Gut mucosal atrophy after a short enteral fasting period in critically ill patients.
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.
Hernandez
G
G
Hospital Clinico, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago.
Velasco
N
N
Wainstein
C
C
Castillo
L
L
Bugedo
G
G
Maiz
A
A
Lopez
F
F
Guzman
S
S
Vargas
C
C
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
D008353:Mannitol; D007792:Lactulose