Intramucosal pH and intestinal mucosal damage in ischemia-reperfusion

Small bowel transplantation (SBT) has become an increasingly promising trea tment for short bowel syndrome. The evaluation of graft viability after SET , however, has not been established, except by mucosal biopsy. We monitored intestinal mucosal acidity in order to detect small intestinal ischemia-re perfusion injury. Mongrel dogs were used in this study. After laparotomy, t he small bowel was isolated with a vascular pedicle. A tonometer to measure intramucosal pH (pHi) was then positioned in the terminal ileum. The super ior mesenteric artery was occluded with or without concomitant superior mes enteric Vein occlusion for 60 or 120 min. The value of pHi was determined f rom laparotomy (baseline) to 12 h after reperfusion. Whole-thickness specim ens of the ileum were taken before ischemia, just before reperfusion, and I h afterward. Mucosal injury was graded histopathologically. pHi decreased f rom baseline in relation to the degree of histopathological mucosal injury. There was a significant correlation between histological findings and the change in pHi. We conclude that monitoring intestinal mucosal acidity is a reliable way of determining graft viability after SET.