Our Summary

This research paper investigates how the gut adapts after a portion of the small intestine is surgically removed, a procedure that is often necessary in treating diseases like Crohn’s disease. After surgery, the remaining part of the gut changes in shape and function to help make up for the loss. This includes growing taller and deeper, processing more nutrients, fluids and electrolytes, and increasing cell growth in certain areas.

Many patients experience significant fluid and nutrient loss after surgery, but the gut’s adaptive response can help them eventually stop relying on special nutrition given through a vein (known as parenteral nutrition) within two years of surgery. However, some patients still need this special nutrition for their entire life.

Understanding how the gut adapts after surgery is crucial for developing new treatments for short bowel syndrome, a condition that can occur when a large portion of the small intestine is removed. This paper summarizes important studies on this topic, focusing on areas such as cell growth, cell differentiation (how cells change to perform specific functions), cell death, the function of specific cells in the gut, the role of growth factors (substances that help cells grow and divide), and the role of the nervous system in the gut.

FAQs

  1. What is the adaptive response of the gut following an intestinal resection?
  2. What factors regulate the gut’s adaptive response after intestinal resection?
  3. How long does it typically take for patients to wean off parenteral nutrition after substantial small bowel resection?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal resection is to follow a strict postoperative diet plan to support the adaptive response of the remnant gut. This may include eating small, frequent meals and focusing on nutrient-dense foods to promote optimal absorption and healing. It is also important to stay hydrated and monitor for any signs of malabsorption or complications, such as diarrhea or abdominal pain, and report them to your healthcare provider promptly. Regular follow-up appointments and monitoring of nutrient levels may be necessary to ensure proper healing and adaptation after intestinal resection.

Suitable For

Patients who are typically recommended intestinal resection include those with Crohn’s disease, ischemia, trauma, or other disorders that have led to loss of functional small bowel surface area. These patients may experience symptoms such as severe nutrient malabsorption, fluid and electrolyte imbalances, and dependence on parenteral nutrition. The adaptive response of the remnant gut following resection can vary, with some patients being able to wean off of PN within a few years, while others may require lifelong PN dependence. Understanding the molecular mechanisms that regulate the gut adaptive response is crucial for developing new therapies for short bowel syndrome. Key factors in this adaptation process include crypt cell proliferation, epithelial differentiation, apoptosis, enterocyte function, and the role of growth factors and the enteric nervous system.

Timeline

Before intestinal resection:

  • Patients may experience symptoms such as abdominal pain, diarrhea, and weight loss due to the underlying condition requiring surgery (e.g. Crohn’s disease, ischemia, trauma).
  • Diagnostic tests such as imaging studies and endoscopy may be performed to evaluate the extent of the disease and determine the need for surgery.

After intestinal resection:

  • Immediately postoperatively, patients may experience massive fluid and electrolyte loss and reduced nutrient absorption, requiring parenteral nutrition (PN) support.
  • Over time, the remnant gut undergoes a compensatory adaptive response characterized by increased crypt cell proliferation, villus hyperplasia, and enhanced nutrient absorption.
  • Some patients are able to partially or completely wean off PN within two years following resection, while others may remain dependent on PN for life.
  • Further studies are needed to understand the molecular mechanisms that regulate the gut adaptive response and develop novel therapies for short bowel syndrome.

What to Ask Your Doctor

  1. What is the reason for the intestinal resection and how much of the intestine was removed?
  2. What can I expect in terms of recovery and post-operative care?
  3. Will I need to make any changes to my diet or lifestyle following the surgery?
  4. How will the remaining intestine adapt and compensate for the lost portion?
  5. Are there any potential long-term complications or risks associated with the intestinal resection?
  6. Will I need to take any medications or supplements to support my digestion and absorption of nutrients?
  7. How often will I need to follow up with you after the surgery?
  8. Are there any specific symptoms or signs I should watch out for that may indicate a problem with the remaining intestine?
  9. Will I be able to resume normal activities and work after the surgery?
  10. Are there any additional resources or support services available to help me cope with the changes after the intestinal resection?

Reference

Authors: Rubin DC, Levin MS. Journal: Best Pract Res Clin Gastroenterol. 2016 Apr;30(2):237-48. doi: 10.1016/j.bpg.2016.03.007. Epub 2016 Mar 16. PMID: 27086888