Stimulation of mucosal growth by gastric and ileal infusion of single amino acids in parenterally nourished rats.

The effect on the intestinal mucosa of continuously infusing single amino acids, glycine, valine and histidine into the stomach and ileum was compared with saline and an amino acid mixture (AA) in rats fed to parenteral nutrition. After gastric infusion, glycine did not differ from saline, valine increased mucosa in the proximal segments and histidine alone increased mucosa in the proximal bowel equal to AA. After ileal infusion, all amino acids increased mucosa in the ileum. Valine and histidine, but not glycine, increased mucosa in the remote proximal small bowel. Therefore, regional differences occur in mucosal growth response to single amino acids.

Colorectal cancer screening.

The efficacy of Hemoccult screening for colorectal carcinoma is analyzed utilizing five criteria which a screening test should fulfil before it is used for mass screening. The Hemoccult screening protocol has serious weaknesses. It is at best 83% sensitive for cancer and much less sensitive for polyps. An asymptomatic person with one or more positive Hemoccult slides only has a 12% chance of having cancer. In addition, patient acceptance of mass Hemoccult screening is questionable. There is currently little information on potential survival benefits, and Hemoccult screening is expensive with one quarter of all costs incurred in the diagnostic evaluation of false positives. There is insufficient evidence to recommend Hemoccult colorectal cancer screening in asymptomatic persons as a cost-effective practice.

Alterations in pentobarbital pharmacokinetics in response to parenteral and enteral alimentation in the rat.

Recent in vitro observations suggest that the intestine, in addition to the liver, may be an important organ of first-pass drug metabolism. While a variety of changes in intestinal morphology and function in response to continuous parenteral and enteral nutrition have been documented, the effect of different routes of alimentation on intestinal drug metabolism has not been previously investigated. Objectives of this study were to assess the contribution of intestinal pentobarbital metabolism to overall in vivo pentobarbital pharmacokinetics in the rat and to determine if differences in pentobarbital pharmacokinetics were seen between parenterally and enterally nourished animals. After 7 days of continuous infusion of amino acid-glucose mixture via a gastric or jugular vein catheter, pharmacokinetic parameters were determined after 40 mg/kg of pentobarbital was given orally or into the portal or femoral vein. Reduced systemic availability of pentobarbital after oral administration as compared to portal vein injection was seen in both alimentation groups indicating that significant intestinal metabolism of pentobarbital occurred in vivo. Total area under the pentobarbital plasma concentration-time curve was significantly greater in parenterally nourished animals as compared with enterally alimented animals after oral, portal vein and systemic vein drug administration. Differences in pentobarbital, pharmacokinetics between the two alimentation groups appeared to be primarly due to effects on hepatic pentobarbital metabolism. While the mechanism producing these changes has not been defined, differences in gut hormones release and/or pancreatic secretion in response to the two routes of alimentation may be contributory. The widespread use of enteral and parenteral alimentation in clinical medicine suggests that studies to determine if nutrition route of administration similarly influences drug metabolism in humans may be indicated.

Direct and indirect effects of dextrose and amino acids on gut mass.

Oral intake of an elemental diet maintains small intestinal mucosal mass compared to the atrophy seen after intravenous infusion of the same diet. The greatest difference in intestinal mass occurs in the proximal bowel and is thought to occur because of rapid absorption in the proximal small bowel. This study was designed to determine the effects of the individual components of the elemental diet and their site of administration within the small bowel on small intestinal mass. Rats were maintained on intravenous alimentation and the proximal gut (by intragastric infusion) or the ileum was continuously infused with equal volumes of 30% dextrose, 5% dextrose, 5% amino acids, saline, or 30% mannitol. After 1 week of combined intravenous alimentation and gut infusion, the rats were killed and parameters of small intestinal epithelial mass were determined sequentially for the entire bowel. Although saline- and mannitol-infused controls did not differ from uninfused intravenously fed rats, proximal infusion of 30% dextrose reproduced the effects of a complete elemental diet. Proximal infusion of amino acids but not 5% dextrose had a limited effect on the duodenum and jejunum. Ileal infusion of 30% dextrose led to local hyperplasia of the site of infusion and in addition produced hyperplasia of the proximal gut. Ileal amino acid infusion, but not 5% dextrose infusion, led to local ileal hyperplasia. We conclude that: (1) intraluminal dextrose and amino acids have direct effects in maintaining gut mass (2) the gut is more responsive to amino acids compared to 5% dextrose, and (3) ileal 30% dextrose infusion leads to remote effects in the proximal gut, perhaps mediated by hormonal or neurovascular factors.

Small intestinal mass of the rat is partially determined by indirect effects of intraluminal nutrition.

Although intraluminal nutrition presumably maintains small intestinal mass by direct contact with the epithelial cells, hormonal or neurovascular elicited by feeding may play an indirect role. In order to test for the presence of indirect factors, Thiry- Vella fistulae were created from the proximal small intestine of two groups of rats. The bypassed gut of a group of rats receiving an elemental diet intravenously was compared to a second group receiving the same diet by intragastric infusion. After 1 week, there was significantly greater (P less than 0.01) gut weight, mucosal weight, DNA content, and protein content of both the gut in continuity and tje bypassed gut of intragastric infused rats. Total sucrase activity was also greater (P less than 0.01) in intragastric fed rats, and this was due to both a greater protein content and specific activity (P is less than 0.05) of the gut in continuity and to the greater protein content of the bypassed gut. Serum gastrin levels were similar (P less than 0.05) in both groups, suggesting that gastrin may not play a role in initiating the differences reported. This study suggests that intraluminal nutrition maintains the small intestinal epithelial population in part, indirectly, by unidentified hormonal or neurovascular stimuli.