Postoperative enteral feeding does not prevent intestinal bacterial translocation, but reduces the rate of pulmonary infections in pigs undergoing total orthotopic small bowel transplantation.
OBJECTIVE
To assess the effects of a non-elemental liquid diet on nutritional state, composition of bowel flora, intestinal translocation, and pulmonary infections after small bowel transplantation in pigs.


METHODS
Prospective randomised experiment.


METHODS
Teaching hospital, Italy.


METHODS
32 female Large White pigs.


METHODS
Group 1 (n = 6) underwent small bowel transplantation, were treated with immunosuppression, and fed on commercial chow. Group 2 (n = 6) were treated similarly except that they were fed with an enteral feed through a tube gastrostomy starting on day 4 postoperatively. Group 3 (n = 6) were treated similarly to group 1 except that they had no immunosuppression, and Group 4 (n = 6) underwent orthotopic small bowel autotransplantation; 8 further pigs underwent a sham operation only to act as controls.


METHODS
Signs of rejection, graft-versus-host-disease, luminal bacterial overgrowth, bacterial translocation, pneumonia, and the pigs' nutritional state.


RESULTS
All animals in group 3 showed signs of acute rejection. There was appreciable overgrowth of aerobic and anaerobic bacteria in all three groups after allotransplantation compared with controls. The counts of anaerobic bacteria were significantly lower in group 2 (enterally fed animals) compared with those given free access to commercial chow [mean (SD) 2.81 (1.39) log CFU/cm2 compared with 4.80 (1.65), p = 0.047]. Bacterial translocation developed to a similar degree after autografts and allografts and pneumonia developed in fewer animals after enteral feeding (1/6) than after conventional feeding (5/6) but the difference was not significant (p = 0.08, odds ratio 25.0, 95% confidence interval of odds ratio 1.20 to 521.13). Enterally fed animals also lost less weight than conventionally fed animals [2.32 (1.23) kg compared with 4.53 (1.74), p = 0.016].


CONCLUSIONS
Enteral feeding for up to a month slightly reduced the rate of pneumonia and resulted in a better nutritional state in pigs after small bowel transplantation. It had no effect on luminal bacterial overgrowth or translocation.
Biffi
R
R
European Institute of Oncology, Università di Milano, Ospedale Maggiore Policlinico, Italy. rbiffi@ieo.cilea.it
Privitera
G
G
Pozzi
S
S
Conte
E
E
Marzona
L
L
Velio
P
P
Andreoni
B
B
D000818:Animals; D018988:Bacterial Translocation; D016572:Cyclosporine / Q000627:therapeutic use; D004195:Disease Models, Animal; D004750:Enteral Nutrition; D005069:Evaluation Studies as Topic; D005260:Female; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007421:Intestine, Small / Q000637:transplantation*; D011183:Postoperative Complications / Q000517:prevention & control*; D011897:Random Allocation; D013552:Swine; D014182:Transplantation, Autologous
D007166:Immunosuppressive Agents; D016572:Cyclosporine