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PP069-SUN: Outstanding abstract: Efficacy of Formula Diets in Promoting Wound Healing at the Site of Intestinal Anastomosis
Liver and gastrointestinal tract 3/5/7/10/14POD were 1.07, 1.11, 1.10, 1.01, 0.77 in the control, and 0.90, 0.99, 0.91, 0.83, 0.59 in the study group. Wound healing in terms of wound area was significantly earlier in the study group than in the control. Serum CRP levels on pre-/1/4/7/14POD were 0.20, 6.36, 4.10, 1.14, 0.62 in the control, and 0.11, 4.16, 3.44, 0.96, 0.29 in the study group. CRP levels were significantly lower in the study group. Serum albumin levels compared with the preoperative value on 1/4/7/14POD were 0.79, 0.81, 0.90, 1.00 in the control, and 0.82, 0.86, 0.92, 1.04 in the study group. Recovery of serum albumin levels was significantly earlier in the study group. Conclusion: Oral administration of BCAA, glutamine and collagen peptide accelerates second wound healing after stoma closure. This might be partly caused by early reduction of inflammation and stimulation of protein synthesis. Disclosure of Interest: None Declared.
PP069-SUN Outstanding abstract EFFICACY OF FORMULA DIETS IN PROMOTING WOUND HEALING AT THE SITE OF INTESTINAL ANASTOMOSIS M. Aikaawa1 , H. Sato1 , K. Okada1 , Y. Watanabe1 , N. Akimoto1 , K. Okamoto1 , M. Miyazawa1 , I. Koyama1 . 1 Surgery, Saitama Medical University, International Medical Center, Hidaka, Japan Rationale: Collagen synthesis is essential in wound healing processes for conferring strength. We designed a large-animal experimental model to investigate the strength of wound healing and collagen deposition at the site of intestinal anastomosis following administration of a formula diet, which contains HMB, arginine and glutamine. Methods: Pigs (n = 6) were laparotomized under general anesthesia and the small intestines were divided at 3 sites in each pig. End-to-end anastomosis was performed by continuous suture. The pigs were divided into 2 groups: one fed the experimental formula (EX group) and the other not fed the experimental formula (control group). In the EX group, normal diet mixed with the formula (HMB 1500 mg/day, arginine 1700 mg/day, glutamine 1700 mg/day) was fed from the day after the operation. At one week after the anastomosis, relaparotomy was performed and the operated small intestine was extirpated. Then, the anastomotic segments were evaluated by the burst test (BT), tension strength test (TST) and pathologic examination. Results: The BT was 49.4±12.2 mmHg in the EX group and 35.9±13.1 mmHg in the control group. The TST at the first sign of rupture was 6.07±1.43 N in the EX group and 4.07±1.70 N in the control group. The TST at complete division was 10.2±2.07 N in the EX group and 7.54±1.71 N in the control group. The amount of collagen deposition was 4627±1368 N in the EX group and 2834±1099 N in the control group. The TST and amount of collagen deposition in the EX group were significantly larger than the corresponding values in the control group (P < 0.05). Conclusion: The formula diet may promote wound healing by stimulating collagen deposition at sites of intestinal anastomosis site and thereby strengthen the anastomoses. Disclosure of Interest: None Declared.
S45 PP070-SUN Outstanding abstract A RANDOMISED CONTROLLED CROSSOVER TRIAL TO INVESTIGATE THE EFFICACY OF A NEW ORAL REHYDRATION SOLUTION FOR PATIENTS WITH A HIGH OUTPUT STOMA A. Culkin1 , S.M. Gabe1 , J.M. Nightingale1 . 1 Lennard-Jones Intestinal Failure Unit, St Mark’s Hospital, Harrow, United Kingdom Rationale: Patients with high output stomas restrict oral fluid and drink an oral rehydration solution (ORS) to prevent dehydration. Compliance is often poor and patients often add flavouring reducing the sodium concentration rendering the solution unsuitable1 . We aimed to investigate the efficacy and palatability of a new flavoured ORS (ORS1) containing 120mmol/L of sodium in comparison to our usual ORS (ORS2) which is based on the WHO cholera solution containing 90mmol/L of sodium. Methods: Patients were included if they had a stoma, <200cm of small bowel and a urine sodium >20mmol/L. After an overnight fast patients drank 500 ml of ORS1 or ORS2 in 30 minutes. Urine and intestinal output were collected over 6 hours while the patient was nil by mouth. Urine and intestinal output were weighed and an aliquot sent for sodium analysis by flame photometry. After a day wash out patients took the alternate ORS. A palatability questionnaire was completed during the study. 27 subjects were required for the study and t tests were used to compare treatments. Results: Twenty seven patients completed the study. 12F:15M, mean age 62±12 years, aetiology was IBD 9, ischaemia 9, other 8, mean length of bowel 101cm (range 20 200). Outcome
ORS1, mean±SD
ORS2, mean±SD
Mean difference (95% CI)
P value
Intestinal sodium balance Urine sodium excretion (mmol/L)
1±26 31±24
10±28 27±22
11 (2, 19) 4 ( 4, 12)
0.01 0.33
Intestinal sodium balance significantly improved with ORS1 compared to ORS2 with no effect on urine sodium excretion. Twenty-four patients (89%) preferred the taste of ORS1 compared to ORS2. Conclusion: ORS1 is a preferable solution to ORS2 in patients with high output stomas as it results in increased sodium absorption and is more palatable. References [1] A. Culkin. Variability in the content of oral rehydration solution used in intestinal failure may render it ineffective (2012) Clinical Nutrition Supplements, 7: 58. Disclosure of Interest: A. Culkin Grant/Research Support from: Vitaflo International, S. Gabe: None Declared, J. Nightingale: None Declared.
PP071-SUN Outstanding abstract THE EFFECTS OF ORAL RESVERATROL SUPPLEMENTATION ON INFLAMMATORY FACTORS AND QUALITY OF LIFE IN PATIENTS WITH ULCERATIVE COLITIS M. Samsami1 , A. Hekmatdoost, N. Ebrahimi Drayani. 1 Clinical Nutrition, Shahid Beheshti University of Medical Science, Tehran, Iran, Islamic Republic of Rationale: Ulcerative colitis (UC) is one of the inflammatory bowel diseases that immune and inflammatory factors are thought to be effective in this disease. Resveratrol is an
PP069-SUN Outstanding abstract EFFICACY OF FORMULA DIETS IN PROMOTING WOUND HEALING AT THE SITE OF INTESTINAL ANASTOMOSIS M. Aikaawa1 , H. Sato1 , K. Okada1 , Y. Watanabe1 , N. Akimoto1 , K. Okamoto1 , M. Miyazawa1 , I. Koyama1 . 1 Surgery, Saitama Medical University, International Medical Center, Hidaka, Japan Rationale: Collagen synthesis is essential in wound healing processes for conferring strength. We designed a large-animal experimental model to investigate the strength of wound healing and collagen deposition at the site of intestinal anastomosis following administration of a formula diet, which contains HMB, arginine and glutamine. Methods: Pigs (n = 6) were laparotomized under general anesthesia and the small intestines were divided at 3 sites in each pig. End-to-end anastomosis was performed by continuous suture. The pigs were divided into 2 groups: one fed the experimental formula (EX group) and the other not fed the experimental formula (control group). In the EX group, normal diet mixed with the formula (HMB 1500 mg/day, arginine 1700 mg/day, glutamine 1700 mg/day) was fed from the day after the operation. At one week after the anastomosis, relaparotomy was performed and the operated small intestine was extirpated. Then, the anastomotic segments were evaluated by the burst test (BT), tension strength test (TST) and pathologic examination. Results: The BT was 49.4±12.2 mmHg in the EX group and 35.9±13.1 mmHg in the control group. The TST at the first sign of rupture was 6.07±1.43 N in the EX group and 4.07±1.70 N in the control group. The TST at complete division was 10.2±2.07 N in the EX group and 7.54±1.71 N in the control group. The amount of collagen deposition was 4627±1368 N in the EX group and 2834±1099 N in the control group. The TST and amount of collagen deposition in the EX group were significantly larger than the corresponding values in the control group (P < 0.05). Conclusion: The formula diet may promote wound healing by stimulating collagen deposition at sites of intestinal anastomosis site and thereby strengthen the anastomoses. Disclosure of Interest: None Declared.
S45 PP070-SUN Outstanding abstract A RANDOMISED CONTROLLED CROSSOVER TRIAL TO INVESTIGATE THE EFFICACY OF A NEW ORAL REHYDRATION SOLUTION FOR PATIENTS WITH A HIGH OUTPUT STOMA A. Culkin1 , S.M. Gabe1 , J.M. Nightingale1 . 1 Lennard-Jones Intestinal Failure Unit, St Mark’s Hospital, Harrow, United Kingdom Rationale: Patients with high output stomas restrict oral fluid and drink an oral rehydration solution (ORS) to prevent dehydration. Compliance is often poor and patients often add flavouring reducing the sodium concentration rendering the solution unsuitable1 . We aimed to investigate the efficacy and palatability of a new flavoured ORS (ORS1) containing 120mmol/L of sodium in comparison to our usual ORS (ORS2) which is based on the WHO cholera solution containing 90mmol/L of sodium. Methods: Patients were included if they had a stoma, <200cm of small bowel and a urine sodium >20mmol/L. After an overnight fast patients drank 500 ml of ORS1 or ORS2 in 30 minutes. Urine and intestinal output were collected over 6 hours while the patient was nil by mouth. Urine and intestinal output were weighed and an aliquot sent for sodium analysis by flame photometry. After a day wash out patients took the alternate ORS. A palatability questionnaire was completed during the study. 27 subjects were required for the study and t tests were used to compare treatments. Results: Twenty seven patients completed the study. 12F:15M, mean age 62±12 years, aetiology was IBD 9, ischaemia 9, other 8, mean length of bowel 101cm (range 20 200). Outcome
ORS1, mean±SD
ORS2, mean±SD
Mean difference (95% CI)
P value
Intestinal sodium balance Urine sodium excretion (mmol/L)
1±26 31±24
10±28 27±22
11 (2, 19) 4 ( 4, 12)
0.01 0.33
Intestinal sodium balance significantly improved with ORS1 compared to ORS2 with no effect on urine sodium excretion. Twenty-four patients (89%) preferred the taste of ORS1 compared to ORS2. Conclusion: ORS1 is a preferable solution to ORS2 in patients with high output stomas as it results in increased sodium absorption and is more palatable. References [1] A. Culkin. Variability in the content of oral rehydration solution used in intestinal failure may render it ineffective (2012) Clinical Nutrition Supplements, 7: 58. Disclosure of Interest: A. Culkin Grant/Research Support from: Vitaflo International, S. Gabe: None Declared, J. Nightingale: None Declared.
PP071-SUN Outstanding abstract THE EFFECTS OF ORAL RESVERATROL SUPPLEMENTATION ON INFLAMMATORY FACTORS AND QUALITY OF LIFE IN PATIENTS WITH ULCERATIVE COLITIS M. Samsami1 , A. Hekmatdoost, N. Ebrahimi Drayani. 1 Clinical Nutrition, Shahid Beheshti University of Medical Science, Tehran, Iran, Islamic Republic of Rationale: Ulcerative colitis (UC) is one of the inflammatory bowel diseases that immune and inflammatory factors are thought to be effective in this disease. Resveratrol is an