Gut mucosal atrophy after a short enteral pasting period in critically illpatients

Purpose: The purpose of this study was to evaluate the presence of gut muco sal atrophy and changes in mucosal permeability in critically ill patients after a short fasting period. Materials and Methods: Fifteen critically ill patients underwent a period o f enteral fasting of at least 4 days (mean 7.8 days). We took the following measurements the day before initiating enteral nutrition: indirect calorim etry, serum albumin, prealbumin, and lymphocyte count. We also performed a duodenal endoscopic biopsy with histopathological and mucosal morphometric analysis including villus height and crypt depth. The lactulose-mannitol te st was performed to assess gut permeability, A total of 28 healthy voluntee rs served as controls for duodenal biopsy or lactulose-mannitol test. Clini cal data, such as length of fasting, severity score, and previous parentera l nutritional support, were recorded, Results: We found gut mucosal atrophy, expressed as a decrease in villus he ight and crypt depth, in patients compared with controls. The patients also exhibited an abnormal lactulose-mannitol test. Morphometric changes did no t correlate with permeability. Further, we found no correlation between the results of the lactulose-mannitol test and of mucosal morphometry with cli nical data. Conclusions: We found that a short period of enteral fasting was associated with significant duodenal mucosal atrophy and abnormal gut permeability in critically ill patients. Copyright (C) 1999 by W.B, Saunders Company.