AIM To investigate the individual and thecombined effects of glutamine, dietary fiber,and growth hormone on the structural adaptationof the remnant small bowel.METHODS Forty-two adult male Sprague-Dawley rats underwent 85% mid-small bowel( TPN ) support during the first threepostoperational days. From the 4thpostoperational day, animals were randomlyassigned to receive 7 different treatments for 8days: TPNcon group, receiving TPN and enteral20 g.L- 1 glycine perfusion; TPN + Gin group,receiving TPN and enteral 20 g.L-1 glutamineperfusion; ENcon group, receiving enteralnutrition (EN) fortified with 20 g@L-1 glycine; EN+ Gin group, enteral nutrition fortified with20g. L-1 glutamine; EN + Fib group, enteralnutrition and 2 g. d- 1 oral soybean fiber; EN + GHgroup, enteral nutrition and subcutaneousgrowth hormone (GH) (0.31U) injection twicedaily; and ENint group, glutamine-enriched EN.oral soybean fiber, and subcutaneous GHinjection.RESULTS Enteral glutamine perfusion duringTPN increased the small intestinal villus height(jejunal villus height 250 μm ±29 μm in TPNconvs 330 μm ± 54 μm in TPN + Gin, ileal villus height260μm±28μm in TPNcon vs 330 μm±22μm inTPN + Gin, P＜0.05) and mucosa thickness( jejunal mucosa thickness 360 μm ± 32 μm inTPNcon vs 460 μm ± 65 μm in TPN + Gin, ilealmucosa thickness 400 μm ± 25 μm in TPNcon vs490μm ± 11 μm in TPN + Gin, P＜0.05) incomparison with the TPNcon group. Either fibersupplementation or GH administration improvedbody mass gain (end body weight 270 g ± 3.6 g inEN+Fib, 265.7 g ± 3.3 g in EN+GH, vs 257g±3.3g in ENcon, P＜0.05), elevated plasmainsulin-like growth factor ( IGF-Ⅰ ) level(880 μg. L-1 ± 52 μg. L-1 in EN + Fib, 1200 μg. L-1± 96 μg. L- 1 in EN ± GH, vs 620 μg. L-1 ±43 μg. L-1 in ENcon, P＜0.05), and increased thevillus height (jejunum 560 μm ± 44 μm in EN ± Fib,530 μm± 30 μm in EN ± GH, vs 450 μm ± 44 μm inENcon, ileum 400 μm ± 30 μm in EN + Fib, 380 μm±49 μm in EN± GH, vs 320 μm± 16 μm in ENcon,P＜0.05) and the mucosa thickness (jejunum740 μm ± 66 μm in EN ± Fib, 705 μm ± 27 μm in EN ±GH, vs 608 μm ± 58 μm in ENcon, ileum 570 μm ±27 μm in EN ± Fib, 560 μm ± 56 μm in EN ± GH, vs480μm ± 40 μm in ENcon, P＜0.05) in remnantjejunum and ileum. Glutamine-enriched ENproduced little effect in body mass, plasma IGF-Ⅰ level, and remnant small bowel mucosalstructure. The ENint group had greater bodymass (280g ± 2.2g), plasma IGF-Ⅰ level(1450g@L-1 ± 137g. L 1), and villus height(jejunum 620 μm ± 56 μm, ileum 450 um ± 31 μm)and mucosal thickness (jejunum 800 μm ± 52 μm,ileum 633 μm± 33 μm) than those in ENcon, EN +Gin (jejunum villus height and mucosa thickness450 μm ± 47 μm and 610 μm ± 63 μm, ileum villusheight and mucosa thickness 330 μm ± 39 μm and500 μm± 52 μm), EN + GH groups (P＜0.05), andthan those in EN + Fib group although nostatistical significance was attained.CONCLUSION Both dietary fiber and GH whenused separately can enhance the postresectionalsmall bowel structural adaptation. Simultaneoususe of these two gut-trophic factors can producesynergistic effects on small bowel structuraladaptation. Enteral glutamine perfusion isbeneficial in preserving small bowel mucosalstructure during TPN, but has little beneficialeffect during EN.
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