肠粘膜屏障与胃肠疾病

肠粘膜屏障主要包括机械屏障、免疫屏障、生物屏障,三者之间相辅相成,其功能主要在于防止肠道内细菌及内毒素移位。胃肠道功能的正常发挥有赖于肠粘膜屏障稳定,腹泻、肠易激综合征、炎症性肠病以及全身炎症综合征等诸多临床疾病均存在不同程度的肠粘膜屏障损伤。本文就肠粘膜屏障构成体系,肠屏障损伤与胃肠道疾病的关系的研究情况作综述。     

营养、生长激素与胃肠道修复、重建

0引言 营养是生物得以生长、修复器官、组织与维护生命活动的基础.胃肠道是人类获得营养的主要器官,其他组织、器官的修复需要从胃肠道获得营养.胃肠道本身修复与重建时,同样需要有营养底物.20世纪80年代以来,人们对肠道的功能有了更深的认识,胃肠道除了有消化、吸收营养的功能外,尚有屏障功能[1].肠道屏障功能与消化吸收功能对机体都十分重要,屏障功能对危重病人的病理生理有着更直接、更重要的影响.因此,胃肠道的修复、重建不但是肠道解剖学连续性的修复、重建,也应包含肠道功能特别是屏障功能的维护与修复.     

营养药理学--肠屏障功能及营养药理学实践

胃肠道的生物学功能通常未能引起人们的足够重视。胃肠道是机体内最大的淋巴器官，有类似肝脏的代谢功能。消化道的吸收面积是皮肤表面积的100倍，具有防止微生物入侵的重要屏障功能。生理情况下肠道内有许多细菌，数量是地球上人类总数的1000倍；在肠梗阻或炎症状态下肠道内细菌数量会     

空肠喂养管的护理

肠内营养是通过胃肠道经口服或管饲来提供营养物质及其他各种营养素的临床营养支持方法。手术后实施肠内营养补充，能及时改善病人的营养状况，维持肠粘膜屏障功能，减少细菌移位，促进肠功能恢复，可减少感染及并发症的发生。且空肠喂养适应于各种癌症患者营养的补充。     

颅脑手术后昏迷病人肠内营养支持的应用研究

0 引言 近年来,EN支持在临床中的作用越来越重要,与PN相比,EN不但有供给营养的作用,而且能改善肠黏膜屏障功能,促进肠蠕动功能的恢复,加速门静脉系统的血液循环,促进胃肠道激素的分泌[1].     

补充性肠外营养

<正>临床营养支持治疗发展至今已40余年,大量的研究结果已证实合理的营养支持对改善病人的临床结局具有重要作用,营养支持已成为临床规范化治疗的重要组成之一[1]。肠内营养(EN)的物质系经门静脉进入循环,能改善肠功能、维护肠黏膜屏障,具有肠外营养(PN)无法比拟的优势。因此,众多的临床营养支持治疗指南都强调,当病人胃肠道功能正常时,首选EN支持[2]。但在临床实践中,EN的实施常有困难:如病     

如何对付宝宝湿疹

对于湿疹,几乎可以说每个宝宝都避免不掉会出现的症状。几乎每个宝宝都得过湿疹,只是轻重的问题。对于这个令初为人母的妈妈颇为头疼的问题,我们集中了6个最具有代表性的问题,看看到底湿疹是怎么一回事。病因病理:1.消化道的屏障发育不全。胃肠道黏膜发育得不好,肠道屏障功能不成熟而出现渗漏现象,导致食物过敏源易于通过肠道黏膜进入体内而诱发湿疹。2.皮肤的屏障发育不全。婴幼儿的皮肤薄、嫩,皮肤的屏障功     

“序贯疗法”优化手术后早期肠内营养

肠内营养较肠外营养更符合生理,具有保护肠屏障功能、肝功能和免疫功能,促进胃肠道功能及蛋白质合成,降低应激反应及胰岛素抵抗,降低感染并发症和医疗费用等重要作用和优势。肠内营养实施的关键是对肠内营养适应证、并发症和禁忌证的认识,以及对肠内营养制剂、置管途径及器械装置配套的合理选择。为增加手术后肠内营养耐受性,降低并发症,提高营养支持治疗效果,提出了肠内营养临床应用新方法一手术后早期肠内营养“序贯疗法”。     

淋巴小结相关上皮细胞在肠黏膜屏障中的作用

淋巴小结相关上皮细胞(M细胞)是覆盖在器官相关淋巴组织(OALT)上的滤泡相关上皮(FAE)中特殊分化出来的一种细胞.在胃肠道,M细胞主要承担着向黏膜下转运肠腔内的抗原,进而诱发免疫反应的功能.作为胃肠道黏膜免疫屏障的门户,M细胞被认为是肠黏膜免疫屏障中重要的功能性通道.以下就M细胞的特殊结构、生物学特性及其在肠黏膜屏障中的特殊作用作一综述.     

重症急性胰腺炎48例分析

重症急性胰腺炎（SAP）由于胰腺组织受损坏死，大量含肿瘤坏死因子、白细胞介素类及内毒素等成分的腹膜液渗出，使消化道组织水肿，胃肠道蠕动功能障碍，粘膜屏障功能受损，肠道细菌移位和毒素吸收，甚至引起全身炎症反应或导致多器官功能障碍综合征。研究表明造成患者死亡的主要原因是胰腺组织坏死，     

肠道免疫机制对肠内营养改善患者结局的影响

胃肠道作为人体最大的保护屏障,能够帮助机体抵御外界有害物质的侵袭和攻击,其保护屏障分别为:机械屏障、生物屏障和免疫屏障.近年来越来越多的研究表明胃肠道免疫屏障的重要性及其免疫机制在肠内营养改善患者结局过程中发挥着重要作用.本文将从肠道免疫机制对肠内营养改善患者结局的影响作一综述.     

The Intestinal Barrier Dysfunction as Driving Factor of Inflammaging

The intestinal barrier, composed of the luminal microbiota, the mucus layer, and the physical barrier consisting of epithelial cells and immune cells, the latter residing underneath and within the epithelial cells, plays a special role in health and disease. While there is growing knowledge on the changes to the different layers associated with disease development, the barrier function also plays an important role during aging. Besides changes in the composition and function of cellular junctions, the entire gastrointestinal physiology contributes to essential age-related changes. This is also reflected by substantial differences in the microbial composition throughout the life span. Even though it remains difficult to define physiological age-related changes and to distinguish them from early signs of pathologies, studies in centenarians provide insights into the intestinal barrier features associated with longevity. The knowledge reviewed in this narrative review article might contribute to the definition of strategies to prevent the development of diseases in the elderly. Thus, targeted interventions to improve overall barrier function will be important disease prevention strategies for healthy aging in the future.     

新生儿消化道畸形13例诊断体会

目的：分析新生儿消化道畸形的临床表现及诊断原则。方法：对13例新生儿消化道畸形进行回顾性分析。结果：新生儿消化道畸形的临床表现以呕吐和腹胀为重要体征,消化道钡剂X线有助于诊断。结论：新生儿消化道畸形的误诊率高,了解消化道畸形的临床表现,选择适当的检查方法,尽早作出正确诊断,是改善预后的关键。     

一氧化氮与肠屏障功能

肠屏障功能是肠道的一个重要特征,可以保护宿主不受外来抗原的干扰和入侵,它由一系列特异性和非特异性防御机制组成,包括肠管的蠕动、消化液的分泌、肠上皮细胞间的紧密连接以及肠道免疫系统.在烧伤、创伤、失血性休克、放疗、化疗、严重感染等情况下,会相继出现肠屏障破坏、细菌移位,严重者会发生多器官功能障碍.一氧化氮作为一种细胞的小分子物质,在各种生理病理中具有重要作用.近来研究发现,其毒性代谢产物过氧亚硝基阴离子(ONOO-)参与肠黏膜损伤.作者就一氧化氮与ONOO-在肠屏障功能的保护和损伤方面作一综述.     

Attitudes,Beliefs, and Barriers Related to Milk Consumption in Older,Low-Income Women

ObjectiveTo determine attitudes, beliefs, and barriers related to adequate milk consumption in low-income women ages ≥ 60 years.MethodsNine focus groups were conducted with a convenience sample of 59 women at congregate meal sites in a metropolitan area. Grounded in Social Cognitive Theory, focus group questions were used to explore personal, behavioral, and environmental factors associated with milk consumption.ResultsKey response themes indicated a positive attitude for the taste of milk (except for low-fat), a primary belief that milk was important for bones and health, and a primary barrier of gastrointestinal side effects.Conclusions and ImplicationsKnowledge regarding the benefits of milk and the dislike of its taste were not the primary reason for the lack of consumption. Instead, gastrointestinal side effects seemed to be the major barrier to adequate consumption. Future nutrition campaigns should test strategies for lactose intolerance management when communicating with low-income older women.     

The role of probiotics in gastrointestinal surgery

The intestinal microbiota, which is a complex and dynamic population of different bacterial species, represents an important contribution to the health of the host. This microbiota plays a key role by promoting the integrity of the epithelial barrier and the development of mucosal immunity. However, under some stressful situations, such as after gastrointestinal surgery, infectious complications may originate from the intestinal microbiota of the patient. This phenomenon is known as the gut origin of sepsis hypothesis. However, the supply of probiotics has beneficial effects under similar conditions despite some controversial results. Therefore, it is important to carefully assess the efficacy of probiotics in the prevention and treatment of complications in surgical patients and to evaluate the safety of its use. This review provides an overview of the proposed mechanisms of probiotic action and the significant progress in this field, mainly concerning gastrointestinal surgery.     

Probiotics and mucosal barrier in children

PURPOSE OF REVIEW: Colonization by the microbiota plays an important role in intestinal tract maturation of newborn. Once installed, indigenous microbiota maintains this modulation and also protects against infectious aggression. Due to these abilities, gut microbiota can be considered a 'microbial organ' that contributes to health of human host. Factors can affect microbiota colonization as well as its maintenance and ingestion of probiotics is a promissory way to counteract these perturbations. This review discusses recent papers dealing with the use of probiotics and their effects on intestinal barrier in children. RECENT FINDINGS: Data obtained from experiments in animal models or cell cultures as well as from clinical trials suggest that probiotics may prevent infectious and inflammatory diseases in which reduction of mucosal barrier functions is involved. SUMMARY: Recent results suggest that probiotics control maturation and maintenance of the intestinal barrier in children. However, human data are limited and more biological and well controlled clinical trials must be carried out for a more precise understanding of the mechanisms underlying the probiotic action and the balance of the complex gastrointestinal ecosystem with which probiotics are expected to interact.     

Use of probiotics as prophylaxis for postoperative infections

Postoperative bacterial infections are common despite prophylactic administration of antibiotics. The wide-spread use of antibiotics in patients has contributed to the emergence of multiresistant bacteria. A restricted use of antibiotics must be followed in most clinical situations. In surgical patients there are several reasons for an altered microbial flora in the gut in combination with an altered barrier function leading to an enhanced inflammatory response to surgery. Several experimental and clinical studies have shown that probiotics (mainly lactobacilli) may reduce the number of potentially pathogenia bacteria (PPM) and restore a deranged barrier function. It is therefore of interest to test if these abilities of probiotics can be utilized in preoperative prophylaxis. These factors may be corrected by perioperative administration of probiotics in addition to antibiotics. Fourteen randomized clinical trials have been presented in which the effect of such regimens has been tested. It seems that in patients undergoing liver transplantation or elective surgery in the upper gastrointestinal tract prophylactic administration of different probiotic strains in combination with different fibers results in a three-fold reduction in postoperative infections. In parallel there seems to be a reduction in postoperative inflammation, although that has not been studied in a systematic way. The use of similar concepts in colorectal surgery has not been successful in reducing postoperative infections. Reasons for this difference are not obvious. It may be that higher doses of probiotics with longer duration are needed to influence microbiota in the lower gastrointestinal tract or that immune function in colorectal patients may not be as important as in transplantation or surgery in the upper gastrointestinal tract. The favorable results for the use of prophylactic probiotics in some settings warrant further controlled studies to elucidate potential mechanisms, impact on gut microbiota and influence on clinical management. The use of probiotics must be better delineated in relation to type of bacteria, dose and length of administration.     

Role of sucralfate in gastrointestinal diseases

Sucralfate is a cytoprotective drug widely used in clinical practice to prevent or treat several gastrointestinal diseases such as gastro-esophageal reflux, gastritis, peptic ulcer, stress ulcer and dyspepsia. Sucralfate is a safe and well tolerated drug, as demonstrated by the quite complete lack of side effects and it is, for this reason, one of the most important therapeutic choices in the management of acid related diseases during pregnancy. Moreover, sucralfate has recently been shown to be useful in non-acid related gastrointestinal disease as well. In fact, sucralfate has also been administered topically in patients with radiation-induced mucosal procto-sigmoiditis or ulcerative colitis with surprising results. The drug is actually able to form a physical barrier between epithelium and damaging agents (-bile salts, drugs, refluxate...). Moreover, sucralfate increases the local levels of fibroblast growth factors and induces a rise in the mucosal concentration of prostaglandins which are considered important factors in mucosal healing. The aim of this paper is to describe the current and probably forthcoming uses of sucralfate in the field of gastrointestinal disorders. Moreover, we investigate the role of sucralfate as a reliable means to prevent the occurrence of reflux-like symptoms after Helicobacter pylori eradication and in the management of Helicobacter pylori negative patients affected by non-ulcer dyspepsia.     

Probiotics,Prebiotics, and Synbiotics: Implications and Beneficial Effects against Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is still a common functional gastrointestinal disease that presents chronic abdominal symptoms but with a pathophysiology that is not yet fully elucidated. Moreover, the use of the synergistic combination of prebiotics and probiotics, known as synbiotics, for IBS therapy is still in the early stages. Advancements in technology led to determining the important role played by probiotics in IBS, whereas the present paper focuses on the detailed review of the various pathophysiologic mechanisms of action of probiotics, prebiotics, and synbiotics via multidisciplinary domains involving the gastroenterology (microbiota modulation, alteration of gut barrier function, visceral hypersensitivity, and gastrointestinal dysmotility) immunology (intestinal immunological modulation), and neurology (microbiota–gut–brain axis communication and co-morbidities) in mitigating the symptoms of IBS. In addition, this review synthesizes literature about the mechanisms involved in the beneficial effects of prebiotics and synbiotics for patients with IBS, discussing clinical studies testing the efficiency and outcomes of synbiotics used as therapy for IBS.