Intestinal ornithine decarboxylase in short bowel syndrome patients with oral diet

The major consequence of extensive intestinal resection is loss of absorptive surface area, which results in malabsorption of nutrients; this condition is known as short-bowel syndrome (SBS). Patients with extensive small intestinal resection and colectomy leading to jejunostomy have the most severe SBS. Ornithine decarboxylase (ODC) plays a central role in cell proliferation and in the process of gut adaptation. Polyamine synthesis in crypt cells mediates the action of extracellular growth factors on DNA synthesis and mitotic activity. The aim of this study was to examine ODC expression and activity, diamine oxidase (DAO) activity and polyamine levels in the jejunal mucosa and red blood cells of SBS patients with a jejunostomy. The study group consisted of 6 patients (4 men and 2 women, mean age 55.8±9.8 years), who had undergone extensive small bowel resection and colectomy. All patients were maintained on cyclic parenteral nutrition and non-restricted oral nutrition. Two groups of patients operated on for unrelated reasons were included as the jejunum control group (n=6) and the ileum control group (n=13). Non statistical differences were observed in polyamine levels of red blood cells versus the control group (spermidine: 21.0±3.6 vs. 17.7±1.1 and spermine: 17.1±8.6 vs. 13.2±1.6 nmol/ml RBC, respectively). No significant decreases in putrescine and spermidine levels were observed between the groups, but spermine levels in SBS jejunum were significantly lower than the controls (P<0.05). In SBS patients a significant decrease in ODC and DAO activity were observed vs jejunum. A significant decrease in ODC-mRNA abundance was found for the SBS patients as compared to the two control groups (P<0.05). These results suggest that in SBS patients with jejunostomy intestinal adaptation may be impaired.