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PubMed1996

Risk factors associated with parvovirus enteritis in dogs: 283 cases (1982-1991).

OBJECTIVE: To determine breed, sex, and seasonal predisposition for development of canine parvovirus (CPV) enteritis in dogs. DESIGN: Retrospective case-control study. SAMPLE POPULATION: Medical records from 283 dogs with confirmed CPV enteritis and from 834 age-matched control dogs that were healthy or had been admitted with nonenteric illness. PROCEDURE: Effects of season, breed, sex, and neutering on the risk of developing CPV enteritis were examined by calculation of unadjusted odds ratios and performance of multivariate analysis. Stratified and contingency table analyses were performed to identify interactions and confounding among variables. RESULTS: Rottweilers, American Pit Bull Terriers, Doberman Pinschers, and German Shepherd Dogs were at increased risk and Toy Poodles and Cocker Spaniels were at decreased risk for developing CPV enteritis, compared with that for mixed-breed dogs. For dogs more than 6 months old, sexually intact males were twice as likely as intact females to develop CPV enteritis. Dogs were 3 times more likely to be admitted with CPV enteritis in July, August, and September, compared with the rest of the year. Dogs were 12.7 times more likely to be admitted with CPV enteritis if they had not been currently vaccinated. CLINICAL IMPLICATIONS: Lack of vaccination is a significant risk factor for development of CPV enteritis. Seasonal, sex, and breed predispositions for the development of CPV enteritis also exist.

Animals↗

PubMedDate not supplied

[Decrease of the incidence of sepsis syndrome after early enteral nutrition of patients with severe burns].

The objective of this study was to evaluate the effect of early enteral nutrition on the incidence of the septic syndrome as well as its tolerance, in patients with severe burns. We retrospectively studied 64 patients older than 15 years of age, with a greater than 20% burned body surface area. They were divided into 2 groups as a function of the time elapsed between the beginning of Enteral Nutrition and the time of the burning: 23 patients were given Enteral Nutrition within 24 hours after the burn, and in 41 patients the enteral nutrition was started later than 24 hours after sustaining the thermal injury. Both groups were similar with respect to age, sex, percentage of 2nd and 3rd degree burns, incidence of inhalation, and deaths. All patients received the Enteral Nutrition through a nasogastric tube, with administration of a polymeric, hyperprotein and hypocaloric formula through a continuous infusion pump. In our study we saw a reduction of the incidence of the septic syndrome in the patients who received early enteral Nutrition (26%; 6 patients of a total of 23), with respect to those who did non receive early Enteral Nutrition (54%; 22 patients of a total of 41), with a statistical significance of p > 0.05. There were no differences between both groups with respect to the digestive tolerance to Enteral Nutrition. From our study we can deduce that early Enteral Nutrition reduces the incidence of septic complications, without this increasing the digestive intolerance to the same.

Adolescent↗

PubMed1997

Enteral or parenteral feeding after total gastrectomy: prospective randomised pilot study.

OBJECTIVE: To compare the efficacy and cost of enteral and parenteral feeding after total gastrectomy. DESIGN: Prospective randomised open study. SETTING: University hospital, Finland. SUBJECTS: 29 patients undergoing curative total gastrectomy for gastric cancer. INTERVENTIONS: 13 patients were given early enteral feeding by nasojejunal tube and 16 patients parenteral nutrition by central venous catheter. MAIN OUTCOME MEASURES: Postoperative complications, duration of hospital stay, serum CRP and albumin concentrations, cost, and postoperative abdominal symptoms. RESULTS: One patient in the enteral feeding group discontinued the study on day 1. Oesophagojejunal leaks developed in one patient in each group. Infective complications occurred in 3 (23%) in the enteral group and 5 (31%) in the parenteral group. Serum CRP concentration on day six was lower in the enteral feeding group than in the parenteral feeding group (32 (16) g/L compared with 61 (41) g/L; p = 0.02). Enteral feeding was well tolerated. Diarrhoea developed earlier in the enteral than in the parenteral group (days 3-5 compared with 5-7, respectively) but there was a tendency to an increased risk of diarrhoea in the parenteral group. Parenteral feeding was more than four times as expensive as enteral feeding. CONCLUSION: Enteral nasojejunal feeding is safe and well tolerated after total gastrectomy. It is also cheaper than parenteral nutrition.

Aged↗

PubMedDate not supplied

[Percutaneous endoscopic gastrostomy and gastrojejunostomy. Experience and its role in domiciliary enteral nutrition].

UNLABELLED: Percutaneous Endoscopic Gastrostomy (PEG) and its variation Percutaneous Endoscopic Gastrojejunostomy (PEGJ), has become the method of choice to achieve an enteral access route in patients who require long term enteral nutrition, especially in the area of the At Home Enteral Nutrition (AHEN). We present our experience on the first PEG's and PEGJ's carried out in our hospital. MATERIAL: We studied 48 patients (14 women and 34 men) in whom a PEG/Percutaneous Endoscopic Gastrojejunostomy (PEGJ) was indicated, as they required enteral nutrition for prolonged periods of time (> 4 weeks) and/or they presented obstructive dysphagia, neuromotor dysphagia, or incorrigible vomiting in the two cases in whom PEGJ was carried out. 34 patients underwent the Ponsky-Gauderer technique, 6 patients underwent the Sacks-Vine technique, and 2 patients underwent a PEGJ. 24 hours after the PEGJ enteral nutrition (EN) was begun in a progressive manner. During the hospitalization period there was a daily follow up of the patient. In those cases in which At Home Enteral Nutrition was programmed, the patients/families were trained in the techniques and the care of the PEG and the EN, and the control was carried out through the Nutrition out patient department. RESULTS: PEG was successfully carried out in 42 patients (88%). 35 patients had previously been given EN through a naso-gastric tube (NGT), while in 7 cases the PEG was the first enteral access route. The average duration of the PEG was 212 days, and 27 patients (64%) needed the PEG for more than 3 months. The mean caloric supply was 1921 +/- 200 kcal/day. The mode of administration was by means of an intermittent infusion by gravity in 31 cases, and by continuous infusion using a volumetric pump in 11 patients. Two patients with pregnancy induced hyperemesis underwent a PEGJ in the 3rd and the 4th month of pregnancy, with the pregnancy being successfully brought to term and ending in vaginal deliveries. Carrying out a PEG permitted release from hospital and the programming of At Home Enteral Nutrition in 30 patients. With respect to the evolution of the patients, 22 patients have died during the course of the study. 18 patients remain in follow up in an ambulatory Enteral Nutrition program, and in the two patients with pregnancy induced hyperemesis, the PEGJ was removed after the pregnancy was successfully ended. There were no complications of any kind in 21 patients. The most common complication was the infection of the gastrostomy, which occurred in 13 patients. There was an accidental removal of the gastrostomy tube in 3 patients. In 3 cases there was an eversion of the gastric mucosa through the ostomy within the first 24-hours, and 20 days after the PEG respectively. In 2 cases there was an incarceration of the gastrostomy tube in the abdominal wall. Only two patients showed an important reflux of the gastric contents. There were no deaths as a result of PEG complications. CONCLUSION: From our experience we can conclude the advantages of PEG as a long term nutritional support, showing a low incidence of complications, and the endoscopic technique has a zero mortality.

Adult↗

PubMed1998

Interaction of omeprazole with enteric-coated salicylate tablets.

OBJECTIVE: Enteric-coated tablets are designed to resist gastric fluids and to disrupt and dissolve in the alkaline medium of the small intestine. Main objective of the present study was to investigate whether the increase in gastric pH due to omeprazole treatment alters the release rate of a drug from enteric-coated formulation. To this end, we have compared the single dose pharmacokinetics of a single-unit enteric-coated salicylate to that of uncoated acetylsalicylic acid tablets in the presence and absence of omeprazole treatment. METHODS: Study was carried out according to 4 x 4 Latin square design. Eight healthy subjects received either uncoated acetylsalicylic acid tablets or single-unit enteric-coated sodium salicylate tablets alone or following 4 days of treatment with single-dose 20 mg omeprazole, and blood samples were collected for 24 hours. Serum salicylate levels were determined by the modified spectrophotometric method of Brodie et al. [1994]. RESULTS: Salicylate was absorbed rapidly from uncoated tablets but absorption of salicylate from enteric-coated tablets was delayed, as expected. According to our results, omeprazole treatment did not influence the bioavailability from uncoated acetylsalicylic acid tablets but the absorption rate of salicylate from enteric-coated tablets was increased significantly. CONCLUSION: Findings of the present study demonstrate that omeprazole treatment significantly increases the rate of absorption of single-unit enteric-coated medication. Enhanced rate of absorption is most probably due to an early disruption of enteric coating and the intragastric release of the drug secondary to an omeprazole-mediated increase in gastric pH. The results of the present study also corroborate previous findings which have demonstrated highly variable absorption of enteric-coated single units.

Adult↗

PubMed1993

From neural crest to bowel: development of the enteric nervous system.

The ENS resembles the brain and differs both physiologically and structurally from any other region of the PNS. Recent experiments in which crest cell migration has been studied with DiI, a replication-deficient retrovirus, or antibodies that label cells of neural crest origin, have confirmed that both the avian and mammalian bowel are colonized by émigrés from the sacral as well as the vagal level of the neural crest. Components of the extracellular matrix, such as laminin, may play roles in enteric neural and glial development. The observation that an overabundance of laminin develops in the presumptive aganglionic region of the gut in ls/ls mutant mice and is associated with the inability of crest-derived cells to colonize this region of the bowel has led to the hypothesis that laminin promotes the development of crest-derived cells as enteric neurons. Premature expression of a neuronal phenotype would cause crest-derived cells to cease migrating before they complete the colonization of the gut. The acquisition by crest-derived cells of a nonintegrin, nerve-specific, 110 kD laminin-binding protein when they enter the bowel may enable these cells to respond to laminin differently from their pre-enteric migrating predecessors. Crest-derived cells migrating along the vagal pathway to the mammalian gut are transiently catecholaminergic (TC). This phenotype appears to be lost rapidly as the cells enter the bowel and begin to follow their program of terminal differentiation. The appearance and disappearance of TC cells may thus be an example of the effects of the enteric microenvironment on the differentiation of crest-derived cells in situ. Crest-derived cells can be isolated from the enteric microenvironment by immunoselection, a method that takes advantage of the selective expression on the surfaces of crest-derived cells of certain antigens. One neurotrophin, NT-3, promotes the development of enteric neurons and glia in vitro. Because trkC is expressed in the developing and mature gut, it seems likely that NT-3 plays a critical role in the development of the ENS in situ. Although the factors that are responsible for the development of the unique properties of the ENS remain unknown, progress made in understanding enteric neuronal development has recently accelerated. The application of new techniques and recently developed probes suggest that the accelerated pace of discovery in this area can be expected to continue.

Animals↗

PubMed2006

Health risks of enteric viral infections in children.

Children are at a greater risk of infections from serious enteric viral illness than adults for a number of reasons. Most important is the immune system, which is needed to control the infection processes. This difference can lead to more serious infections than in adults, who have fully developed immune systems. There are a number of significant physiological and behavioral differences between adults and children that place children at a greater risk of exposure and a greater risk of serious infection from enteric viruses. Although most enteric viruses cause mild or asymptomatic infections, they can cause a wide range of serious and life-threatening illnesses in children. The peak incidence of most enteric viral illnesses is in children <2yr of age, although all age groups of children are affected. Most of these infections are more serious and result in higher mortality in children than adults. The fetus is also affected by enterovirus and infectious hepatitis resulting in significant risk of fetal death or serious illness. In addition to the poliovirus vaccine, the only vaccine available is for hepatitis A virus (HAV). A vaccine for rotavirus has currently been withdrawn, pending review because of potential adverse effects in infants. No specific treatment is available for the other enteric viruses. Enteric viral infections are very common in childhood. Most children are infected with rotavirus during the first 2yr of life. The incidence of enteroviruses and the viral enteric viruses ranges from 10% to 40% in children and is largely dependent on age. On average, half or more of the infections are asymptomatic. The incidence of hepatitis A virus is much lower than the enteric diarrheal viruses. There is no current evidence for hepatitis E virus (HEV) acquisition in children in the U.S. Enteric viral diseases have a major impact on direct and indirect health care costs (i.e., lost wages) and amount to several billion dollars a year in the U.S. Total direct and indirect costs for nonhospitalized cases may run from $88/case for Norwalk virus to $1,193/case for enterovirus aseptic meningitis. Direct costs of hospitalization ran from $887/case for Norwalk virus to $86,899/case for hepatitis A. These costs are based on 1997-1999 data. Generally, attack rates during drinking water outbreaks are greater for children than adults. The exception appears to be hepatitis E virus where young adults are more affected. However, pregnant women suffer a high mortality, resulting in concurrent fetal death. Also, secondary attack rates are much higher among children, probably because of fewer sanitary habits among this age group. Overall, waterborne outbreaks of viral disease have a greater impact among children than adults. To better quantify the impact on children, the literature hould be further reviewed for case studies of waterborne outbreaks where data are available on the resulting illness by age group. The EPA and/or Centers for Disease Control should attempt to collect these data as future outbreaks are documented.

Adolescent↗

PubMed2003

Enteric pathogens and soil: a short review.

It is known that soil is a recipient of solid wastes able to contain enteric pathogens in high concentrations. Although the role of soil as a reservoir of certain bacterial pathogens is not in question, recent findings show that soil may have a larger role in the transmission of enteric diseases than previously thought. Many of the diseases caused by agents from soil have been well characterized, although enteric diseases and their link to soil have not been so well studied. Gastrointestinal infections are the most common diseases caused by enteric bacteria. Some examples are salmonellosis ( Salmonella sp.), cholera ( Vibrio cholerae), dysentery ( Shigella sp.) and other infections caused by Campylobacter jejuni, Yersinia sp. and Escherichia coli O157:H7 and many other strains. Viruses are the most hazardous and have some of the lowest infectious doses of any of the enteric pathogens. Hepatitis A, hepatitis E, enteric adenoviruses, poliovirus types 1 and 2, multiple strains of echoviruses and coxsackievirus are enteric viruses associated with human wastewater. Among the most commonly detected protozoa in sewage are Entamoeba histolytica, Giardia intestinalis and Cryptosporidium parvum. This article reviews the existing literature of more than two decades on waste disposal practices that favor the entry of enteric pathogens to soil and the possible consequent role of the soil as a vector and reservoir of enteric pathogens.

Animals↗

PubMed1987

Predicting enteric fever without bacteriological culture results.

We used Bayes' theorem to calculate the probability of enteric fever in 260 patients presenting with undiagnosed fever, without recourse to blood or stool culture results. These individuals were divided into 110 patients with enteric fever (63 culture positive, 47 culture negative) and 150 patients with other causes of fever. Comparison of the frequencies of occurrence of 19 clinical and laboratory events, said to be helpful in the diagnosis of enteric fever, in the two groups revealed that only 8 events were significantly more frequent in enteric fever. These were: a positive Widal test at a screening dilution of 1:40; a peak temperature greater than = 39 degrees C; previous treatment for the fever; a white blood cell count less than 9 X 10(6)/litre; a polymorphonuclear leucocyte count less than 3.5 X 10(6)/litre; splenomegaly; fever duration greater than 7 d; and hepatomegaly. When the probability of enteric fever was determined prospectively in 110 patients, using only 6 of these discriminating events, the probability of patients with a positive prediction having enteric fever (diagnostic specificity) was 0.80 (95% confidence interval: 0.68 to 0.91) and the probability of those with a negative prediction not having enteric fever (diagnostic sensitivity) was 0.92 (0.85 to 0.99). Using all 19 events did not alter the diagnostic specificity or diagnostic sensitivity. This study shows that a small number of clinical and laboratory features can objectively discriminate enteric fever from other causes of fever in the majority of patients. Calculating the probability of enteric fever can aid in diagnosis, when culturing for salmonella is either unavailable or is negative.

Bayes Theorem↗

PubMed2006

Glial-derived neurotrophic factor modulates enteric neuronal survival and proliferation through neuropeptide Y.

BACKGROUND & AIMS: Glial-derived neurotrophic factor (GDNF) promotes the survival and proliferation of enteric neurons. Neuropeptide Y (NPY) is an important peptide regulating gastrointestinal motility. The role of NPY on the survival and proliferation of enteric neurons is not known. We examined the effects of GDNF on the expression and release of NPY from enteric neurons and the role of NPY in promoting enteric neuronal proliferation and survival. METHODS: Studies were performed in primary enteric neuronal cultures and NPY knockout mice (NPY(-/-)). GDNF-induced expression of NPY was assessed by reverse-transcription polymerase chain reaction (RT-PCR), immunocytochemistry, and enzyme-linked immunosorbent assay. Using NPY-siRNA and NPY-Y1 receptor antagonist, we examined the role of NPY in mediating the survival and proliferation effects of GDNF. Gastrointestinal motility was assessed by measuring gastric emptying, intestinal transit, and isometric muscle recording from intestinal muscle strips. RESULTS: GDNF induced a significant increase in NPY messenger RNA and protein expression in primary enteric neurons and the release of NPY into the culture medium. NPY (1 mumol/L) significantly increased proliferation of neurons and reduced apoptosis. In the presence of NPY-siRNA and NPY-Y1 receptor antagonist or in enteric neurons cultured from NPY(-/-) mice, GDNF-mediated neuronal proliferation and survival was reduced. NPY increased the phosphorylation of Akt, a downstream target of the PI-3-kinase pathway. In NPY(-/-) mice, there were significantly fewer nNOS-containing enteric neurons compared with wild-type (WT) mice. NPY(-/-) mice had accelerated gastric emptying and delayed intestinal transit compared with WT mice. CONCLUSIONS: We demonstrate that NPY acts as an autocrine neurotrophic factor for enteric neurons.

Animals↗

PubMed2002

A method for purifying enteric glia from rat myenteric plexus.

The enteric nervous system is a large and complex division of the peripheral nervous system. The glia associated with it share some characteristics with the olfactory-ensheathing glia, astrocytes and Schwann cells. To facilitate studies of rat enteric glia, we have developed a method for preparing them in large quantities with a high degree of homogeneity. The enteric glia were isolated from the small intestine of Wistar rats by enzymatic digestion with dispase. The cell isolate was added to a mitotically arrested layer of 3T3 cells. Subsequent separation of the enteric glia from the 3T3 cells was done enzymatically, with unavoidable loss of many enteric glia and potential contamination of enteric glia cultures with the 3T3 cells. Therefore, 3T3 cells were cultured in Nunc 0.2-microm tissue culture inserts that could be readily removed from the wells when no longer needed. There was no loss of the enteric glia. The cultures consisted entirely of GFAP-labeled cells, presumptive enteric glia. This method permits the culturing of large numbers of highly purified enteric glia without the use of expensive growth factors and complement-mediated cytolysis.

3T3 Cells↗

PubMed1997

Experience with enteric conversion after pancreatic transplantation with bladder drainage.

BACKGROUND: Bladder drainage by the duodenal segment technique is currently the preferred method of handling the exocrine secretions after vascularized pancreatic transplantation. Despite improving results, however, the management of metabolic and urologic complications associated with bladder drainage remains problematic. STUDY DESIGN: A retrospective survey was performed of a consecutive case series of 196 pancreatic transplantations in 186 patients with diabetes over an 80-month period. All patients underwent whole organ pancreatic transplantation with bladder drainage by the duodenal segment technique. RESULTS: A total of 25 conversions (13 percent) from bladder drainage to enteric drainage were performed in 24 patients (24 side-to-side duodenoenterostomies, one Roux-en-Y limb duodenoenterostomy). The mean time of enteric conversion after pancreatic transplantation was 22 +/- 18 months (range, 1 to 72 months). All but two of the enteric conversions were performed at least 6 months after pancreatic transplantation. Indications for enteric conversion included dehydration with intractable metabolic acidosis (n = 18; 9 percent), urologic complications (n = 5; 3 percent), or problems with the duodenal segment (n = 2; 1 percent). The mean length of hospitalization for enteric conversion was 12 +/- 7 days (range, 6 to 30 days). All patients experienced improvement in their symptoms after enteric conversion. Anastomotic leaks developed postoperatively in five patients; two were managed operatively and three were managed nonoperatively. Oral bicarbonate supplementation was eliminated in all but one patient after enteric conversion. Patient survival is 100 percent and pancreatic graft survival (insulin independence) is 96 percent after a mean follow-up of 22 months after enteric conversion. CONCLUSIONS: Enteric conversion after pancreatic transplantation with bladder drainage is a safe and effective therapy for refractory problems related to the duodenal segment, altered physiologic function, or urologic complications and should be considered after 6 months for patients with persistent side effects.

Adult↗

PubMed2000

Enteral tube feeding for cystic fibrosis.

BACKGROUND: Enteral tube feeding is routinely used in many cystic fibrosis centres when weight for height percentage is less than 85%, when there has been weight loss for greater than a two month period or when there has been no weight gain for two to three months (under five years old) or for six months (over five years old). OBJECTIVES: To examine the evidence that in patients with cystic fibrosis supplemental enteral tube feeding improves nutritional status, respiratory function, and quality of life without significant adverse effects. SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group specialised register and contacted the companies which market enteral feeds and reviewed their databases. Date of the most recent search of the Group's specialised register: November 1999. SELECTION CRITERIA: All randomised controlled trials comparing supplemental enteral tube feeding for one month or longer with no specific intervention in patients with cystic fibrosis. DATA COLLECTION AND ANALYSIS: There are no trials included in this review. MAIN RESULTS: There are no trials included in this review. REVIEWER'S CONCLUSIONS: Supplemental enteral tube feeding is widely used throughout the world to improve nutritional status in patients with cystic fibrosis. The methods mostly used, nasogastric or gastrostomy feeding, are invasive, expensive, and may have a negative effect on self esteem and body image. Reported use of enteral tube feeding suggests that it results in nutritional and respiratory improvement and it is disappointing that their efficacy has not been fully assessed by randomised controlled trials. With the more frequent recommendations to use enteral tube feeding as an early rather than a late intervention, this systematic review identifies the need for a multi-centre randomised controlled trial assessing both efficacy and possible adverse effects of enteral tube feeding in cystic fibrosis.

Cystic Fibrosis↗

PubMed2006

Early versus delayed enteral nutrition support for burn injuries.

BACKGROUND: A burn injury increases the body's metabolic demands, and therefore nutritional requirements. Provision of an adequate supply of nutrients is believed to lower the incidence of metabolic abnormalities, thus reducing septic morbidity, improving survival rates, and decreasing hospital length of stay. Enteral nutrition support is the best feeding method for patients who are unable to achieve an adequate oral intake to maintain gastrointestinal functioning, however, its timing (i.e. early versus late) needs to be established. OBJECTIVES: To assess the effectiveness and safety of early versus late enteral nutrition support in adults with burn injury. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, issue 1, 2006), the Cochrane Injuries Group's Specialised Register, MEDLINE (1966 to May week 1, 2006), EMBASE (1980 to week 17, 2005) and CINAHL (1982 to May week 1, 2006). SELECTION CRITERIA: We included all randomised controlled trials comparing early enteral nutrition support (within 24 hours of injury) versus delayed enteral support (greater than 24 hours). DATA COLLECTION AND ANALYSIS: Two authors used standardised forms to independently extract the data. Each trial was assessed for internal validity with differences resolved by discussion. MAIN RESULTS: A total of three randomised controlled trials were eligible for inclusion in this review. Results of the studies indicate that evidence about the benefit of early enteral nutritional support on standardised clinical outcomes such as length of hospital stay and mortality, remains inconclusive. Similarly, the question of whether early enteral feeding influenced or decreased metabolic rate as documented in part by our included studies, remains uncertain. AUTHORS' CONCLUSIONS: This systematic review has not found sufficient evidence to support or refute the effectiveness of early versus late enteral nutrition support in adults with burn injury. The trials showed some promising results that would suggest early enteral nutrition support may blunt the hypermetabolic response to thermal injury, but this is insufficient to provide clear guidelines for practice. Further research incorporating larger sample sizes and rigorous methodology that utilises valid and reliable outcome measures, is essential.

Adult↗

PubMed2007

Genetic screen for mutations affecting development and function of the enteric nervous system.

An intact enteric nervous system is required for normal gastrointestinal tract function. Several human conditions result from decreased innervation by enteric neurons; however, the genetic basis of enteric nervous system development and function is incompletely understood. In an effort to increase our understanding of the mechanisms underlying enteric nervous system development, we screened mutagenized zebrafish for changes in the number or distribution of enteric neurons. We also established a motility assay and rescreened mutants to learn whether enteric neuron number is correlated with gastrointestinal motility in zebrafish. We describe mutations isolated in our screen that affect enteric neurons specifically, as well as mutations that affect other neural crest derivatives or have pleiotropic effects. We show a correlation between the severity of enteric neuron loss and gastrointestinal motility defects. This screen provides biological tools that serve as the basis for future mechanistic studies.

Animals↗

PubMed1997

Enteral nutrition for Crohn's disease in Japan.

UNLABELLED: Indication for and an evaluation of enteral nutrition in Crohn's disease differ between Japan and western countries. PURPOSE: Japanese results are reported and differences are discussed. RESULTS: Enteral nutrition with an elemental diet is first-line therapy for active Crohn's disease in Japan. The remission induction rate of elemental diet therapy is approximately 80 percent, which is superior to steroids. Furthermore, elemental diet therapy induces radiographic and endoscopic remission. On the other hand, meta-analysis from randomized, controlled trials showed steroids to be more effective than enteral nutrition in western countries. The differences are considered to be the result of such differences as therapeutic duration of enteral nutrition, the composition of enteral diets used, criteria for remission, the quality of life score of a long-term fast with a nasogastric tube, medical care, and health insurance system. The main mechanism of the therapeutic effect of elemental diet is speculated to be attributable to removal of food antigens and decreases of secretion and motility (bowel rest) by very low fat. To prevent relapse and rehospitalization, home enteral nutrition is now used widely in Japan. The therapeutic effect is observed in patients with ileal involvement, and more than 1,200 kcal/day is more effective than a lower amount. CONCLUSION: Most Japanese studies were open-labeled, uncontrolled trials. We should conduct randomized, controlled trials comparing enteral nutrition with steroids during the active stage of Crohn's disease and home enteral nutrition with drugs in maintaining remission and investigate the therapeutic effect, quality of life, and costs.

Crohn Disease↗

PubMed1996

[Feasibility and complications in early enteral nutrition of severely injured polytrauma patients via duodenal tubes].

Early enteral nutrition is widely accepted for its support of organ structure and function ("gut injury hypothesis") and reduction of infectious complications and hypermetabolism in critically ill postoperative or postinjury patients. Nineteen severely injured patients (Injury Severity Score 40.3 +/- 11.6) were studied for the feasibility of early enteral nutrition via a duodenal feeding tube. Despite maxillary fractures, rhinoliquorrhea and blunt abdominal trauma the enteral feeding was mostly started immediately after trauma. Intermittent diarrhea or constipation resolved after reduction of the feeding rate within 1 or 2 days. Total enteral nutrition could not be realized in all cases; a central venous line was always additionally necessary. However, the goal was not complete enteral nutrition but a continuous enteral supply to maintain the integrity of the gut. The study has shown that early enteral nutrition via a duodenal feeding tube is also feasible in severely injured patients. The expenditure to overcome the technical and organizational problems seems to be justified. Enterally fed patients may have a better outcome that those in whom only parenteral is employed.

Adolescent↗

PubMed2003

Differentiation of neurospheres from the enteric nervous system.

The enteric nervous system (ENS) derives from neural crest cells, which migrate from the neural tube into the developing gut. The neuronal and glial precursor cells migrate mainly from the oral towards the anal end of the gastrointestinal tract. So far, knowledge about the multipotent influences upon the ENS development, especially its neurotrophic support, derives mainly from knock-out models. The in vitro technique of isolating enteric neuronal precursor cells allows to study the effects of various factors upon their appropriate development in more detail. We therefore adapted the method of growing neurospheres, which are agglomerates of neuronal precursor cells and differentiated neurones and glial cells, from the central nervous system (CNS) for the ENS. The gut of NMRI mice at E12 were dissected, mildly dissociated and plated in 25-cm(2) culture flasks. The cultures were maintained in N1 supplemented DMEM/F12 medium with the appropriate neurotrophin cocktails (bFGF, GDNF, Neurturin, CNTF). After several days in culture most of the cells die, while the surviving cells form clusters from which domes, and later spheres arise. The spheres could be harvested and processed for further experiments. First investigations revealed, that the amount of precursor cells was much less in enteric neurospheres as seen in corresponding cultures from the CNS. We found about 43% HNK-1-NCAM+ in enteric and approximately 90% Nestin-+ cells in midbrain neurospheres. Differentiation studies of the enteric neurospheres showed that especially ciliary neurotrophic factor (CNTF) increased the number of enteric neurones (PGP positive), while the amount of HNK-1 precursor cells decreased under the influence of all tested neurotrophins but GDNF. The culture of the freshly dissociated enteric neurospheres in a three-dimensional matrix yielded a secondary network which allows to investigate the pattern formation of the ENS. The generation of enteric neurospheres and the following differentiation and 3D culture in vitro can increase our knowledge of the amount and time point of neurotrophic as well as the ECM-protein influence upon the appropriate development of the ENS.

Animals↗