Gut function and immune and inflammatory responses in patients perioperatively fed with supplemented enteral formulas
M. Braga, L. Gianotti, A. Cestari, A. Vignali, F. Pellegatta, A. Dolci and V. Di Carlo
Department of Surgery, Scientific Institute S Raffaele Hospital, University of Milan, Italy.
OBJECTIVE: To evaluate if the perioperative administration of a
supplemented enteral formula modulates selective inflammatory and immune
variables and gut function after surgery. DESIGN: Prospective, randomized,
double-blind, clinical trial. SETTING: Department of surgery, university
hospital. PATIENTS: Forty patients with neoplasm of the colorectum or
stomach. INTERVENTION: Seven days before surgery, the patients drank 1 L/d
of a control enteral formula (n = 20) or the same formula enriched with
arginine, RNA, and omega-3 fatty acids (n = 20).Jejunal infusion with the
same formulas was started 6 hours after operation and continued until day
7. MAIN OUTCOME MEASURES: Immune response was determined by phagocytosis
ability and respiratory burst of polymorphonuclear cells, and inflammatory
response by plasma levels of C-reactive protein. Operative intestinal
microperfusion, postoperative intestinal mucosa oxygen metabolism, and
plasma intestinal isoenzyme of alkaline phosphatase were used as indicators
of gut function. Plasma nitric oxide also was determined. RESULTS: In the
enriched group, phagocytosis ability and respiratory burst after surgery
was higher (P < .01) and C-reactive protein level was lower (P < .05)
than in the control group. The enriched group had higher mean (+/-SD)
intestinal microperfusion (180 +/- 46 vs 146 +/- 59 perfusion units, P <
.05), intestinal mucosa oxygen metabolism (pHi 7.39 +/- 0.2 vs pHi 7.33 +/-
0.1, P < .05), and 5-fold lower levels of intestinal isoenzyme of
alkaline phosphatase (P < .05). Postoperative levels of nitric oxide
were higher in the enriched group (P < .05, analysis of variance).
CONCLUSION: The perioperative administration of an enriched enteral formula
significantly improved gut function and positively modulated postsurgical
immunosuppressive and inflammatory responses.
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