M. Braga et al., GUT FUNCTION AND IMMUNE AND INFLAMMATORY RESPONSES IN PATIENTS PERIOPERATIVELY FED WITH SUPPLEMENTED ENTERAL FORMULAS, Archives of surgery, 131(12), 1996, pp. 1257-1264
Objective: To evaluate if the perioperative administration of a supple
mented enteral formula modulates selective inflammatory and immune var
iables and gut function after surgery. Design: Prospective, randomized
, double-bind, clinical trial. Setting: Department of surgery, univers
ity hospital. Patients: Forty patients with neoplasm of the colorectum
or stomach. Intervention: Seven days before surgery, the patients dra
nk 1 L/d of a control enteral formula (n=20) or the same formula enric
hed with arginine, RNA, and omega-3 fatty acids (n=20). Jejunal infusi
on with the same formulas was started 6 hours after operation and cont
inued until day 7. Main Outcome Measures: Immune response was determin
ed by phagocytosis ability and respiratory burst of polymorphonuclear
cells, and inflammatory response by plasma levels of C-reactive protei
n. Operative intestinal microperfusion, postoperative intestinal mucos
a oxygen metabolism, and plasma intestinal isoenzyme of alkaline phosp
hatase were used as indicators of gut function. Plasma nitric oxide al
so was determined. Results: In the enriched group, phagocytosis abilit
y and respiratory burst after surgery was higher (P<.01) and C-reactiv
e protein level was lower (P<.05) than in the control group. The enric
hed group had higher mean (+/-SD) intestinal microperfusion (180+/-46
vs 146+/-59 perfusion units, P<.05), intestinal mucosa oxygen metaboli
sm (pHi 7.39+/-0.2 vs pHi 7.33+/-0.1, P<.05), and 5-fold lower levels
of intestinal isoenzyme of alkaline phosphatase (P<.05). Postoperative
levels of nitric oxide were higher in the enriched group (P<.05, anal
ysis of variance). Conclusion: The perioperative administration of an
enriched enteral formula significantly improved gut function and posit
ively modulated postsurgical immunosuppressive and inflammatory respon
ses.