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Abstract

Background: Using a massively bowel-resected rat model, our previous study demonstrated that small bowel segment reversal stimulates jejunal hyperplasia but may also increase the possibility of bacterial translocation and the elevation of circulating white blood cells and serum interleukin-6 that may reduce the whole-body anabolism. The aim of this study is to investigate whether oral antibiotics might attenuate the inflammatory responses and might therefore facilitate the beneficial effects of bowel segment reversal. Methods: Male Wistar rats (∼270 g) underwent a 70% small bowel resection with (REV group) or without (CON group) a 3-cm small bowel segment reversal, or underwent a sham operation (SHAM group). After surgeries, half of the animals in the REV group were given oral clindamycin plus amoxicillin (50 plus 50 mg/kg/d, ANT group) for 3 weeks. Results: Oral antibiotics administration significantly attenuated the decreases in feeding efficiency (g of body weight/100 kcal diet) and increases in the circulation of white blood cells, serum nitric oxide, and interleukin-6 (1-way ANOVA, p < .05), which are associated with bowel segment reversal. In addition, antibiotics significantly increased serum concentrations of insulin-like growth factor-I, significantly decreased the total numbers of bacteria in the intestine, and tended to reduce the extent of jejunal hyperplasia in rats with bowel segment reversal. Conclusions: Our results suggest that oral antibiotics may be used as an adjuvant to attenuate the inflammatory responses and to enhance the anabolic responses in massively bowel-resected patients with bowel segment reversal.

Clinical experiences regarding the effects of bowel segment reversal remain controversial. Using a clinically relevant rat model, we demonstrated that oral antibiotics might improve feeding efficiency, attenuate intestinal bacterial overgrowth, and decrease elevated circulating white blood cells, nitric oxide, and interleukin-6 in massively bowel-resected rats with bowel segment reversal.

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References

Shanbhogue LK, Molenaar JC. Short bowel syndrome: metabolic and surgical management. Br J Surg. 1994 ;81:486– 499.

Goulet O. Short bowel syndrome in pediatric patients.Nutrition. 1998;14:784– 787.

O'Keefe SJ, Buchman AL, Fishbein TM, Jeejeebhoy KN, Jeppesen PB, Shaffer J. Short bowel syndrome and intestinal failure: consensus definitions and overview. Clin Gastroenterol Hepatol. 2006 ;4:6– 10.

Thompson JS, Quigley EM, Adrian TE. Effect of reversed intestinal segments on intestinal structure and function. J Surg Res. 1995 ;58:19– 27.

Panis Y, Messing B, Rivet P, et al. Segmental reversal of the small bowel as an alternative to intestinal transplantation in patients with short bowel syndrome. Ann Surg. 1997 ;225:401– 407.

Pigot F, Messing B, Chaussade S, Pfeiffer A, Pouliquen X, Jian R. Severe short bowel syndrome with a surgically reversed small bowel segment.Dig Dis Sci. 1990;35:137– 144.

Thompson JS, Langnas AN, Pinch LW, Kaufman S, Quigley EM, Vanderhoof JA. Surgical approach to short-bowel syndrome: experience in a population of 160 patients. Ann Surg. 1995 ;222:600– 607.

Sondenaa K, Nesvik I, Nygaard K, Sauer T. Mucosal surface area of a reversed intestinal segment in rats. Scand J Gastroenterol. 1991 ;26:1240– 1246.

Uchiyama M, Iwafuchi M, Matsuda Y, et al. Changes in intestinal motility after massive small bowel resection with a reversed jejunal segment.J Smooth Muscle Res. 1996 ;32:17– 26.

10.

Duran B. The effects of long-term total parenteral nutrition on gut mucosal immunity in children with short bowel syndrome: a systematic review.BMC Nurs. 2005;4:2 .

11.

Binderow SR, Cohen SM, Wexner SD. Must early postoperative oral intake be limited to laparoscopy? Dis Colon Recum. 1994 ;37:584– 589.

12.

Booth IW. Enteral nutrition as primary therapy in short bowel syndrome. Gut. 1994 ;35(1 suppl):S69– S72.

13.

Jeejeebhoy KN. Management of short bowel syndrome: avoidance of total parenteral nutrition. Gastroenterology. 2006 ;130(2 suppl 1):S60– S66.

14.

Nauth J, Chang CW, Mobarhan S, Sparks S, Borton M, Svoboda S. A therapeutic approach to wean total parenteral nutrition in the management of short bowel syndrome: three cases using nocturnal enteral rehydration.Nutr Rev. 2004;62:221– 231.

15.

Nightingale J, Woodward JM, Small Bowel and Nutrition Committee of the British Society of Gastroenterology. Guidelines for management of patients with a short bowel. Gut. 2006 ;55(suppl 4):iv1– iv12.

16.

Jackson CS, Buchman AL. The nutritional management of short bowel syndrome. Nutr Clin Care. 2004 ;7:114– 121.

17.

Lo HC, Hsu KH, Wang SF. Small bowel segment reversal induces intestinal hyperplasia but reduces whole-body growth in massively bowel-resected rats. JPEN J Parenter Enteral Nutr. 2001 ;25:73– 80.

18.

Asensio AB, Garcia-Urkia N, Aldazabal P, Bachiller P, Garcia-Arenzana JM, Eizaguirre I. Incidence of bacterial translocation in four different models of experimental short bowel syndrome. Cirugia Pediatr. 2003;16:20– 25.

19.

Collantes Perez J, Prada Oliveira JA, Gomez Luy C, Vallo De Castro JJ, Verastegui Escolano C. A useful experimental model of short bowel syndrome. J Invest Surg. 2004 ;17:9– 14.

20.

Baglie S, Groppo FC, Filho TR. Tissue pharmacokinetics of amoxicillin: an experimental design in rats. Braz J Infect Dis. 2000 ;4:197– 203.

21.

O'Reilly T, Kunz S, Sande E, Zak O, Sande MA, Tauber MG. Relationship between antibiotic concentration in bone and efficacy of treatment of staphylococcal osteomyelitis in rats: azithromycin compared with clindamycin and rifampin. Antimicrob Agents Chemother. 1992 ;36:2693– 2697.

22.

Lo HC, Hinton PS, Peterson CA, Ney DM. Simultaneous treatment with IGF-I and GH additively increases anabolism in parenterally fed rats.Am J Physiol. 1995;269:E368– E376.

23.

Granger DL, Taintor RR, Boockvar KS, Hibbs JB. Measurement of nitrate and nitrate in biological samples using nitrate reductase and Griess reaction. Methods Enzymol. 1996 ;268:142– 151.

24.

Thissen JP, Ketelslegers JM, Underwood LE. Nutritional regulation of the insulin-like growth factors. Endocrinol Rev. 1994 ;5:80– 101.

25.

Moldawer LL, Copeland EW 3rd. Proinflammatory cytokines, nutritional support, and the cachexia syndrome: interactions and therapeutic options. Cancer. 1997;79:1828– 1839.

26.

Shenkin A. Cytokine changes in the postoperative period.Proc Nutr Soc. 1994;3:159– 167.

27.

Hierholzer C, Harbrecht B, Menezes JM, et al. Essential role of induced nitric oxide in the initiation of the inflammatory response after hemorrhagic shock. J Exp Med. 1998 ;187:917– 928.

28.

Ford H, Watkins S, Reblock K, Rowe M. The role of inflammatory cytokines and nitric oxide in the pathogenesis of necrotizing enterocolitis.J Pediatr Surg. 1997;32:275– 282.

29.

Lo HC, Tsai FA, Lin SC, Wang HF. Systemic and local secretions of cytokines and nitric oxide in massively bowel-resected rats with or without small bowel segment reversal. Cytokine. 2001 ;14:112– 120.

30.

Labriola L, Jadoul M, Daudons M, Pirson Y, Lambert M. Massive amoxicillin crystalluria causing anuric acute renal failure. Clin Nephrol. 2003;59:455– 457.

31.

Berezhinskaia VV, Dolgova GV, Egorenko GG, et al. Study of general toxic and organotropic properties of clindamycin in longterm experiments.Antibiot Khimioter. 1992 ;37:18– 20.

32.

Rubin DC, Swietlicki EA, Wang JL, Donson BD, Lavin MS. Enterocytic gene expression in intestinal adaptation: evidence for a specific cellular response. Am J Physiol. 1996 ;270:G143– G152.

33.

Ireton-Jones C. The role of nutrition in the adaptation of the small intestine after massive resection. Nutr Clin Pract. 2003 ;18:338– 339.

Oral Antibiotics Attenuate Bowel Segment Reversal–Induced Systemic Inflammatory Response and Body Weight Loss in Massively Bowel-Resected Rats

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