Net digestive absorption and adaptive hyperphagia in adult short bowel patients.
OBJECTIVE
Intestinal adaptation after small bowel resection in humans is debated. We have quantified in adult short bowel (remnant small bowel length <2 m) patients oral intake and net digestive absorption and their evolution over time.


METHODS
Oral intake and faecal output were studied over three days in 90 patients (39 and 51 without or with parenteral nutrition, respectively) and in 14 patients in early (<6 months) and late (>6 months) periods after digestive continuity. Nitrogen and fat output were measured using chemiluminescence and Van de Kamer techniques, respectively.


RESULTS
In the whole group, 81% of patients had hyperphagia (spontaneous oral intake >1.5 x resting energy expenditure), independently and negatively related to fat absorption (p<0.01) and body mass index (p<0.001) but not braked by the presence of parenteral nutrition. Protein and fat absorption were related to small bowel length. We observed, in the late in comparison with the early period after digestive continuity: an increase in oral intake (1.6 v 2.3 resting energy expenditure), decrease in stool weight/oral intake ratio, no reduction in per cent fat absorption, and protein absorption improvement associated with a significant increase in the amount of protein absorbed (40 v 64 g/day; p<0.05), both being correlated with remnant small bowel length (p<0.01).


CONCLUSIONS
This study confirms an adaptive hyperphagia in adult short bowel patients. Over time, hyperphagia and amount of protein absorbed increased, the latter being related to remnant small bowel length, indicating a behavioural adaptation that allows expression of intestinal absorptive adaptation.
Hepatogastroenterology and Nutrition Support Department, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France. pascal.crenn@lrb.ap-hop-paris.fr
P
P
Crenn
M C
MC
Morin
F
F
Joly
S
S
Penven
F
F
Thuillier
B
B
Messing
D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003672:Defecation; D004044:Dietary Proteins / Q000493:pharmacokinetics; D004435:Eating; D002149:Energy Intake; D005260:Female; D006801:Humans; D006963:Hyperphagia / Q000503:physiopathology*; D007408:Intestinal Absorption; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D012778:Short Bowel Syndrome / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy
D004044:Dietary Proteins