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Intestinal adaptation: structure, function, and regulation.

D P O'Brien1, L A Nelson, F S Huang

  • 1Children's Hospital Medical Center, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA.

Seminars in Pediatric Surgery
|May 1, 2001
PubMed
Summary
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Following small bowel resection (SBR), the remaining intestine adapts by increasing its size and absorptive capacity. Effective intestinal adaptation is crucial to prevent long-term complications like liver dysfunction.

Area of Science:

  • Gastroenterology
  • Surgical Physiology
  • Intestinal Adaptation

Background:

  • Massive small bowel resection (SBR) leads to significant loss of digestive and absorptive capacity.
  • The remnant intestine initiates a complex adaptive process to compensate for this loss.
  • Inadequate adaptation can result in lifelong parenteral nutrition dependence and associated complications.

Purpose of the Study:

  • To elucidate the physiological changes and mediators involved in intestinal adaptation post-SBR.
  • To highlight the functional consequences of successful and inadequate intestinal adaptation.
  • To emphasize the importance of understanding adaptation for developing novel therapeutic strategies.

Main Methods:

  • The study reviews the known adaptive responses of the remnant intestine following SBR.

Related Experiment Videos

  • It discusses the cellular and molecular mechanisms driving intestinal adaptation.
  • It examines the functional outcomes and potential complications related to adaptation.

    • Main Results:

    • Post-SBR, the remnant intestine exhibits increased weight, cellularity, villus height, crypt depth, and absorptive surface area.
    • Functional adaptations include upregulation of key nutrient transporters (e.g., Na+/glucose cotransporter) and digestive enzymes.
    • Mediators like luminal nutrients and gastrointestinal secretions are implicated in driving adaptation.

    Conclusions:

    • Intestinal adaptation is a critical compensatory mechanism after SBR, involving proliferative and functional changes.
    • Failure to adapt adequately leads to dependence on parenteral nutrition and risks of cholestatic liver disease, bacterial translocation, and sepsis.
    • Further understanding of intestinal adaptation mechanisms is essential for developing therapies to enhance this process.