• Jie Chen, Xing-Peng Wang, Pi Liu, Ka Wu, Min Xu, Xiao-Feng Yu, and Gen-Sheng Wang.
• Department of Gastroenterology, First People's Hospital of Shanghai, Jiaotong University, Shanghai 200080, China.
• Zhonghua Yi Xue Za Zhi. 2004 Oct 17;84(20):1726-31.

ObjectiveTo evaluate the effects of continuous early enteral nutrition on the gut barrier function in acute necrotizing pancreatitis (ANP).MethodsThirty mongrel dogs underwent laparotomy and 5% mixed solution of sodium taurocholate with trypsin was infused into the pancreatic ducts so as to induce model of ANP. Permanent duodenal and jejunal fistulas were retained. Then the 30 dogs were randomly divided into 6 groups of 5 dogs: total parenteral nutrition (TPN) group, normal saline (NS) group, duodenal nutrison multifibre (DN) group, duodenal PEPTI-2000Varient (DP) group, jejunal nutrison multifibre (JN) group, and jejunal PEPTI-2000Varient (JP) group, the last 4 groups being called enteral nutrition (EN) group together. Infusion of nutritional solutions was performed via the duodenal or jejunal fistulas, beginning 24 hours after the operation and lasting for 5 days. The levels of endotoxin and D-(-)-lactate in the peripheral plasma were measured every day. On the days 2 and 5 after the operation test solution to measure the enteral permeability, containing lactulose and mannitol, was infused via the fistulas and then urine within 6 hours thereafter was collected to detect the concentrations of lactulose and mannitol and calculate the lactulose/mannitol ratio. Seven days after the operation the dogs were killed to take the pancreas and intestines to be examined by microscopy. Feces was collected. ERIC-PCR fingerprint method was used to examine the structure and distribution of ERIC series of the microbial communities in the gut.ResultsThe plasma D-(-)-lactate of the NS group gradually increased and peaked on the 5th day after the operation, and that of the TPN group gradually increased too, however, lower than that of the NS group at any time points and was significantly lower on the 5th day (P < 0.05). The plasma D-(-)-lactate of the EN groups increased first and then decreased and was lower than those of the TPN and NS groups with significant differences on the 4th and 5th days (all P < 0.05). Five days after the operation the lactulose/mannitol ratio decreased in every groups and with significant differences between the EN groups and TPN and NS groups and between the TPN and NS groups (all P < 0.05). The plasma endotoxin level increased in every groups, however, the endotoxin levels of the EN groups at any time points were all lower than those of the TPN group and much more lower than those in the NS group with significant differences between the EN groups and TPN group and NS group on specific days after operation (all P < 0.05). The pathological changes of the intestinal mucosa were more severe in the NS group than in the TPN group, and much more severe than in the EN groups. The makeup and distribution of intestinal microbial in the EN groups were similar to those of the normal dogs. However, the makeup and distribution of intestinal microbial in the TPN groups were quite different from those of the normal dogs.ConclusionEN helps maintain gut mucosal barrier, decreases endotoxin translocation, and decreases the extent of mucosal atrophy in ANP.

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