Morphological and functional changes in the colon after massive small bowel resection

Healey, Kate L.; Bines, Julie E.; Thomas, Sarah L.; Wilson, Guineva; Taylor, Russell G.; Sourial, Magdy; Pereira-Fantini, Prue M.

doi:10.1016/j.jpedsurg.2010.02.040

« Previous Next »Journal of Pediatric Surgery
Volume 45, Issue 8 , Pages 1581-1590, August 2010

Morphological and functional changes in the colon after massive small bowel resection☆

Kate L. Healey
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
Julie E. Bines
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
Sarah L. Thomas
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
Guineva Wilson
- Department of Surgery, Royal Children's Hospital, Victoria, Australia
Russell G. Taylor
- Department of Surgery, Royal Children's Hospital, Victoria, Australia
Magdy Sourial
- Department of Surgery, Royal Children's Hospital, Victoria, Australia
Prue M. Pereira-Fantini
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Corresponding author. Intestinal Failure and Clinical Nutrition Group, Murdoch Children's Research Institute, Parkville 3052, Australia. Tel.: +61 3 8341 6452; fax: +61 3 8341 6449.
- Dr Prue Pereira-Fantini is supported by a grant provided by the Murdoch Children's Research Institute.

Received 3 November 2009; received in revised form 3 February 2010; accepted 3 February 2010.

Abstract

Purpose

Anecdotal evidence suggests that the colon plays an important role after small bowel resection (SBR). However, colonic changes have not previously been studied. The aim of this study was to characterize morphological and functional changes within the colon after SBR and elucidate the influence of diet complexity on adaptation.

Method

In study 1, 4-week-old piglets underwent a 75% SBR or sham operation and were studied at 2, 4, and 6 weeks postoperation to allow analysis of early and late adaptation responses. Piglets received a polymeric infant formula (PIF).

In study 2, SBR piglets received an elemental diet and were studied at 6 weeks postoperation and compared with SBR + PIF piglets from study 1. For both studies, immunohistochemistry was used to quantitate intestinal cell types. Changes in functional proteins were measured by Western blot, enteroendocrine/peptide YY (PYY), enterocyte/liver fatty acid binding protein (L-FABP), and goblet cells/trefoil factor 3 (TFF3).

Results

In study 1, early and late adaptation-related changes were observed after SBR. Early adaptation included increased numbers of enterocytes (P = .0001), whereas late adaptation included increased proliferative cell numbers (P = .02). Enteroendocrine, goblet, and apoptotic cells numbers were significantly elevated in the resected group at all time-points studied (P < .05). Functional changes included increased levels of L-FABP (P = .04) and PYY (P = .03). There was no change in TFF3 expression.

In study 2, feeding with an elemental diet resulted in suboptimal adaptation as evidenced by reduced rate of weight gain and significant reductions in total cell numbers (P = .0001), proliferative (P = .0001) and apoptotic cells (P = .04), enteroendocrine cells (P = .001), and PYY expression (P .004).

Conclusion

These findings indicate that significant morphological and functional changes occur in the colon after massive SBR and that these occur as early and late adaptation responses. Elemental diet was associated with suboptimal adaptation suggesting an effect of diet complexity on colonic adaptation.

Key words: Colon, Short bowel syndrome, Small bowel resection, Immunohistochemistry, Western blot, Adaptation