Imbalance between Jejunum and Ileum in the Response of Brush Border Hydrolases to Oral Feeding after Intravenous Alimentation in Rats

Enterokinase initiates digestion of protein by conversion of trypsinogen into trypsin. The interactions between enterokinase and trypsin were investigated in 6 patients with intractable diarrhea of infancy and 34 children with celiac disease. The six infants between 2 and 3 months with intractable diarrhea of infancy had reduced mucosal enterokinase activity (9.5 ± 4.8µM per gram of protein per minute) and reduced intraluminal trypsin activity (2.9 ± 0.7µM per gram of protein per minute) as compared with healthy controls (109 ± 34.2µM per gram of protein per minute and 14.3 ± 5.8µM per gram of protein per minute) respectively. The activities of all enzymes returned toward normal following treatment with intravenous alimentation. The mucosal morphology of all pretreatment biopsies in all cases showed Grade III atrophy which improved. These findings suggest that enterokinase deficiency and reduced intraluminal trypsin activity in intractable diarrhea of infancy may be one of the contributing factors to protein malabsorption and consequent malnutrition. Thirty-four children with celiac disease were between the age of 9 months and 13 years. The 11 newly diagnosed patients with celiac disease demonstrated Grade III to IV atrophy of the mucosa. The 23 patients with treated celiac disease on a gluten-free diet showed a normal to Grade II atrophy. In both treated and untreated celiac disease the enterokinase activities and the intraluminal trypsin activity were within normal limits. The enterokinase activity in celiac disease is near normal in contrast to the marked reduction noted in intractable diarrhea of infancy even though the intestinal mucosa shows marked morphological alteration and the disaccharidase activities are greatly reduced in celiac disease. After a prolonged alimentary fast of up to 26 days on intravenous alimentation, two patients with intractable diarrhea of infancy showed improvement in the activities of enterokinase and trypsin. These findings demonstrate that enterokinase and trypsin activities in the gut were present and improved in the absence of oral feeding.

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Preterm birth makes the immature intestine sensitive to feeding-induced intestinal atrophy

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00776.2004 ◽

2005 ◽

Vol 289 (4) ◽

pp. R1212-R1222 ◽

Cited By ~ 46

Author(s):

Charlotte Reinhard Bjornvad ◽

Mette Schmidt ◽

Yvette Miata Petersen ◽

Søren Krogh Jensen ◽

Hanne Offenberg ◽

...

Keyword(s):

Preterm Birth ◽

Brush Border ◽

Enzyme Activities ◽

Formula Feeding ◽

Oral Feeding ◽

Microbial Colonization ◽

Milk Formula ◽

Mrna Levels ◽

Brush Border Enzyme ◽

And Function

Preterm birth and formula feeding predispose to small intestinal dysfunction, which may lead to necrotizing enterocolitis (NEC). In piglets, we tested whether the physiological and environmental transitions occurring at birth affect the response of the immature intestine to enteral feeding. Pig fetuses (106 days gestation, term = 115 days) were prepared with esophageal feeding tubes and fed either sow's colostrum ( n = 8) or infant formula ( n = 7) in utero. After 24 h of oral feeding, the pig fetuses were delivered by cesarean section and their gastrointestinal morphology and function were compared with those of preterm newborn (NB) littermates that were not fed ( n = 8) or fed colostrum ( n = 7) or formula ( n = 13) for 24 h after birth. Before birth, both colostrum and formula feeding resulted in marked increases in intestinal mass, brush-border enzyme activities, and plasma glucagon-like peptide 2 concentrations, to levels similar to those in NB colostrum-fed piglets. In contrast, NB formula-fed piglets showed reduced intestinal growth, decreased brush-border enzyme activities, and intestinal lesions, reflecting NEC. NB formula-fed pigs also showed impaired enterocyte endocytotic function and decreased antioxidative capacity, whereas brush-border enzyme mRNA levels were unaltered, relative to NB colostrum-fed pigs. Our results indicate that the feeding-induced growth and enzyme maturation of the immature intestine are not birth dependent. However, with a suboptimal diet (milk formula), factors related to preterm birth (e.g., microbial colonization and metabolic and endocrine changes) make the immature intestine sensitive to atrophy and development of NEC.

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Scanning Electron Microscopy of Human Jejunum in Whipple's Disease

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100079279 ◽

1977 ◽

Vol 35 ◽

pp. 354-355

Author(s):

John H. L. Watson ◽

C. N. Sun

Keyword(s):

Electron Microscopy ◽

Scanning Electron Microscopy ◽

Basement Membrane ◽

Lamina Propria ◽

Brush Border ◽

Whipple’S Disease ◽

Whipple's Disease ◽

Biopsy Specimens ◽

Brush Borders ◽

Scanning Electron

That the etiology of Whipple's disease could be bacterial was first suggested from electron micrographs in 1960. Evidence for binary fission of the bacteria, their phagocytosis by histiocytes in the lamina propria, their occurrence between and within the cells of the epithelium and on the brush border of the lumen were reported later. Scanning electron microscopy has been applied by us in an attempt to confirm the earlier observations by the new technique and to describe the bacterium further. Both transmission and scanning electron microscopy have been used concurrently to study the same biopsy specimens, and transmission observations have been used to confirm those made by scanning.The locations of the brush borders, the columnar epithelial cells, the basement membrane and the lamina propria beneath it were each easily identified by scanning electron microscopy. The lamina propria was completely filled with the wiener-shaped bacteria, Fig. 1.

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The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00097 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1507-1515

Author(s):

Lauren L. Madhoun ◽

Robert Dempster

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Hospital Discharge ◽

Neonatal Intensive Care ◽

Oral Feeding ◽

Medical Attention ◽

Primary Role ◽

Speech Language Pathologists ◽

The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-19-00158 ◽

2020 ◽

Vol 5 (4) ◽

pp. 1006-1010

Author(s):

Jennifer Raminick ◽

Hema Desai

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Oxygen Therapy ◽

Respiratory Illness ◽

High Flow ◽

Oral Feeding ◽

Respiratory Support ◽

Acute Respiratory Illness ◽

High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

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