Intestinal adaptation after small bowel resection in human infants

Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Journal of Pediatric Surgery (Impact Factor: 1.39). 06/2011; 46(6):1045-51. DOI: 10.1016/j.jpedsurg.2011.03.027
Source: PubMed


In animal models, the small intestine responds to massive small bowel resection (SBR) through a compensatory process termed adaptation, characterized by increases in both villus height and crypt depth. This study seeks to determine whether similar morphologic alterations occur in humans after SBR.
Clinical data and pathologic specimens of infants who had both an SBR for necrotizing enterocolitis and an ostomy takedown from 1999 to 2009 were reviewed. Small intestine mucosal morphology was compared in the same patients at the time of SBR and at the time of ostomy takedown.
For all samples, there was greater villus height (453.6 ± 20.4 vs 341.2 ± 12.4 μm, P < .0001) and crypt depth (178.6 ± 7.2 vs 152.6 ± 6 μm, P < .01) in the ostomy specimens compared with the SBR specimens. In infants with paired specimens, there was an increase of 31.7% ± 8.3% and 22.1% ± 10.0% in villus height and crypt depth, respectively. There was a significant correlation between the amount of intestine resected and the percent change in villus height (r = 0.36, P < .05).
Mucosal adaptation after SBR in human infants is similar to what is observed in animal models. These findings validate the use of animal models of SBR used to understand the molecular mechanisms of this important response.

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Available from: Christopher R Erwin, Feb 04, 2014
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    • "The length of remaining healthy tissue is a key determinant of patient outcomes in SBS. After surgery, the intestine adapts and increases in circumference and length in an attempt to compensate for the loss of tissue (Dekaney et al., 2007; Garrison et al., 2009; McDuffie et al., 2011; Seetharam and Rodrigues, 2011). Surgical lengthening procedures have been explored to exploit this phenomenon but result in far less than a 2-fold increase in length (Chang et al., 2006; Khalil et al., 2012; Oliveira et al., 2012; Scott et al., 2015). "
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