Effects of Heat-Treated Probiotics and Short-Chain Fatty Acids on Jejunal Integrity and Fecal Microbiome in Rats with Massive Bowel Resection

Objectives Massive bowel resection and total parenteral nutrition (TPN) are the major factors to affect intestinal integrity and microbiome in patients with short bowel syndrome (SBS). Studies showed that dead probiotics, which have no ability to produce short-chain fatty acids (SCFAs) to nourish enterocytes, may have similar benefits as live probiotics in promoting intestinal health. The aim of this study was to compare the effects of live and heat-treated probiotics with or without SCFAs on jejunal integrity and fecal microbiome in TPN-supported SBS rats. Methods Male SD rats were performed with intestinal resection, from 10 cm distal to the ligament of the Treitz to 5 cm distal to the colon, for SBS induction and with intubation of the right jugular vein for TPN infusion. TPN was administered right after the surgeries (day 0); and oral distilled water, live or heat-treated Lactobacillus acidophilus and Bifidobacterium bifidum, or the combination of heat-treated probiotics and intravenous SCFAs (acetate, propionate and butyrate) were administered from day 1 to day 6 to the SBS rats. Healthy, orally fed rats with no surgery were included as controls. Results The results showed that SBS rats had malnutrition, anemia, and jejunal damage. In the jejunum of the SBS rats, the increased glucagon-like peptide-2 was further increased by the live probiotics; the increased 19 kDa caspase 3 was decreased by heat-treated bacteria; and the decreased claudin 4 and toll-like receptor-4 were increased by the combination treatment of heat-treated probiotics and SCFAs. The results of 16S metagenomic next-generation sequencing revealed that the SBS-decreased alpha-diversity and Firmicutes and the SBS-increased ratio of Firmicutes to Bacteroidetes were reversed by heat-treated bacteria; and the SBS-increased Proteobacteria and Actinobacteria were decreased by the live probiotics. The SBS-induced change in beta diversity was not altered by any treatment. Conclusions In conclusion, the combination treatment of heat-treated probiotics and SCFAs may improve jejunal integrity and the live and heat-treated probiotics may alter, at least partially, the bacterial diversity and distribution of the feces in SBS patients with TPN. Funding Sources MOST 105-2320-B-030-003-MY3.

Still time to perform intestinal revascularization in patients with acute mesenteric ischemia with peritonitis: An analysis of bowel viability in resections

Objective: Acute mesenteric ischemia is often fatal, and many survivors develop short bowel syndrome. To avoid massive bowel resection, revascularization is recommended for acute mesenteric ischemia patients. However, whether acute mesenteric ischemia patients with clinical peritonitis can be revascularized remains uncertain. Therefore, this study aimed to evaluate the histopathological potential reversibility of resected bowel in acute mesenteric ischemia patients with peritonitis. Methods: We retrospectively reviewed the medical records of acute mesenteric ischemia patients treated at the Kameda Medical Center between January 2001 and March 2015. Pathological evaluation regarding bowel resection was performed. Patients with and without peritonitis were compared. The primary outcome was the proportion of patients with reversible or irreversible ischemia. Patients with reversible and irreversible ischemia were characterized. Results: Of 41 patients, 17 underwent laparotomy, 6 endovascular surgery, and 18 palliative care. Among 23 patients receiving curative treatment, 7 had peritonitis and 13 did not. Seven patients of each group received bowel resection, but 85.7% of those with peritonitis had reversible ischemia. We categorized patients with ischemia into reversible and irreversible groups. The median time between symptom onset and diagnosis in the reversible group was >27 h. Systemic inflammatory response syndrome was found in 72.2% and 66.7% of the reversible and irreversible groups, respectively. Conclusion: Acute mesenteric ischemia patients with clinical peritoneal signs may have potentially reversible ischemia. As a result, revascularization should be considered, even in the case of peritonitis.