Mp. Pakarinen et al., ADAPTIVE LIPID-METABOLISM AFTER ILEAL AUTOTRANSPLANTATION IN PIGS WITH PROXIMAL GUT RESECTION, Surgery, 122(5), 1997, pp. 950-961
Background. Transplantation of the small intestine impairs intestinal
absorptive function, but the adaptive response of a segmental graft is
unknown. The aim of this study was to investigate the effects of ilea
l autotransplantation on the adaptive absorption and metabolism of lip
ids in pigs that had undergone proximal gut resection. Methods. Serum
lipids, plasma vitamins A and E, absorption and excretion of cholester
ol, bile acids and fat, plasma cholesterol precursor and plant sterol
proportions to cholesterol (respective markers of cholesterol synthesi
s and absorption) enteric structure, and transit were determined 4, 8,
and 24 weeks after 7.5 % proximal resection with (n = 15) or without
(n = 15) autotransplantation of the remaining Ileum. Results. As compa
red with pigs that underwent proximal gut resection, the additional au
totransplantation reduced the adaptive increase in total serum and hig
h-density lipoprotein cholesterol, plasma plant sterol proportions and
vitamin E concentrations, cholesterol and fat absorption efficiency,
and villus height (p < 0.05 for all) during the 14 postoperative weeks
and resulted in increases of up to 4.6, 2.7, 1.3, and 2.1 times the p
lasma cholesterol precursors (p < 0.005), fecal excretion of bile acid
s (p < 0.0005), neutral steroids (p < 0.005), and net elimination of c
holesterol (p < 0.0005), respectively. Cholesterol and fat absorption
and plasma plant sterols were significantly enhanced between 8 and 14
weeks after autotransplantation (p < 0.05, p < 0.005, and p < 0.05, re
spectively), whereas fecal elimination of cholesterol remained increas
ed until the end of the follow-up. Conclusions. Autotransplantation of
the ileum in pigs that have undergone proximal small bowel resection
disturbs the adaptive absorption of cholesterol, bile acids, fat, and
fat-soluble vitamins, resulting, through increased fecal elimination o
f cholesterol, in decreased serum cholesterol despite a marked compens
atory increase in cholesterol synthesis.