title: Nutritional effects of surgical and medical treatment for short bowel syndrome.
abstract: BACKGROUND
  The choice of treatment options in short bowel syndrome (SBS) is hampered by a lack of comparative studies. This study uses a previously validated juvenile pig model of SBS to compare nontreated controls (C), surgical treatment with either proximal colon interposition (CI) or bowel lengthening (BL), with medical treatment with codeine and cimetidine (M).
  
  
  METHODS
  Treatment was initiated 6 weeks after resection of 75% of the small bowel, and animals were followed until sacrifice at week 16. Feed intake and weight gain were monitored throughout; in vivo nutrient absorption, in vitro nutrient transport, sodium-glucose cotransporter activity, and intestinal morphology (gross and microscopic) were examined at the end of treatment.
  
  
  RESULTS
  BL and M treatments resulted in improved rates of weight gain; this improvement was associated with improved absorption of dietary fat. The treatments did not affect carbohydrate or protein absorption in vivo. In vitro fatty acid absorption was not increased in any group. Active uptake of glucose was increased in the colon interposition group, but phlorizin binding (reflecting sodium glucose cotransporter activity) did not differ between groups. Gross serosal and microscopic mucosal surface areas increased in all groups; however, there were no significant differences between the treatment groups.
  
  
  CONCLUSIONS
  These results demonstrate that bowel lengthening and medical treatment improved the rate of weight gain in this model of SBS. This appeared to be due to improvement in the absorption of dietary fat, which was not caused by alterations in in vitro uptake or mucosal surface area, suggesting these treatments have their affects by altering motility or intraluminal digestion. These findings suggest that these treatments are worthy of further study in treating patients (primary pediatric) with SBS.
authors.affiliation: Department of Surgery, Alberta Children's Hospital, University of Calgary, Canada. sigalet@ucalgary.ca
authors.forename: D L
authors.initials: DL
authors.lastname: Sigalet
authors.forename: G M
authors.initials: GM
authors.lastname: Lees
authors.forename: F X
authors.initials: FX
authors.lastname: Aherne
authors.forename: R
authors.initials: R
authors.lastname: Fedorak
authors.forename: M
authors.initials: M
authors.lastname: Keelan
authors.forename: A B
authors.initials: AB
authors.lastname: Thomson
authors.forename: J
authors.initials: J
authors.lastname: van Aerde
mesh_terms: D000818:Animals; D002927:Cimetidine / Q000627:therapeutic use; D003061:Codeine / Q000627:therapeutic use; D004041:Dietary Fats / Q000493:pharmacokinetics*; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000502:physiology; D009294:Narcotics / Q000627:therapeutic use; D012778:Short Bowel Syndrome / Q000188:drug therapy* / Q000601:surgery*; D013552:Swine; D016896:Treatment Outcome; D015430:Weight Gain
chemical_list: D004041:Dietary Fats; D004791:Enzyme Inhibitors; D009294:Narcotics; D002927:Cimetidine; D003061:Codeine