A Digestive Cartridge Reduces Parenteral Nutrition Dependence and Increases Bowel Growth in a Piglet Short Bowel Model.

OBJECTIVE: To determine whether use of an immobilized lipase cartridge (ILC) to hydrolyze fats in enteral nutrition (EN) reduces parenteral nutrition (PN) dependence in a porcine model of short bowel syndrome with intestinal failure (SBS-IF).

BACKGROUND: SBS-IF occurs following intestinal loss resulting in malabsorption and PN dependence. Limited therapeutic options are available for achieving enteral autonomy.

METHODS: Eleven Yorkshire piglets underwent 75% jejunoileal resection and were randomized into control (n=6) and treatment (n=5) groups. PN was initiated postoperatively and reduced as EN advanced, if pre-defined clinical criteria were fulfilled. Animals were studied for 14 days, and changes in PN/EN calories were assessed. Intestinal adaptation, absorption, and nutrition were evaluated at the end of the study (day 15). Comparisons between groups was performed using analysis of covariance adjusted for baseline.

RESULTS: ILC animals demonstrated 19% greater reduction in PN calories (P<0.0001) and higher mean EN advancement (66% vs. 47% of total calories, P<0.0001) during the 14-day experiment. Treatment animals had increased intestinal length (19.5 vs. 0.7%, P=0.03) and 1.9-fold higher crypt cell proliferation (P=0.02) compared to controls. By day 15, ILC treatment resulted in higher plasma concentrations of GLP-2 (P=0.02), EPA (P<0.0001), DHA (P=0.004), Vitamin A (P=0.02), LDL (P=0.02), and HDL (P=0.04). There were no differences in liver enzymes or total bilirubin between the two groups.

CONCLUSIONS: ILC use in conjunction with enteral feeding reduced PN dependence, improved nutrient absorption, and increased bowel growth in a porcine SBS-IF model. These results support a potential role for the ILC in clinical SBS-IF.