Nutritional benefit of recycling bowel content in an infant with short bowel syndrome.
Nutritional benefit of recycling bowel content in an infant with short bowel syndrome.
复制标题
回收肠道内容物对患有短肠综合症的婴儿的营养益处。
DOI：
10.1097/mpg.0000000000001630
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Kuwahara T.
中科院分区：
文献类型：
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作者：
Tanaka A;Nakayama-Imaohji H;Shimono R;Suzuki M;Fujii T;Kubo H;Yasuda S;Koyano K;Nakamura S;Katsuki N;Kuwahara T.
致编辑：短肠综合征 (SBS) 是肠道衰竭的主要原因 (1)。患有这种情况的患者通常会建造近端造口。肠内容物回收 (RBC) 是一种将造口近侧排出的食糜注射到远端的过程 (2-7)。红细胞有望挽救未吸收的营养物质，促进肠道功能成熟，并改变造口下游的肠道微生物群。我们报告了红细胞对 SBS 婴儿营养状况、肠道成熟和肠道微生物组成的影响。还讨论了添加合生元的潜在好处。一名患有胎便性腹膜炎的女婴接受了广泛的肠道解剖，并构建了双环回肠造口术，留下了 58 厘米的小肠和完整的结肠。开始红细胞联合合生素治疗（丁酸梭菌、两歧双歧杆菌和部分水解瓜尔胶），体重增加改善，肠外营养需求减少78%（图1）。肠粘膜显着成熟，回肠绒毛长度（205.36 Æ20.3 vs 555.34 Æ61.92 mm，P ¼ 0.0016）、宽度（64.67 Æ11.21 vs 118.93 Æ19. 47 mm，P ¼0. 0016）和隐窝深度改善(101.98 Æ8. 99 对比 242.9 Æ15。 857 毫米，P=0。 0016）。通过使用 16S 核糖体 RNA 基因测序定期评估粪便微生物群的多样性，并随着红细胞和合生元治疗的反应而增加，微生物群的模式变得与健康年龄匹配的婴儿相似。在我们的案例中，红细胞与合生元治疗相结合可能通过预防远端肠萎缩和建立共生肠道微生物群来改善营养状况。
To the Editor: Short bowel syndrome (SBS) is a major cause of intestinal failure (1). A proximal stoma is often constructed in patients with this condition. Recycling of bowel content (RBC) is a procedure that involves injection of chyme discharged from the proximal side of a stoma into the distal side (2–7). RBC is expected to salvage unabsorbed nutrients, facilitate maturation of intestinal function, and alter the gut microflora downstream of the stoma. We report on the effects of RBC on nutrition status, bowel maturation, and microbial composition of the gut in an infant with SBS. Potential benefits of adding synbiotics are also addressed.A female infant with meconium peritonitis underwent extensive intestinal dissection with construction of a doublelooped ileostomy, leaving 58cm of the small intestine and an intact colon. RBC combined with synbiotic therapy (Clostridium butyricum, Bifidobacterium bifidum, and partially hydrolyzed guar gum) was started, weight gain improved and parental nutrition requirements decreased by 78%(Fig. 1). There was significant maturation of the intestinal mucosa with improved ileal villus length (205.36 Æ20. 3 vs 555.34 Æ61. 92 mm, P ¼ 0.0016), width (64.67 Æ11. 21 vs 118.93 Æ19. 47 mm, P ¼0. 0016), and crypt depth (101.98 Æ8. 99 vs 242.9 Æ15. 857 mm, P ¼0. 0016). Diversity of the fecal microbiota was assessed periodically by using 16S ribosomal RNA gene sequencing and increased in response to RBC and synbiotic therapy, with the pattern of the microbiota becoming similar to that in healthy age-matched infants. In our case, RBC combined with synbiotic treatment may have improved nutritional status by preventing distal bowel atrophy and establishing a symbiotic intestinal microbiota.