The effects of long-term total parenteral nutrition on gut mucosal immunity in children with short bowel syndrome: a systematic reviewReport as inadecuate

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BMC Nursing

, 4:2

First Online: 01 February 2005Received: 28 January 2004Accepted: 01 February 2005


BackgroundShort bowel syndrome SBS is defined as the malabsorptive state that often follows massive resection of the small intestine. Most cases originate in the newborn period and result from congenital anomalies. It is associated with a high morbidity, is potentially lethal and often requires months, sometimes years, in the hospital and home on total parenteral nutrition TPN. Long-term survival without parenteral nutrition depends upon establishing enteral nutrition and the process of intestinal adaptation through which the remaining small bowel gradually increases its absorptive capacity. The purpose of this article is to perform a descriptive systematic review of the published articles on the effects of TPN on the intestinal immune system investigating whether long-term TPN induces bacterial translocation, decreases secretory immunoglobulin A S-IgA, impairs intestinal immunity, and changes mucosal architecture in children with SBS.

MethodsThe databases of OVID, such as MEDLINE and CINAHL, Cochran Library, and Evidence-Based Medicine were searched for articles published from 1990 to 2001. Search terms were total parenteral nutrition, children, bacterial translocation, small bowel syndrome, short gut syndrome, intestinal immunity, gut permeability, sepsis, hyperglycemia, immunonutrition, glutamine, enteral tube feeding, and systematic reviews. The goal was to include all clinical studies conducted in children directly addressing the effects of TPN on gut immunity.

ResultsA total of 13 studies were identified. These 13 studies included a total of 414 infants and children between the ages approximately 4 months to 17 years old, and 16 healthy adults as controls; and they varied in design and were conducted in several disciplines. The results were integrated into common themes. Five themes were identified: 1 sepsis, 2 impaired immune functions: In vitro studies, 3 mortality, 4 villous atrophy, 5 duration of dependency on TPN after bowel resection.

ConclusionBased on this exhaustive literature review, there is no direct evidence suggesting that TPN promotes bacterial overgrowth, impairs neutrophil functions, inhibits blood-s bactericidal effect, causes villous atrophy, or causes to death in human model.

The hypothesis relating negative effects of TPN on gut immunity remains attractive, but unproven. Enteral nutrition is cheaper, but no safer than TPN. Based on the current evidence, TPN seems to be safe and a life saving solution.

List of abbreviations usedSBSShort bowel syndrome

TPNTotal parenteral nutrition.

IgAImmunoglobulin A

S-IgASecretory immunoglobulin A

GALTGut-associated lymphoid tissue


MALTMucosa-associated lymphoid tissue

NECNecrotizing enterocolitis

MMCMigrating motor complex


NONitric oxide

NOSNitric oxide synthase

NSAIDsNonsteroidal anti-inflammatory drugs

TNFTumor necrosis factor



ACTHAdrenocorticotropic hormone

ADHAntidiuretic hormone

FFAFree fatty acids

PPMPathogenic microorganism

PMNNeutrophil polymorhonuclear

PRCTProspective randomized clinical trials

ICUIntensive Care Unit


GTGastrostomy tube


JTJejunostomy tube

AGAAmerican Gastroenterological Association

ASPENAmerican society for parenteral and enteral nutrition

PICCsPercutaneously inserted central catheters

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6955-4-2 contains supplementary material, which is available to authorized users.

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Author: Beyhan Duran


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