Intestinal permeability after early postoperative enteral nutrition in patients with upper gastrointestinal malignancy

Background: Increased intestinal permeability may lead to sepsis in resecte d upper gastrointestinal (GI) cancer patients. This study sought to determi ne whether these patients demonstrated increased intestinal permeability an d if early postoperative enteral nutrition would alter this result. Methods : Nineteen patients undergoing complete resection of upper GI malignancy we re randomized into two groups: the nonfed group received TV crystalloid, an d the fed group started enteral nutrition by jejunostomy on postoperative d ay (POD) 1. Six nonoperative Volunteers were controls. The lactulose/mannit ol test was performed on PODs 1 and 5. Ten grams of lactulose and 5 g of ma nnitol were given, and urine was collected for 6 hours. Results: All patien ts (nonfed, 1.895 +/- 0.34; fed, 0.893 +/- 0.24) had elevated lactulose/man nitol ratios on POD 1 vs controls (0.262 +/- 0.1; p < .008 and p = .05). Th ese elevated levels returned toward control levels in both groups by day 5 (nonfed, 0.533 +/- 0.1, p = .06; fed, 0.606 +/- 0.12, p = .08). Conclusions : Major upper GI surgery for malignancy resulted in a significant increase in intestinal permeability on POD 1. With or without enteral nutrition, thi s measure of intestinal permeability returned to normal on POD 5 in well-no urished patients.