Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Medical Gastroenterology and Hepatology, Rigshospitalet, Copenhagen, Denmark.
JPEN J Parenter Enteral Nutr. 2020 May;44(4):677-687. doi: 10.1002/jpen.1704. Epub 2019 Sep 9.
Weaning from parenteral support is considered indirect evidence of intestinal adaptation in patients with short bowel syndrome (SBS), but direct evidence is lacking. The objective of this study was to examine if intestinal adaptation could be demonstrated as increase in intestinal absorption of energy and wet weight over time measured by repeated metabolic balance studies (MBSs) and to examine whether adaptation was determined by the anatomy of the remnant bowel.
We retrospectively analyzed data from 48 repeated MBSs performed in 13 adult patients with SBS. Results were presented graphically and interpreted. The interpatient and intrapatient heterogeneity was compared based on anatomy of the remnant bowel.
The number of repeated MBSs ranged from 2 to 7, and time between last intestinal resection and MBS from 5 months to 18.1 years. In 6 patients, the first MBS was performed within 2 years after last resection, but only 1 patient had repeated MBSs within this period. Nine patients had an end jejunoileostomy, and 4 patients had a jejuno-colonic or ileo-colonic anastomosis. None of the patients had jejunoileal anastomosis with a preserved ileocecal valve. Interpatient and intrapatient heterogeneity of wet weight and energy absorption was larger in patients without colon in continuity. The wet weight and energy absorption data showed no tendency toward intestinal adaptation in any anatomical group.
We observed no signs of late-phase intestinal adaptation in this selected group of patients with SBS. Future prospective MBSs are needed to understand the time course and magnitude of intestinal adaptation.
在短肠综合征（SBS）患者中，从肠外支持中脱机被认为是肠道适应的间接证据，但缺乏直接证据。本研究的目的是通过重复代谢平衡研究（MBS）来检查肠道适应是否可以表现为能量和湿重的吸收随时间增加，并检查适应是否取决于残留肠道的解剖结构。
我们回顾性分析了 13 名 SBS 成年患者的 48 次重复 MBS 的数据。结果以图形方式呈现并进行解释。根据残留肠道的解剖结构比较了患者间和患者内的异质性。
重复 MBS 的次数范围为 2 至 7 次，最后一次肠切除与 MBS 之间的时间为 5 个月至 18.1 年。在 6 名患者中，第一次 MBS 是在最后一次切除后 2 年内进行的，但只有 1 名患者在此期间进行了重复 MBS。9 名患者有终末空回肠造口术，4 名患者有空肠结肠或回肠结肠吻合术。没有患者有空肠回肠吻合术并保留回盲瓣。无结肠连续的患者中，湿重和能量吸收的患者间和患者内异质性较大。湿重和能量吸收数据在任何解剖学组中均未显示出肠道适应的趋势。
我们在这组选定的 SBS 患者中未观察到晚期肠道适应的迹象。需要进行前瞻性 MBS 以了解肠道适应的时间进程和幅度。
