- Email: [email protected]
Administration of Lactobacillus plantarum 299v reduces side effects of external radiation on colon anastomotic healing in rats
AGAAI071
April 2000
4969
4971
ADMINISTRATION OF LACTOBACILLUS PLA NTA RUM 299V REDUCES SIDE EFFECTS OF EXTERNAL RADIATION ON COLON ANASTOMOTIC HEALING IN RATS. Qing Liu, Soran Nobaek, Diya Adawi, Yilei Mao, Peter Mansson, Peter Blomquist, Goran Molin, Mats Ekelund , Bengt Jeppsson, Dept of Surg, Malmo Univ Hasp, Malmo, Sweden; Dept of Food Technology, Lund Univ, Lund, Sweden ; Dept of Surg, Lund Univ Hosp, Lund, Sweden . Preoperative radiotherapy of patients with rectal carcinoma is frequently used to reduce the incidence of local recurrence. However, the radiation therapy is associated with severaJ complications, including diarrhea, retarded anastomotic healing and mucosal atrophy. Exogenous administration of lactobacilli has been demonstrated to be effec tive in stimulating intestinal mucosal growth and reduce mucosal inflammation. The objective of this study was to examine the effects of Lactobacillus planta rum 299v administratio n on external radiation injury in colon anastomotic healing at different time points. Sprague-Dawley rats were treated with Lb. plantarum 299v or saline as control and received external radiation of the lower abdomen (10 Gy/day) on day 3 and 7 of the experiment. After 4 days. a colonic resection with anastomosis was performed. Animals were sacrificed on 4th , 7110 and 11th day postoperatively. Body weight, white blood cell (WBC) count, mucosal myeloperoxidase (MPO) activity, hydroxyprolin e, nucleotide, DNA and RNA contents, colonic bacterial microflora, bacterial translocation, and histology were evaluated. On the 4110 postoperative day body weight, WBC and MPO decreased significantly after radiation. On the 7th postoperative day MPO decreased after radiation. In the two irradiated groups it decreased significantly in the Lb. plantarum group compared to the radiated group without treatment. Collagen concentrati on on the 7th postoperati ve day was significantly higher in Lb. plantarum group without radiation compared to the group with radiation without Lb. plantaru m. On the 11th postoperative day MPO was significantly higher in irradiated rats without treatment compared to Lb. planta rum treatment The collagen content of the colonic anastomosis decreased significantly in irradiated rats without treatment compared to those treated with Lb. plantarum. It therefore seems that administration of Lactobacillus plantarum 299v reduces the intestinal injury and inflammation following external radiation and improves the colonic anastomotic healing.
NUTRITIONAL STATUS OF PATIENTS WITH CHRONIC PAN· CREATITIS ADMITTED TO A TERTIARY CARE CENTER. Laura E. Matarese, Darwin L. Conwell, Douglas L. Seidner, Gregory Zuccaro, Ezra Steiger, The Cleveland Clin Fdn, Cleveland, OH. Background: Patients with chronic pancreatitis (CP) are at increased risk of developing protein calorie malnutrition (PCM) due to pancreatic insufficiency and inadequate oral intake due to post prandial pain. It is important to assess the nutritional status of these patients in order to identify those patients at nutritional risk. The aim of this study was to determine the incidence and severity of PCM in these patients based on anthropometric , laboratory and immune status data. Methods: The nutrition assessment data base was querried to determine the number of patients with an ICD 9 code (577.2) for CP who had been seen between 1983 and 1999. Nutrition assessment parameters included height, weight, usual body weight (UBW), ideal body weight (IBW), actual body weight (ABW), per cent weight loss. body mass index (BMI), triceps skinfold (TSF), mid-upper arm muscle circumerference (MUAMC), albumin (ALB), transferrin (TFN), totallymphocyte count (TLC), response to delayed hypersensitivity skin tests (DHST), and prognostic nutrition index (PNI). Results are expressed as mean z SD. Results: 59 patients (21 females, 38 males) with a mean age of 49 ::': 4.3 years were identified. Ninety percent had evidenced of PCM based on weight loss, BMI, anthropometry, serum ALB, and DHST . There was marked weight loss of 17% ::': 13%. The mean BMI was 19.66 ::':3.95; TSF was 9 mm ::': 5; MUAMC was 21.5 em ::': 3; serum ALB was 3.3 ::': 0.7. Eighty-six percent of the patients had DHST placed. Of these, 41 % (n= 21) did not respond to skin tests, 39% (n= 20) responded to one skin test, 12 % (n = 6) responded to two skin tests, 6 % (n = 3) responded to 3 skin tests and 2% (n = I) responded to all four skin tests. Mean transferrin levels was 20 1 + 81. The mean PNI was 35 ::': 3l.Conclusion: Patients with CP are at increased risk of PCM. We identified a 90% percent incidence of PCM in patients with CP admitted to a tertiary care setting. Further prospective investigations are needed to evaluate the consequences associated with this degree of PCM.
4970 INFL UENCE OF UNDERLYING DIAGNOSIS ON OUTCOME OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) INSER· TION. Widjaja Luman, Cheung Wk, Chong Tw, Ng Hs, Singapore Gen Hosp, Singapore, Singapore; St Luke' s Hosp, Singapoire, Singapore. Introduction: There has been a rapid increase in the insertion of PEG for patients with dysph agia from a variety of causes. The impact of underlying diagnosis on the outcome of PEG is poorly documented. Methods: We undertook a retrospective review of PEG inserted in our institution between January 1995 to March 1999. Casenotes were reviewed and data on outcome was gathered from carers ( realtives or staff st nursing home). Results: 149 cases were identified from our database and 129 patients were succesffuly reviewed. There were 80 males. Median period of follow up was 300 days (Range 2-1740). 8 patients with stroke and 5 patients with nasopharyngeal carcinoma (NPC) died within 30 days after PEG; causes of death were mainly from pneumonia and advanced stage of cancer . At follow up, 6 patients with stroke were no longer on PEG as they had recovered their swallowing ability. 5 of these patients had insertion of PEG within 30 days after the onset of stroke. 7 patients with NPC were cured of their disease but had PEG inserted for dysphagia secondary to fibrosis of oropharyngea l muscle from previous radiotherapy. 6 of these patients were alive and required longterm PEG. Co nclusions: Majority of stroke patients required their PEG long term. PEG should however not be inserted in the immediate period after stroke as some of these patients may regain their swallowing ability. Outcome on patients with advanced NPC is poor. In contrast, NPC patients who were cured of their disease but suffered from dysphagia from oropharyngeal fibrosis appeared to do well. Underlying diagnosis Stroke NPC Head injury MotorNeurone Dis Parkinso'sDis Misc.
Number of cases
Medianage (Years)
Patient survival
Number of patients alive
78 28 6 3 5
72 55 65 61 82 55
298 273 819 330 360 352
35 6 5
9
2 1 4
Misc. includes patients withoesophageal carcinoma, braintumour, Wilson's disease, Guillain
Barre's syndrome
4972 EFFECT OF GASTRIC DISTENSION ON FOOD INTAKE AND SATIETY IN HEALTHY HUMAN SUBJECTS. Daniel Matzinger, Lukas Degen, Daniel Fronterotta, Christoph Beglinger, Gastroenterology, Basel, Switzerland; Univ Hosp, Basel, Switzerland. Background: Regulation of food intake is a complex process involving multiple signals. The interaction effect on food intake resulting from gastric signals and the amount of food previously eaten (e.g., a preload) has only insuffciently been explored. It is uncertain to give an example to which extent the volume and the composition of a meal affects food intake and satiety. The aim of the study was to investigate the effect of different volumes of two different macronutrient preloads on satiety and food intake in human subjects. Methods: 15 healthy male volunteers were studied in a randomized, 5-period cross- over design. On each study day, subjects were asked to drink one of the following preloads: a) 400 m1 water (W); b) 400 ml carbohydrate (CH); c) 800 ml CH; d) 400 m1 protein (PRO) and e) 800 m1 PRO. 20 min later a standard test meal was presented on each occasion and subjects were free to eat and drink ad libitum. Volunteers scored feelings for hunger and fullness on a standard visual analogue scale throughout the experiments. The amount of food eaten, of fluid drunk as well as the eating time were assessed. Data were analysed using ANOV A. Results (see table): (Mean::': SEM). 800 m1 protein preload significantly increased feelings of fullness and reduced feelings of hunger (pS O.OOO5). Summary: I) Preloads of 800 ml significantly induced satiation and reduced food and calorie intake. 2) The effect was more pronounced after ingestion of the protein preload. Conclusion: Gastric distension induced by a preload I)induced early satiety and 2) reduced calorie intake. The effect was more pronoun ced with protein than with carbohydrate most likely reflecting differences in gastric emptying rates. Preload
W400 ml CH 400 ml PR0400ml CH 800 mJ PRO 800 ml
Food intake (g)
Fluid Intake (ml)
Calories (keal)
654±42 616±33 621±47 541±4r 492±35"
71 3±36 645±48 633±50 633±41 571±46"
1968±120 1802±91 1773±125 1617±131' 1477±110"
, =P:s0.005 vsconlrol (water preload); " = p ~ 0.0005 vs control
April 2000
4969
4971
ADMINISTRATION OF LACTOBACILLUS PLA NTA RUM 299V REDUCES SIDE EFFECTS OF EXTERNAL RADIATION ON COLON ANASTOMOTIC HEALING IN RATS. Qing Liu, Soran Nobaek, Diya Adawi, Yilei Mao, Peter Mansson, Peter Blomquist, Goran Molin, Mats Ekelund , Bengt Jeppsson, Dept of Surg, Malmo Univ Hasp, Malmo, Sweden; Dept of Food Technology, Lund Univ, Lund, Sweden ; Dept of Surg, Lund Univ Hosp, Lund, Sweden . Preoperative radiotherapy of patients with rectal carcinoma is frequently used to reduce the incidence of local recurrence. However, the radiation therapy is associated with severaJ complications, including diarrhea, retarded anastomotic healing and mucosal atrophy. Exogenous administration of lactobacilli has been demonstrated to be effec tive in stimulating intestinal mucosal growth and reduce mucosal inflammation. The objective of this study was to examine the effects of Lactobacillus planta rum 299v administratio n on external radiation injury in colon anastomotic healing at different time points. Sprague-Dawley rats were treated with Lb. plantarum 299v or saline as control and received external radiation of the lower abdomen (10 Gy/day) on day 3 and 7 of the experiment. After 4 days. a colonic resection with anastomosis was performed. Animals were sacrificed on 4th , 7110 and 11th day postoperatively. Body weight, white blood cell (WBC) count, mucosal myeloperoxidase (MPO) activity, hydroxyprolin e, nucleotide, DNA and RNA contents, colonic bacterial microflora, bacterial translocation, and histology were evaluated. On the 4110 postoperative day body weight, WBC and MPO decreased significantly after radiation. On the 7th postoperative day MPO decreased after radiation. In the two irradiated groups it decreased significantly in the Lb. plantarum group compared to the radiated group without treatment. Collagen concentrati on on the 7th postoperati ve day was significantly higher in Lb. plantarum group without radiation compared to the group with radiation without Lb. plantaru m. On the 11th postoperative day MPO was significantly higher in irradiated rats without treatment compared to Lb. planta rum treatment The collagen content of the colonic anastomosis decreased significantly in irradiated rats without treatment compared to those treated with Lb. plantarum. It therefore seems that administration of Lactobacillus plantarum 299v reduces the intestinal injury and inflammation following external radiation and improves the colonic anastomotic healing.
NUTRITIONAL STATUS OF PATIENTS WITH CHRONIC PAN· CREATITIS ADMITTED TO A TERTIARY CARE CENTER. Laura E. Matarese, Darwin L. Conwell, Douglas L. Seidner, Gregory Zuccaro, Ezra Steiger, The Cleveland Clin Fdn, Cleveland, OH. Background: Patients with chronic pancreatitis (CP) are at increased risk of developing protein calorie malnutrition (PCM) due to pancreatic insufficiency and inadequate oral intake due to post prandial pain. It is important to assess the nutritional status of these patients in order to identify those patients at nutritional risk. The aim of this study was to determine the incidence and severity of PCM in these patients based on anthropometric , laboratory and immune status data. Methods: The nutrition assessment data base was querried to determine the number of patients with an ICD 9 code (577.2) for CP who had been seen between 1983 and 1999. Nutrition assessment parameters included height, weight, usual body weight (UBW), ideal body weight (IBW), actual body weight (ABW), per cent weight loss. body mass index (BMI), triceps skinfold (TSF), mid-upper arm muscle circumerference (MUAMC), albumin (ALB), transferrin (TFN), totallymphocyte count (TLC), response to delayed hypersensitivity skin tests (DHST), and prognostic nutrition index (PNI). Results are expressed as mean z SD. Results: 59 patients (21 females, 38 males) with a mean age of 49 ::': 4.3 years were identified. Ninety percent had evidenced of PCM based on weight loss, BMI, anthropometry, serum ALB, and DHST . There was marked weight loss of 17% ::': 13%. The mean BMI was 19.66 ::':3.95; TSF was 9 mm ::': 5; MUAMC was 21.5 em ::': 3; serum ALB was 3.3 ::': 0.7. Eighty-six percent of the patients had DHST placed. Of these, 41 % (n= 21) did not respond to skin tests, 39% (n= 20) responded to one skin test, 12 % (n = 6) responded to two skin tests, 6 % (n = 3) responded to 3 skin tests and 2% (n = I) responded to all four skin tests. Mean transferrin levels was 20 1 + 81. The mean PNI was 35 ::': 3l.Conclusion: Patients with CP are at increased risk of PCM. We identified a 90% percent incidence of PCM in patients with CP admitted to a tertiary care setting. Further prospective investigations are needed to evaluate the consequences associated with this degree of PCM.
4970 INFL UENCE OF UNDERLYING DIAGNOSIS ON OUTCOME OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) INSER· TION. Widjaja Luman, Cheung Wk, Chong Tw, Ng Hs, Singapore Gen Hosp, Singapore, Singapore; St Luke' s Hosp, Singapoire, Singapore. Introduction: There has been a rapid increase in the insertion of PEG for patients with dysph agia from a variety of causes. The impact of underlying diagnosis on the outcome of PEG is poorly documented. Methods: We undertook a retrospective review of PEG inserted in our institution between January 1995 to March 1999. Casenotes were reviewed and data on outcome was gathered from carers ( realtives or staff st nursing home). Results: 149 cases were identified from our database and 129 patients were succesffuly reviewed. There were 80 males. Median period of follow up was 300 days (Range 2-1740). 8 patients with stroke and 5 patients with nasopharyngeal carcinoma (NPC) died within 30 days after PEG; causes of death were mainly from pneumonia and advanced stage of cancer . At follow up, 6 patients with stroke were no longer on PEG as they had recovered their swallowing ability. 5 of these patients had insertion of PEG within 30 days after the onset of stroke. 7 patients with NPC were cured of their disease but had PEG inserted for dysphagia secondary to fibrosis of oropharyngea l muscle from previous radiotherapy. 6 of these patients were alive and required longterm PEG. Co nclusions: Majority of stroke patients required their PEG long term. PEG should however not be inserted in the immediate period after stroke as some of these patients may regain their swallowing ability. Outcome on patients with advanced NPC is poor. In contrast, NPC patients who were cured of their disease but suffered from dysphagia from oropharyngeal fibrosis appeared to do well. Underlying diagnosis Stroke NPC Head injury MotorNeurone Dis Parkinso'sDis Misc.
Number of cases
Medianage (Years)
Patient survival
Number of patients alive
78 28 6 3 5
72 55 65 61 82 55
298 273 819 330 360 352
35 6 5
9
2 1 4
Misc. includes patients withoesophageal carcinoma, braintumour, Wilson's disease, Guillain
Barre's syndrome
4972 EFFECT OF GASTRIC DISTENSION ON FOOD INTAKE AND SATIETY IN HEALTHY HUMAN SUBJECTS. Daniel Matzinger, Lukas Degen, Daniel Fronterotta, Christoph Beglinger, Gastroenterology, Basel, Switzerland; Univ Hosp, Basel, Switzerland. Background: Regulation of food intake is a complex process involving multiple signals. The interaction effect on food intake resulting from gastric signals and the amount of food previously eaten (e.g., a preload) has only insuffciently been explored. It is uncertain to give an example to which extent the volume and the composition of a meal affects food intake and satiety. The aim of the study was to investigate the effect of different volumes of two different macronutrient preloads on satiety and food intake in human subjects. Methods: 15 healthy male volunteers were studied in a randomized, 5-period cross- over design. On each study day, subjects were asked to drink one of the following preloads: a) 400 m1 water (W); b) 400 ml carbohydrate (CH); c) 800 ml CH; d) 400 m1 protein (PRO) and e) 800 m1 PRO. 20 min later a standard test meal was presented on each occasion and subjects were free to eat and drink ad libitum. Volunteers scored feelings for hunger and fullness on a standard visual analogue scale throughout the experiments. The amount of food eaten, of fluid drunk as well as the eating time were assessed. Data were analysed using ANOV A. Results (see table): (Mean::': SEM). 800 m1 protein preload significantly increased feelings of fullness and reduced feelings of hunger (pS O.OOO5). Summary: I) Preloads of 800 ml significantly induced satiation and reduced food and calorie intake. 2) The effect was more pronounced after ingestion of the protein preload. Conclusion: Gastric distension induced by a preload I)induced early satiety and 2) reduced calorie intake. The effect was more pronoun ced with protein than with carbohydrate most likely reflecting differences in gastric emptying rates. Preload
W400 ml CH 400 ml PR0400ml CH 800 mJ PRO 800 ml
Food intake (g)
Fluid Intake (ml)
Calories (keal)
654±42 616±33 621±47 541±4r 492±35"
71 3±36 645±48 633±50 633±41 571±46"
1968±120 1802±91 1773±125 1617±131' 1477±110"
, =P:s0.005 vsconlrol (water preload); " = p ~ 0.0005 vs control