title: A prospective study comparing histology and enteric enzyme function of patients with extrahepatic portal vein obstruction before and after shunt surgery.
abstract: BACKGROUND
  This was a prospective observational study carried out to objectively assess the effect of shunt surgery on intestinal morphology and function in patients with extrahepatic portal vein obstruction (EHPVO) and correlate it with growth improvement.
  
  
  METHODS
  Twenty patients who were operated upon for EHPVO were divided into two groups for the purpose of analysis depending on the outcome of surgery: group A--patients who underwent successful shunt surgery (n=14) and group B--patients who underwent splenectomy with devascularization (n=1) and those with thrombosed shunts (n=5). The patient groups were created on the basis of the type and outcome of the surgery and not prospective stratification. Growth parameters, endoscopy findings, duodenal histology, brush border enzyme activity, urinary D-xylose levels, fecal steatocrit, fecal α-1 antitrypsin, serum growth hormone and insulin-like growth factor-1 levels, and quality-of-life scores were assessed before surgery and at a mean of 24.9 weeks after surgery.
  
  
  RESULTS
  There was no significant difference between the preoperative and postoperative duodenal histology. Preoperative brush border lactase activity was significantly lower than normal and did not change significantly after surgery. EHPVO did not affect intestinal absorption or permeability. Shunt surgery resulted in significantly improved z scores for height after surgery as well as quality of life. There was no significant growth hormone resistance.
  
  
  CONCLUSIONS
  Our patients did not have any significant malabsorption or abnormality in small intestinal structure and function when compared with established normal levels. There was no significant change in the above parameters after shunt surgery, although an improvement in growth was observed. Thus, factors other than enteropathy or other lesser known enteral factors seem to be responsible for the growth retardation observed in EHPVO and its subsequent improvement after shunt surgery.
authors: Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Abhilasha T
authors: AT
authors: Handu
authors: Kaushal K
authors: KK
authors: Prasad
authors: Babu R
authors: BR
authors: Thapa
authors: Prema
authors: P
authors: Menon
authors: Yatindra K
authors: YK
authors: Batra
authors: Katragadda L N
authors: KL
authors: Rao
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000201:enzymology* / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006128:Growth / Q000502:physiology; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D008297:Male; D011169:Portal Vein / Q000503:physiopathology / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D013156:Splenectomy / Q000379:methods*; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I