Gut mucosal atrophy after a short enteral fasting period in critically ill patients

Hernández G.; Velasco N.; Wainstein, C; Castillo L.; Bugedo G.; Maiz A.; López F; Guzman, S; Vargas C.

Keywords: permeability, membrane, serum, nutrition, diet, cell, feeding, histopathology, humans, human, male, time, intestine, aged, biopsy, illness, lactulose, albumin, adult, female, restriction, mannitol, mucosa, article, prealbumin, lymphocyte, fasting, assessment, atrophy, case-control, controlled, duodenum, clinical, calorimetry, factors, studies, study, count, middle, normal, and, Total, Aged,, 80, over, Intestinal, endoscopic, Critical, enteric, villus, parenteral, crypt, Duodenoscopy, Nutrition,


Purpose: The purpose of this study was to evaluate the presence of gut mucosal atrophy and changes in mucosal permeability in critically ill patients after a short fasting period. Materials and Methods: Fifteen critically ill patients underwent a period of enteral fasting of at least 4 days (mean 7.8 days). We took the following measurements the day before initiating enteral nutrition: indirect calorimetry, serum albumin, prealbumin, and lymphocyte count. We also performed a duodenal endoscopic biopsy with histopathological and mucosal morphometric analysis including villus height and crypt depth. The lactulose-mannitol test was performed to assess gut permeability. A total of 28 healthy volunteers served as controls for duodenal biopsy or lactulose-mannitol test. Clinical data, such as length of fasting, severity score, and previous parenteral nutritional support, were recorded. Results: We found gut mucosal atrophy, expressed as a decrease in villus height and crypt depth, in patients compared with controls. The patients also exhibited an abnormal lactulose-mannitol test. Morphometric changes did not correlate with permeability. Further, we found no correlation between the results of the lactulose-mannitol test and of mucosal morphometry with clinical data. Conclusions: We found that a short period of enteral fasting was associated with significant duodenal mucosal atrophy and abnormal gut permeability in critically ill patients.

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Título de la Revista: JOURNAL OF CRITICAL CARE
Volumen: 14
Número: 2
Fecha de publicación: 1999
Página de inicio: 73
Página final: 77