all).

Research conclusions

Feeding short peptide EN supplemented with glutamine can accelerate postoperative recovery after IPAA in rats. It can also improve nutritional status, which has important implications for the nutritional support of patients with UC after IPAA. In terms of nutritional support, EN can be used in patients with UC at the early postoperative stage, and glutamine may be added as appropriate to improve the nutritional status of patients and speed up their recovery.

Research perspectives

In the future, we will further study on the nutritional support following IPAA procedure, such as enteral nutrition supplemented with probiotics, to improve the postoperative life quality.