GUT FUNCTION AND IMMUNE AND INFLAMMATORY RESPONSES IN PATIENTS PERIOPERATIVELY FED WITH SUPPLEMENTED ENTERAL FORMULAS

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.