title: Gut mucosal atrophy after a short enteral fasting period in critically ill patients.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the presence of gut mucosal atrophy and changes in mucosal permeability in critically ill patients after a short fasting period.
  
  
  METHODS
  Fifteen critically ill patients underwent a period of enteral fasting of at least 4 days (mean 7.8 days). We took the following measurements the day before initiating enteral nutrition: indirect calorimetry, serum albumin, prealbumin, and lymphocyte count. We also performed a duodenal endoscopic biopsy with histopathological and mucosal morphometric analysis including villus height and crypt depth. The lactulose-mannitol test was performed to assess gut permeability. A total of 28 healthy volunteers served as controls for duodenal biopsy or lactulose-mannitol test. Clinical data, such as length of fasting, severity score, and previous parenteral nutritional support, were recorded.
  
  
  RESULTS
  We found gut mucosal atrophy, expressed as a decrease in villus height and crypt depth, in patients compared with controls. The patients also exhibited an abnormal lactulose-mannitol test. Morphometric changes did not correlate with permeability. Further, we found no correlation between the results of the lactulose-mannitol test and of mucosal morphometry with clinical data.
  
  
  CONCLUSIONS
  We found that a short period of enteral fasting was associated with significant duodenal mucosal atrophy and abnormal gut permeability in critically ill patients.
authors.affiliation: Hospital Clinico, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago.
authors.forename: G
authors.initials: G
authors.lastname: Hernandez
authors.forename: N
authors.initials: N
authors.lastname: Velasco
authors.forename: C
authors.initials: C
authors.lastname: Wainstein
authors.forename: L
authors.initials: L
authors.lastname: Castillo
authors.forename: G
authors.initials: G
authors.lastname: Bugedo
authors.forename: A
authors.initials: A
authors.lastname: Maiz
authors.forename: F
authors.initials: F
authors.lastname: Lopez
authors.forename: S
authors.initials: S
authors.lastname: Guzman
authors.forename: C
authors.initials: C
authors.lastname: Vargas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001706:Biopsy; D016022:Case-Control Studies; D002463:Cell Membrane Permeability; D016638:Critical Illness / Q000628:therapy*; D004384:Duodenoscopy; D004386:Duodenum / Q000473:pathology*; D005215:Fasting / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000166:cytology / Q000473:pathology* / Q000503:physiopathology; D007792:Lactulose / Q000493:pharmacokinetics / Q000652:urine; D008297:Male; D008353:Mannitol / Q000493:pharmacokinetics / Q000652:urine; D008875:Middle Aged; D015596:Nutrition Assessment; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D008353:Mannitol; D007792:Lactulose