期刊
JOURNAL OF PEDIATRIC SURGERY
卷 58, 期 6, 页码 1074-1078出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jpedsurg.2023.02.031
关键词
Short bowel syndrome; Small bowel resection; Enterohepatic circulation; Hepatic injury; Bile acids
By performing different intestinal resection surgeries in mice, it was found that preserving the ileocecal region is beneficial for bile acid metabolism and reduces liver injury by decreasing hepatic oxidative stress. This challenges the notion that preserving the ileocecal region is beneficial for patients with short bowel syndrome.
Background: Massive small bowel resection (SBR) is associated with liver injury and fibrosis. Efforts to elucidate the driving force behind hepatic injury have identified multiple factors, including the gener-ation of toxic bile acid metabolites.Methods: Sham, 50% proximal, and 50% distal SBR were carried out in C57BL/6 mice to determine the effect of jejunal (proximal SBR) versus ileocecal resection (distal SBR) on bile acid metabolism and liver injury. Tissues were harvested at 2 and 10-week postoperative timepoints.Results: When compared with 50% proximal SBR, mice that underwent distal SBR exhibited less hepatic oxidative stress as verified by decreased mRNA expression of tumor necrosis factor -a (TNFa, p <= 0.0001), nicotinamide adenine dinucleotide phosphate oxidase (NOX, p <= 0.0001), and glutathione synthetase (GSS, p <= 0.05). Distal SBR mice also exhibited a more hydrophilic bile acid profile with reduced abun-dance of insoluble bile acids (cholic acid (CA), taurodeoxycholic acid (TCA), and taurolithocholic acid (TLCA)), and increased abundance of soluble bile acids (tauroursodeoxycholic acid (TUDCA)). In contrast with proximal SBR, ileocecal resection alters enterohepatic circulation leading to reduced oxidative stress and promotes physiological bile acid metabolism.Conclusion: These findings challenge the notion that preservation of the ileocecal region is beneficial in patients with short bowel syndrome. Administration of selected bile acids may present potential therapy to mitigate resection-associated liver injury. Level of evidence: IIIdCase-Control Study.(c) 2023 Elsevier Inc. All rights reserved.
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