Gut barrier function and the surgeon

Saadia, Roger; Schein, Moshe; MacFarlane, Campbell; Boffard, Kenneth D.

doi:10.1002/bjs.1800770505

Cited by 124 publications

(43 citation statements)

References 71 publications

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“…Thus we selected mortality, hospital . Total parenteral nutritional support has long been the standard source of exogenous nutrients for these patients, however this is costly and associated with many disadvantages, including dysfunction of the intestinal mucosal barrier, which, in turn, promotes sepsis of intestinal origin (27,28). While these concepts should now be replaced by the principle that pancreatic stimulation should be maintained and that the stress response should be contained to reduce the likelihood of multiorgan failure, nosocomial infections and mortality (29).…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis: Total Parenteral Nutrition Versus Total Enteral Nutrition in Predicted Severe Acute Pancreatitis

et al. 2012

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Background Total parenteral nutrition (TPN) as a traditional mode of treatment in severe acute pancreatitis was still used widely in clinical work. In addition, enteral nutrition treatment methods have developed; early enteral nutrition has already been highlighted for severe acute pancreatitis, but the therapeutic risks versus benefits need to be studied. Aims and Objective To compare total parenteral nutrition with total enteral nutrition (TEN) in patients with severe acute pancreatitis by performing a meta-analysis. Materials and Methods Electronic databases including PubMed, EMBASE, Science Citation Index, were searched to find relevant randomized controlled trials. Two reviewers independently identified relevant trials evaluating the effect of total parenteral nutrition and early enteral nutrion. Outcome measures were the mortality, hospital length of stay, infectious complications, duration of nutrition, organ failure and surgical inter- p=0.22,)] and as for duration of nutrition [p=0.72, 95%CI -1.50(-9.56-6.56)] there was not enough data to compare the differences. Conclusion Total enteral nutritional support is associated with lower mortality, fewer infectious complications, decreased organ failure and surgical intervention rate compared to parenteral nutritional support.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis: Total Parenteral Nutrition Versus Total Enteral Nutrition in Predicted Severe Acute Pancreatitis

et al. 2012

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“…1 The gut plays a very important role, not only for digestion and absorption of diets, but also as a barrier function to protect the internal milieu from pathogens . Bacterial translocation from the gut is emerging as an important pathogenic phenomenon and are potential sources of septicemia in critically ill or im munocompromised hosts (44,45) . Bacterial translocation can be stimulated by a disruption in the gastrointestinal microflora due to surgery, antibiotics, radiation , and impaired immune function (46).…”

Section: Nucleic Acids and Immunitymentioning

confidence: 99%

Nucleic Acids and/or Their Components: A Possible Role in Immune Function.

Adjei

Yamamoto

Kulkarni

1995

Journal of Nutritional Science and Vitaminology, J Nutr Sci Vit

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SummaryDietary sources of nucleic acids and/or their components, have not been considered essential for normal growth and development. However, growing evidence shows that the compounds regulate various steps of the immune system and demonstrate the neccessity of the com pounds in the response to immunological challenge. The significance of exogenously administered purine or pyrimidine bases, nucleotides, and nucleosides in the immune response is reviewed. Key Words nucleoside, nucleotide, infection, immunity, parenteral for mula, enteral formula Nucleic acids and/or their components in the diet have not been considered essential for normal growth and development because it was generally assumed that living organisms, including humans, could synthesize adequate amounts of the compounds required for normal growth and development and that dietary sources are not utilized. This assumption was based on studies done on normal healthy individuals who were not confronted with an immunological challenge (1, 2). Recent studies have documented that the gut and the immune system depend mainly on salvage of purine and pyrimidine bases and that the de novo synthesis is not adequate to meet the demand of various metabolically active cells or tissues. This report reviews current knowledge on the role of nucleic acids and/or their components.Nucleotides are low molecular weight biological compounds that are involved in almost all biochemical processess. They consist of either purines or pyrimidines (nitrogen containing bases). The major purine bases are adenine and guanine, and the major pyrimidines are thymine, cytosine, and uracil. Nucleotides are the building blocks of DNA and RNA and play essential roles in structural, metabolic, energetic, and regulatory functions particularly as components of adenosine tri phosphate and other nucleotide triphosphates and in many co-enzymes. The daily

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“…However, bacterial translocation from the gastrointestinal tract to the systemic circulation is considered to be of major importance for the pathogenesis of postoperative infections [6][7][8][9]. Physical injury of the intestinal mucosa leading to disruption of the gut barrier and increased intestinal permeability as well as microbial imbalance and decreased immunodeficiency of the surgical patient are considered to be the main causes of bacterial translocation [10][11][12].…”

mentioning

confidence: 99%

Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials

Pitsouni

Alexiou

Saridakis

et al. 2009

Eur J Clin Pharmacol

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Background Advances in surgery have considerably lowered postoperative morbidity. However, infection remains a considerable morbidity factor. The aim of this review is to identify the potential benefit(s) of the perioperative administration of probiotics/synbiotics to patients undergoing abdominal surgery. Methods We searched PubMed, Scopus, Web of Science, and Cochrane library to identify randomized controlled trials (RCTs) that studied the perioperative administration of probiotics/synbiotics to patients undergoing abdominal surgery. Results Nine RCTs studying 733 patients were included in our review. The incidence of postoperative pneumonia, cholangitis, and any infections as well as the duration of postoperative hospital stay and length of antibiotic therapy were lower among patients receiving probiotics than in the control group [six RCTs, 355 patients, odds ratio (OR) 0.24, 95% confidence interval (CI) 0.09-0.68; three RCTs, 209 patients, OR0.18, 95% CI0.05-0.57; seven RCTs, 514 patients, OR 0.26, 95% CI 0.12-0.55; five RCTs, 313 patients, OR −2.70, 95% CI−5.15 to −0.25; four RCTs, 250 patients, OR −4.01, 95% CI−5.11 to −2.92, respectively], while the incidence of postoperative wound infection, urinary tract infection, intra-abdominal abscess, and mortality was not different between patients of the compared groups (six RCTs, 355 patients, OR0.52, 95% CI0.23-1.18; five RCTs, 313 patients, OR0.44, 95% CI0. four RCTs, 226 patients, OR0.44, nine RCTs, 685 patients, OR0.98, respectively). Conclusion The use of probiotics/synbiotics may reduce postoperative infections after abdominal surgery. This is a promising infection-preventive measure that may decrease morbidity, length of antibiotic therapy, duration of hospital stay, and pressure for emergence of antimicrobial resistance. However, the results of this meta-analysis should be interpreted with caution due to the significant heterogeneity of the studies included.

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Gut barrier function and the surgeon

Cited by 124 publications

References 71 publications

Meta-analysis: Total Parenteral Nutrition Versus Total Enteral Nutrition in Predicted Severe Acute Pancreatitis

Meta-analysis: Total Parenteral Nutrition Versus Total Enteral Nutrition in Predicted Severe Acute Pancreatitis

Nucleic Acids and/or Their Components: A Possible Role in Immune Function.

Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials

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