       Document 0614
 DOCN  M9650614
 TI    Gastrointestinal surface protection and mucosa reconditioning.
 DT    9605
 AU    Bengmark S; Jeppsson B; Department of Surgery, Lund University, Sweden.
 SO    JPEN J Parenter Enteral Nutr. 1995 Sep-Oct;19(5):410-5. Unique
       Identifier : AIDSLINE MED/96105880
 AB    BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSION: 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.
 DE    Animal  Fermentation  Gastrointestinal
       System/CHEMISTRY/MICROBIOLOGY/*PHYSIOLOGY  Glutathione/ADMINISTRATION &
       DOSAGE/PHARMACOLOGY  Human  Intestinal
       Mucosa/CHEMISTRY/MICROBIOLOGY/*PHYSIOLOGY  Mucus/PHYSIOLOGY  Oats
       Phospholipids/ANALYSIS/PHYSIOLOGY  Support, Non-U.S. Gov't  JOURNAL
       ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

