SMALL-INTESTINAL MUCOSA CHANGES, INCLUDING EPITHELIAL-CELL PROLIFERATIVE ACTIVITY, OF CHILDREN RECEIVING TOTAL PARENTERAL-NUTRITION (TPN)

We examined the small intestinal histology disaccharidase activities a s well as the incorporation of [H-3]thymidine into DNA of biopsies mai ntained in organ culture from seven children (ages 9 months to 5 years ) receiving total parenteral nutrition (TPN). Three children suffered from inflammatory bowel disease and received TPN for one month (short term). Four required long-term TPN (>9 months) for short-bowel syndrom e. DNA was extracted from the samples following serial precipitation w ith perchloric acid. Results were compared to those from 22 age-matche d children investigated for abdominal pain or chronic diarrhea. Short- term TPN resulted in slightly lower lactase, sucrase, and palatinase a ctivities that were not statistically different from controls. Long-te rm TPN resulted in focal mild villus atrophy and a decrease in disacch aridase activity in two patients. Biopsies from long-term TPN patients incorporated less thymidine compared to those of controls (P < 0.001) when data was expressed per total biopsy (3.6 +/- 1.1 vs. 8.4 +/- 1.1 fmol) or per milligram of tissue (1.0 +/- 0.12 vs 2.7 +/- 0.7 fmol). The above,data are in general agreement with the hypoplastic effect of TPN in animals. However, in children, much longer periods of TPN are required to realize the changes.