Gut function and immune and inflammatory responses in patients perioperatively fed with supplemented enteral formulas

Objective: To evaluate if the perioperative administration of a supplemented enteral formula modulates selective inflammatory and immune variables and gut function after surgery. Design: Prospective, randomized, double-bind, clinical trial. Setting: Department of surgery, university hospital. Patients: Forty patients with neoplasm of the colorectum or stomach. Intervention: Seven days before surgery, the patients drank 1 L/d of a control enteral formula (n=20) or the same formula enriched with arginine, RNA, and omega-3 fatty acids (n=20). Jejunal infusion with the same formulas was started 6 hours after operation and continued until day 7. Main Outcome Measures: Immune response was determined by phagocytosis ability and respiratory burst of polymorphonuclear cells, and inflammatory response by plasma levels of C-reactive protein. Operative intestinal microperfusion, postoperative intestinal mucosa oxygen metabolism, and plasma intestinal isoenzyme of alkaline phosphatase were used as indicators of gut function. Plasma nitric oxide also was determined. Results: In the enriched group, phagocytosis ability and respiratory burst after surgery was higher (P<.01) and C-reactive protein level was lower (P<.05) than in the control group. The enriched group had higher mean (+/-SD) intestinal microperfusion (180+/-46 vs 146+/-59 perfusion units, P<.05), intestinal mucosa oxygen metabolism (pHi 7.39+/-0.2 vs pHi 7.33+/-0.1, P<.05), and 5-fold lower levels of intestinal isoenzyme of alkaline phosphatase (P<.05). Postoperative levels of nitric oxide were higher in the enriched group (P<.05, analysis of variance). Conclusion: The perioperative administration of an enriched enteral formula significantly improved gut function and positively modulated postsurgical immunosuppressive and inflammatory responses.