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Protective Effect of Synbiotics on Intestinal Barrier Function after Gastrointestinal Surgery

Author: ZhaoMingLi
Tutor: YuJianChun
School: Beijing Union Medical College
Course: Clinical
Keywords: Gastrointestinal surgery Enteral Nutrition BIOSTIME Intestinal barrier function Probiotics Protective effect Bifidobacterium Mannitol ratio Colonic mucosa Dietary fiber Determination of endotoxin Gram-negative bacteria Colonic flora Concentration ratio PCT enteral Portal Before surgery Mucosal barrier Catheterization
CLC: R96
Type: PhD thesis
Year: 2009
Downloads: 44
Quote: 0
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Background:In recent years, synbiotics and probiotics are used to pretect gut barrier function. Probiotics are normal colonic microfloras, prebiotics are diet fibers which can be fermented by probiotics, synbiotics means the combination of probiotics and prebiotics.we designed perspective RCT basic and clinic studies on the protective effect of pro-pre-and synbiotics on gut barrier function.Part Ⅰ:Section AObjective:Establish rat models of postoperative impaired intestinal barrier function.Methods:Eight Sprague-Dawley(SD) rats received cecectomy and gastrostomy plus the use of amoxicillin and metronidazole to establish models of gastrointestinal operation. Lactulose/mannitol(L/M) ratio and fecal probiotics were measured before and after intervention. The bacterial translocation rate, serum endotoxin level of portal vein and thickness of colonic mucosa were measured after intervention.Results:Fecal probiotics and thickness of colonic mucosa were significantly decreased, lactulose/mannitol(L/M) ratio and serum endotoxin level of portal vein were significantly increased, the bacterial translocation rate was22/32.Conclusions:Cecectomy and gastrostomy plus the use of antibiotics can be used to establish the model of impaired intestinal barrier function.Part I:Section BObjective:Investigate the protective effect of synbiotics on the rat models.Methods:Thirty-two rats were randomly divided into four groups:control group, probiotics group, prebiotics group or synbiotics group. The rats received different enteral nutrition after cecectomy and gastrostomy plus the use of antibiotics. Lactulose/mannitol(L/M) ratio, fecal microflora, bacterial translocation rate, endotoxin level of portal vein serum and thickness of colonic mucosa were measured on postoperative day6.Results:The numbers of fecal probiotics were significantly higher in probiotics group and synbiotics group than in control group and prebiotics group. The bacterial translocation rate in group with probiotics was significantly lower than in group without probiotics. The L/M ratio in synbiotics group was lower than in other groups. The thickness of colonic mucosa in synbiotics group was significantly higher than in other groups.Conclusions:Probiotics can increase the number of probiotics in colon. Synbiotics can increase the thickness of colonic mucosa, decrease the L/M ratio and bacterial translocation.Part ⅡObjective:Observe the protective effect of synbiotics on intestinal barrier function of patients after gastrointestinal surgery.Methods:35patients with gastrointestinal disease were randomly divided into normal EN group, probiotics group, prebiotics group, synbiotics group or PN group. L/M ratio, serum endotoxin level, PCT, CRP, CBC, insulin and hepatic-renal function were measured before surgery, on postoperative days1and8. Postoperative complication and bowel activity were recorded.Results:29patients completed the study. The postoperative exhaust time in EN group was significantly shorter than in PN group. On postoperative day8, the PA in EN group was significantly higher than in PN group, the PCT level, L/M ratio, endotoxin level and lg(HOMA-IR) in EN group was significantly lower than in PN group. No statistical difference was found in the other parameters. The PCT and endotoxin level in synbiotics group are significantly lower than in PN group. No difference was found among4EN groups.Conclusions:EN can shorten exhaust time after operation, increase PA and decrease insulin resistant, PCT level, endotoxin level and L/M ratio. Synbiotics can decrease PCT and endotoxin level.

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