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Glutamine-Enriched Enteral Diet Enhances Bacterial Clearance in Protracted Bacterial Peritonitis, Regardless of Glutamine Form

Department of Surgery, Faculty of Medicine, University of Tokyo, Japan

Hideahi Saito, MD

Surgical Center, University of Tokyo, Japan

Tsuyoshi Inaba, MD

Department of Surgery, Faculty of Medicine, University of Tokyo, Japan

Ming-Tsan Lin, MD

Department of Surgery, Faculty of Medicine, University of Tokyo, Japan

Tomomi Inoue, MD

Department of Surgery, Faculty of Medicine, University of Tokyo, Japan

Shuji Naka, MD

Department of Surgery, Faculty of Medicine, University of Tokyo, Japan

Kazuhiko Fukatsu, MD

Department of Surgery, Faculty of Medicine, University of Tokyo, Japan

Yojiro Hashiguchi, MD

Department of Surgery, Faculty of Medicine, University of Tokyo, Japan

Ilsoo Han, MD

Department of Surgery, Faculty of Medicine, University of Tokyo, Japan

Takeaki Matsuda, MD

Department of Surgery, Faculty of Medicine, University of Tokyo, Japan

Shigeo Ikeda, MD

Department of Surgery, Faculty of Medicine, University of Tokyo, Japan

Tetsuichiro Muto, MD

Department of Surgery, Faculty of Medicine, University of Tokyo, Japan

Background: The effects of glutamine (Gln)-enriched enteral diets on bacterial clearance were investigated in a rat protracted peritonitis model. The effects of the Gln form, peptide-based vs free amino acid-based, were also compared. Methods: Twenty-three rats underwent gastrostomy. An osmotic pump was implanted in the peritoneal cavity. The rats received a continuous intragastric infusion of one of three diets: Gln-depleted (Gln 0), Gln-enriched with the Gln in free amino acid form (Gln F), or Gln-enriched with the Gln in oligopeptide form (Gln P). The three formulas were isocaloric and isonitrogenous. The pumps delivered a continuous infusion ofEscherichia coli, starting at 48 hours after implantation, for 24 hours. Then, the animals were killed. Results: Bacterial numbers in peritoneal lavaged fluid (PLF) and the liver were significantly lower in the Gln P and Gln F groups than in the Gln 0 group. The bacterial number in PLF correlated with that in the liver. Neither the number nor the population of peritoneal exudative cells differed among groups. Plasma levels of proline, alanine and citrulline were significantly higher in the Gln P and Gln F groups than in the Gln 0 group. Both Gln supplemented groups showed significantly greater villous height, crypt depth, and numbers of mitoses per crypt in the small intestine than the Gln 0 group. Conclusions: Supplemental Gln enhances peritoneal and hepatic bacterial clearance, regardless of Gln form. Gln-enriched may be more beneficial than Gln-depleted enteral diets in peritonitis. (Journal of Parenteral and Enteral Nutrition 21:208-214, 1997)

Journal of Parenteral and Enteral Nutrition, Vol. 21, No. 4, 208-214 (1997)
DOI: 10.1177/0148607197021004208


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