Prolonged Fasting Induces Histological and Ultrastructural Changes in the Intestinal Mucosa That May Reduce...

Area of Science:

• Gastroenterology
• Histopathology
• Nutritional Science

Background:

• Malnutrition is common in patients requiring percutaneous endoscopic gastrostomy (PEG).
• Refeeding syndrome is infrequent in PEG-fed patients, possibly due to reduced absorption after prolonged starvation.
• This study investigates intestinal mucosal changes and their reversibility with enteral nutrition.

Purpose of the Study:

• To evaluate initial histological and ultrastructural changes in the intestinal mucosa of patients undergoing PEG after prolonged fasting.
• To assess the reversibility of these changes with enteral refeeding.
• To understand potential mechanisms behind impaired absorption in the early post-PEG period.

Main Methods:

• Observational, prospective, controlled study design.
• Adult patients with malnutrition or inadequate intake for at least one month were enrolled.
• Duodenal biopsies were analyzed histologically and ultrastructurally at baseline and after 3-6 months of PEG feeding, with healthy controls for comparison.

Main Results:

• At baseline, patients showed shorter median villi length (MVL) compared to controls (0.4 mm vs. 0.6 mm) and significant ultrastructural changes including microvilli disruption and enterocyte alterations.
• After 3-6 months of enteral refeeding via PEG, 92.9% of patients exhibited normal duodenal histology with increased MVL (p < 0.001).
• Ultrastructural abnormalities resolved, and enterocytes appeared normal, though some residual dense bodies were noted.

Conclusions:

• Prolonged fasting induces reversible histological and ultrastructural changes in the intestinal mucosa.
• These mucosal alterations likely contribute to impaired absorption in the early phase of percutaneous endoscopic gastrostomy feeding.
• Enteral nutrition effectively reverses these fasting-induced intestinal changes, supporting its role in recovery.