Abstract
After massive resection of the small intestine the remannt mucosa has an important capacity to enlarge the absorptive surface for the digestion, hydrolysis and absorption of nutrients. This intestinal adaptation is achieved by the interaction of various factors. Oral nutrients together with pancreatic biliary secretions stimulate the mucosa to become hyperplastic. Secondary to these luminal factors hormones play an important role in the adaptive process. Among the hormones, enteroglucagon is the most important growth promoting agent together with other growth factors such as epidermal growth factor, prostaglandin E2 and human growth hormone analogues, e.g. plerocercoid growth factor from the plerocercoid larvae of the tapeworm Spirometra mansonoides. The intestinal enterocyte is the target of these factors and within the cell the synthesis of polyamines, which are responsible for rapid growth, is the most essential step for the development of hyperplasia after resection. The rate limiting enzyme for polyamine synthesis ornithine decarboxylase (ODC) reacts to trophic stimuli with an increased activity. Thereafter rapid accumulation of tissue polyamines occurs. Blockade of ODC by specific inhibitors is accompanied by absence of intestinal hyperplasia after resection. Therefore it is concluded that ODC plays a key role in the intestinal adaptation of the remnant small bowel. To start and enhance intestinal hyperplasia after resection in patients with short bowel syndrome introduction of oral nutrition as soon as possible after operation is very important. On account of gastric acid hypersecretion the use of H2 receptor blocking agents is recommended. A decreased intestinal transit time is treated with loperamide. Adequate nutritional support by enteral and (home) parenteral feeding is the prerequisite for the initiation and development of intestinal adaption in short bowel syndrome.
Similar content being viewed by others
Abbreviations
- CCK:
-
cholecystokinin
- CCPR:
-
crypt cell production rate
- DFMO:
-
alpha difluoromethyl-ornithine
- EGF:
-
epidermal growth factor
- FFA:
-
free fatty acids
- hGH:
-
human growth hormone
- LCT:
-
long chain triglycerides
- MCT:
-
medium chain triglycerides
- ODC:
-
ornithine decarboxylase
- PBS:
-
pancreatic biliary secretion
- PGE:
-
prostaglandin E2
- PGF:
-
pleroceroid growth factor
References
Al-Mukhtar MY, Sagor GR, Ghatel MA, Bloom SR, Wright NA (1983) The role of pancreatico-biliary secretions in intestinal adaptation after resection, and its relationship to plasma enteroglucagon. Br J Surg 70:398–400
Altmann GG (1971) Influence of bile and pancreatic secretions on the size of the intestinal villi in the rat. Am J Anat 132:167–178
Altmann GG, Leblond CF (1970) Factors influencing villus size in the small intestine of adult rats as revealed by transposition of intestinal segments. Am J Anat 127:15–36
Batt RM, Peters TJ (1976) Effects of prednisolone on the small intestinal mucosa of the rat. Clin Sci Mol Med 50:511–523
Batt RM, Wells G, Peters TJ (1978) The effects of prednisolone on the rat enterocyte at a subcellular level. Clin Sci Mol Med 55:435–443
Biller JA, Montgomery RK, Grand RJ, Klagsbrun M, Rosenthal A (1986) Use of 3T3 cell growth factor assay for the delineation and characterization of humoral trophic factors involved in intestinal adaptation in the rat. Gastroenterology 91:448–455
Bloom SR (1972) An enteroglucagon tumour. Gut 13:520–523
Bloom SR, Polak JM (1982) The hormonal pattern of intestinal adaption. A major role for enteroglucagon. Scand J Gastroenterol [Suppl] 74:93–103
Buts JP, deKeyser N, Dive C (1987) Cellular adaptation of the rat small intestine after proximal enterectomy: changes in microvillus enzymes and in secretory component of immunoglobulins. Pediatr Res 22:29–33
Byyny RL, Orth DN, Cohen S, Doyne ES (1974) Epidermal growth factor: effects of androgens and adrenergic agents. Endocrinology 95:776–782
Campbell RM, Fell BF (1964) Gastro-intestinal hypertrophy in the lactating rat and its relation to food intake. J Physiol (London) 171:90–97
Cooper A, Floyd TF, Ross AJ, Bishop HC, Templeton JM, Ziegler MM (1984) Morbidity and mortality of short-bowel syndrome acquired in infancy: an update. J Pediatr Surg 19:711–718
Cortot A, Fleming CR, Malagelada JR (1979) Improved nutrient absorption after cimetidine in short bowel. N Engl J Med 300:79–80
Dorney SFA, Ament ME, Berquist WE, Vargas JH, Hassal E (1985) Improved survival in very short small bowel of infancy with use of long-term parenteral nutrition. J Pediatr 107:521–525
Dowling RH (1982) Small bowel adaptation and its regulation. Scand J Gastroenterol [Suppl] 74:53–74
Dowling RH, Booth CC (1967) Structural and functional changes following small intestinal resection in the rat. Clin Sci 32:139–149
Ford WDA, Boelhouwer RU, King WWK, de Vries JE, Ross JS, Malt RA (1983) Total parenteral nutrition inhibits intestinal adaptive hyperplasia in young rats: reversal by feeding. Surgery 96:527–534
Gleeson MH, Bloom SR, Polak JM, Dowling RH (1971) Endocrine tumour in kidney affecting small bowel structure, motility and absorptice function. Gut 12:773–782
Goldman CD, Rudloff MA, Ternberg JL (1987) Cimetidine and neonatal bowel adaptation: an experimental study. J Pediatr Surg 22:484–487
Grey VL, Garofalo C, Greenberg GR, Morin CL (1984) The adaptation of the small intestine after resection in response to free fatty acids. Am J Clin Nutr 40:1235–1242
Halter F, Meyrat P, Fritsche R, Müller O, Lentze MJ, Koelz HR (1984) Both topical and systemic treatments with 16,16-dimethyl prostaglandin E2 are trophic to rat gastric mucosa. Scand J Gastroenterol [Suppl 19] 101:47–53
Hanson WR, Osborne JW, Sharp JG (1977) Compensation by the residual intestine after intestinal resection in the rat. I. Influence of amount of tissue removed. Gastroenterology 72:692–700
Hanson WR, Osborne JW, Sharp JG (1977) Compensation by the residual intestine after intestinal resection in the rat. II. Influence of postoperative time interval. Gastroenterology 72:701–705
Hart MH, Phares CK, Erdman SH, Grandjean CJ, Park YHY, Vanderhoof JA (1987) Augmentation of postresection mucosal hyperplasia by plerocercoid growth factor (PGF). Dig Dis Sci 32:1275–1280
Heroux O, Gridgeman NT (1958) The effect of cold acclimation on the size of organs and tissues of the rat, with special reference to modes of expression of results. Can J Biochem Physiol 36:209–216
Höllwarth ME, Granger DN, Ulrich-Baker MG, Kvietys PR, Ramenofsky ML, Gaginella TS (1988) Pharmacologic enhancement of adaptive growth after extensive small-bowel resection. Pediatr Surg Int 3:55–61
Hughes CA, Breuer RS, Ducker DA, Hatoff DE, Dowling RH (1982) The effect of cholecystokinin and secretin on intestinal and pancreatic structure and function. In: Robinson JWL, Dowling RH, Riecken EO (eds) Mechanisms of intestinal adaptation. MTP Press Ltd, Lancaster, pp 435–450
Jänne J, Pösö H, Raina A (1978) Polyamines in rapid growth and cancer. Biochim Biophys Acta 473:241–293
Johnson LR (1976) The trophic action of gastrointestinal hormones. Gastroenterology 70:278–288
Karasov WH, Diamond JM (1983) Adaptive regulation of sugar and amino acid tranport by vertebrate intestine. Am J Physiol 245:G443-G462
Kedinger M, Simon PM, Raul F, Grenier JF, Haffen K (1982) Effects of various hormones and dietary sugars on the stimulation of brush border enzymes in organ culture. In: Robinson JWL, Dowling RH, Riecken EO (eds) Mechanisms of intestinal adaptation. MTP Press, Lancaster, pp 285–294
Kidwell WR, Bano M, Burdette K, Lococzy I, Salomon D (1985) Mammary derived growth factors in human milk. In: Jensen RG, Neville MC (eds) Human dactation: milk components and methodologies. Plenum Press, New York, pp 209–219
Koelz HR, Lentze MJ, Müller OM, Halter F (1987) Effect of 16,16-dimethyl prostaglandin E2 on small intestinal mucosa in suckling rats. Eur J Clin Invest 17:293–300
Koldovsky O, Bedrich A, Pollack P, Rao RK, Thornburg W (1987) Hormones in milk: their presence and possible physiological significance. In: Goldman AS, Atkinson AS, Hanson LA (eds) Human lactation 3: effects of human milk upon the recipient infant. Plenum Press, New York, pp 183–196
Konturek SJ, Radecki T, Brzozowski R, Piastucki I, Dembinski A, Dembinska-Kiec A, Zmuda A, Gryglewski R, Gregory H (1981) Gastric cytoprotection by epidermal growth factor. Role of endogenous prostaglandins and DNA synthesis. Gastroenterology 81:438–443
Koruda MJ, Rolandelli RH, Settle RG, Saul SH, Rombeau JL (1986) The effect of a pectin-supplemented elemental diet on intestinal adaptation to massive bowel resection. J Parenter Enteral Nutr 10:343–348
Lafont J, Pilon R (1975) Influence of glucocorticoids on some morphological and biochemical aspects of rat small intestinal mucosa. Biochim Biophys Acta 392:288–298
Laplace JP (1973) Effèt humoral de la résection intestinale chez des porcs en circulation sanguine croissée chronique (abstr). Biol Gastroenterol (Paris) 6:359
Lehy T, Accary JP, Dubrasquet M, Lewin MJM (1986) Growth hormone releasing factor (somatocrinin) stimulates epithelial cell proliferation in the rat digestive tract. Gastroenterology 90:646–653
Lhoste E, Aprahamian M, Grenier JF, Stock-Damgé D (1984) La gastrine n'est pas impliquée après résection étendue de l'intestin grêle chez le rat. Gastroenterol Clin Biol 8:145–151
Lichtenberger L, Miller LR, Erwin DN, Johnson LR (1973) Effect of pentagastrin on adult rat duodenal cells in culture. Gastroenterology 65:242–251
Luk GD, Baylin SB (1983) Polyamines and intestinal growth-increased polyamine biosynthesis after jejunectomy. Am J Physiol 245:G656-G660
Luk GD, Baylin SB (1984) Inhibition of intestinal epithelial DNA synthesis and adaptive hyperplasia after jejunectomy in the rat by suppression of polyamine biosynthesis. J Clin Invest 74:698–704
Malo C, Menard D (1982) Influence of epidermal growth factor on the development of suckling mouse intestinal mucosa. Gastroenterology 83:28–35
Menge H, Gräfe M, Lorenz-Meyer H, Riecken EO (1975) The influence of food intake on the development of structural and functional adaptation following ileal resection in the rat. Gut 16:468–472
Miazza BM, Levan H, Vaja S, Dowling RH (1982) Effect of pancreaticobiliary diversion (PBD) on jejunal and ileal structure and function in the rat. In: Robinson JWL, Dowling RH, Riecken EO (eds) Mechanisms of intestinal adaptation. MTP Press, Lancaster, pp 467–477
Morin CL, Ling V (1978) Effect of pentagastrin on the rat small intestine after resection. Gastroenterology 75:224–229
Morin CL, Grey VL, Garofalo C (1981) Influence of lipids on intestinal adaptation after resection. In: Robinson JWL, Dowling RH, Riecken EO (eds) Mechanisms in intestinal adaptation. MTP Press, Cancaster, pp 175–184
Obertop H, Nundy S, Malamud D, Malt RA (1977) Onset of cell proliferation in the shortened gut. Rapid hyperplasia after jejunal resection. Gastroenterology 72:267–270
Osborne M, Frederick PL, Sizer JS (1966) Mechanisms of gastric hypersecretion following massive intestinal resection; clinical and experimental observations. Am J Surg 164:622–634
Oscarson JEA, Veen HF, Williamson RCN, Chir B, Ross JS, Malt RA (1977) Compensatory postresectional hyperplasia and starvation atrophy in small bowel: dissociation from endogenous gastrin levels. Gastroenterology 72:890–896
Pegg AE, McCann PP (1982) Polyamine metabolism and function. Am J Physiol 243:C212-C221
Peng TC, Six KM, Munson PL (1970) Effects of prostaglandin E1 on the hypothalamo-hypophyseal-adrenocortical axis in the rat. Endocrinology 86:202–206
Phares CK, Booth BJM (1985) Monoclonal antibodies to human growth hormone and human chorionic somatomamotropin specifically bind the growth hormone-like factor produced by plerocercoids of the tapeworm Spirometra mansonoides. Fed Proc 44:430
Phares CK, Salem MAM, The human growth hormone analog produced by the tapeworm Spirometra mansonoides is not diabetogenic in obese (ob/ob) mouse. 68th Annual Endocrine Society meeting, June 1986 (74a)
Sagor GR, Ghatei MA, O'Shaughnessey DJ, Al-Mukhtar MYT, Wright NA, Bloom SR (1985) Influence of somatostatin and bombesin on plasma enteroglucagon and cell proliferation after intestinal resection in the rat. Gut 26:89–94
Saruta T, Kaplan NM (1972) Adrenocortical steroid synthesis: the effect of prostaglandins. J Clin Invest 51:2246–2251
Scheving LA, Yeh YC, Tsai TH, Scheving LE (1980) Circadian phase-dependent stimulatory effects of epidermal growth factor on DNA synthesis in the duodenum, jejunum, ileum, caecum, colon and rectum of the adult male mouse. Endocrinology 106:1498–1503
Stauffer UG, Perret M, Shmerling DH (1984) Spätergebnisse nach ausgedehnten Dünndarmresektinen. Monatsschr Kinderheilkd 132:411–417
Taylor B, Murphy GM, Dowling RH (1975) Effect of food intake and the pituitary on intestinal structure and function after resection. Gut 16:397
Ulrich-Baker MG, Smidt WR, Gaginella TS, Granger DN (1987) Splanchnic blood flow during stimulation of gastrointestinal growth. Am J Physiol 15:G692-G698
Vanderhoof JA, Grandjean CJ, Burkley KT, Antonson DL (1984) Effect of casein versus casein hydrolysate on mucosal adaptation following massive bowel resection in infant rats. J Pediatr Gastroenterol Nutr 3:262–267
Vanderhoof JA, Grandjean CJ, Kaufman SS, Burkley KT, Antonson DL (1984) Effect of high percentage medium-chain triglyceride diet on mucosal adaptation following massive bowel resection in rats. J Parenter Enteral Nutr 8:685–698
Vanderhoof JA, Park JHY, Grandjean CJ (1986) Effect of zinc deficiency on mucosal hyperplasia following 70% resection. Am J Clin Nutr 44:670–677
Vanderhoof JA, Euler AR, Park JHY, Grandjean CJ (1987) Augmentation of mucosal adaptation following massive small-bowel resection by 16,16-dimethyl-prostaglandin E2 in the rat. Digestion 36:213–219
Weser E, Hernandez MH (1971) Studies of small bowel adaptation after intestinal resection in the rat. Gastroenterology 60:69–75
Weser E, Heller R, Tawil T (1977) Stimulation of mucosal growth in the rat ileum by bile and pancreatic secretions after jejunal resection. Gastroenterology 73:524–529
Weser E, Bell D, Tawil T (1981) Effects of octapeptide-cholecystokinin, secretin and glucagon on intestinal mucosal growth in parenterally nourished rats. Dig Dis Sci 26:409–416
Williamson RCN (1978) Intestinal adaptation (first of two parts). Structural, functional and cytokinetic changes. N Engl J Med 298:1393–1402
Williamson RCN (1978) Intestinal adaptation (second of two parts). Mechanisms of control. N Engl J Med 298:1444–1450
Williamson RCN, Chir M, Buchholtz TW, Malt RA (1978) Humoral stimulation of cell proliferation in small bowel after transection and resection in rats. Gastroenterology 75:249–254
Wittmann T, Lhoste E, Aprahamian C, Stock-Damgé C (1985) Adaptation pancréatique et intestinale après résection proximale ou distale de l'intestin grêle chez le rat. Schweiz Med Wochenschr 115:1009–1011
Young EA, Weser E (1974) Nutritional adaptation after small bowel resection in rats. J Nutr 104:994–1001
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lentze, M.J. Intestinal adaptation in short-bowel syndrome. Eur J Pediatr 148, 294–299 (1989). https://doi.org/10.1007/BF00444117
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00444117