Bengmark S, Jeppsson B
Department of Surgery, Lund University, Sweden.
JPEN J Parenter Enteral Nutr. 1995 Sep-Oct;19(5):410-5. doi: 10.1177/0148607195019005410.
There is increasing evidence that preservation of the ecology of the gastrointestinal tract and the surface protection system--surfactants, mucus, and fiber--is important for the outcome in postoperative trauma patients, patients after bone marrow and liver transplantation, and patients with HIV or AIDS. Approximately 50% of the nourishment of the small intestine and > 80% of the nourishment of the large intestine comes from the lumen. This is especially deleterious to the large intestine. Within less than a week of intestinal starvation--even in the presence of intense parenteral nutrition--a mucosal atrophy is observed, promoting translocation of potentially pathogenic microorganisms. Enteral nutrition is crucial to the outcome in many of these conditions. If however, such a nutrition is based on simple carbohydrates, peptides, amino acids, or fatty acids, most of the nutrition administered will be absorbed in the upper gastrointestinal tract. Complex fibers and proteins can be regarded as nutrients especially destined to the lower gastrointestinal tract. They are fermented by the probiotic flora, normally colonizing the colonic mucosa, and the necessary nutrients: short-chain fatty acids and amino acids such as arginine and glutamine are produced at the level of the colonic mucosa. Careless antibiotic treatment reduces or eliminates this flora, induces local mucosal starvation, and makes the patients vulnerable to opportunistic infections and microbial intestinal translocation.
In this review the role of the different ingredients of the surface protection system are discussed. A program to recondition the intestines, particularly the colonic mucosa by resupply of species-specific lactobacilli, surfactants, amino acids (especially glutamine), and oat fiber (beta-glucans) is suggested. Extensive experience in animal models and early experience in a patient population are summarized and discussed. Oat has been chosen as a substrate for fermentation because it contains 100 times more of membrane lipids (surfactants) than any other food, has a favorable amino acid pattern (rich in glutamine), and is rich in water-soluble, fermentable-fiber beta-glucans. More than 1000 isolates of human-specific lactobacilli have been studied. Some strains, especially those of plantarum type, have proven effective in colonizing the colonic mucosa, suppressing the potentially pathogenetic flora, and may have other probiotic effects as well.
A totally new enteral formula has been designed based on probiotic bacteria and fiber and aimed at colonizing the intestinal mucosa with a local probiotic effect and fermentation of fiber.
越来越多的证据表明，保护胃肠道生态以及表面保护系统（表面活性剂、黏液和纤维）对于术后创伤患者、骨髓和肝移植术后患者以及艾滋病毒或艾滋病患者的预后至关重要。小肠约50%的营养以及大肠超过80%的营养来自肠腔。这对大肠尤其有害。在肠道饥饿不到一周的时间内——即使在进行强化肠外营养的情况下——也会观察到黏膜萎缩，促进潜在致病微生物的易位。肠内营养对许多此类情况的预后至关重要。然而，如果这种营养基于简单碳水化合物、肽、氨基酸或脂肪酸，那么所给予的大部分营养将在上消化道被吸收。复杂纤维和蛋白质可被视为特别针对下消化道的营养素。它们由通常定植于结肠黏膜的益生菌群发酵，并产生必需营养素：短链脂肪酸以及精氨酸和谷氨酰胺等氨基酸。不当的抗生素治疗会减少或消除这种菌群，导致局部黏膜饥饿，并使患者易患机会性感染和微生物肠道易位。
在本综述中，讨论了表面保护系统不同成分的作用。提出了一个通过重新补充特定种类的乳酸杆菌、表面活性剂、氨基酸（尤其是谷氨酰胺）和燕麦纤维（β-葡聚糖）来调理肠道，特别是结肠黏膜的方案。总结并讨论了在动物模型中的广泛经验以及在患者群体中的早期经验。选择燕麦作为发酵底物是因为它含有的膜脂（表面活性剂）比任何其他食物多100倍，具有良好的氨基酸模式（富含谷氨酰胺），并且富含水溶性、可发酵纤维β-葡聚糖。已经研究了1000多种人类特异性乳酸杆菌分离株。一些菌株，尤其是植物乳杆菌类型的菌株，已被证明在定植结肠黏膜、抑制潜在致病菌群方面有效，并且可能还具有其他益生菌作用。
基于益生菌和纤维设计了一种全新的肠内配方，旨在通过局部益生菌作用和纤维发酵使肠道黏膜定植。
