[Effects of enteral nutrition on intestinal intraepithelial lymphocytes of intestinal mucosal and the barrier of mucus in patients with stomal type enteric fistula].

OBJECTIVE: To investigate the effects of enteral nutrition on intestinal intraepithelial lymphocytes and the barrier of mucus in patients with stomal type enteric fistulas. METHODS: Ten patients with stomal type enteric fistulas after long-term fasting were observed. They received enteral nutrition of 146 kJ.kg(-1).d(-1) non-protein calorie and 0.25 g.kg(-1).d(-1) nitrogen per day. Intestinal mucosa were taken by endoscope through stoma of fistula before, 5 and 10 days after enteral nutrition support. Hematoxylin-eosin stain and immunohistochemical stain were performed to count the cell counts of intestinal intraepithelial lymphocytes (iIELs) and mucin-2 (MUC2) positive cells, specific stain (Alcian Blue) was performed to test the thickness of mucus. RESULTS: Five days after enteral nutrition, MUC2 positive cells and the thickness of mucus were significantly higher than that before enteral nutrition support (P<0.05). Ten days after enteral nutrition, iIEL cell and CD8 counts were also significantly higher than that before enteral nutrition support (P<0.05), MUC2 positive cells and the thickness of mucus showed a significant increase (P<0.01). CONCLUSION: Enteral nutrition is effective in protecting the gut mucosal and improving the immune function of the intestinal intraepithelial in patients with stomal type fistula.

[Diagnosis and management of Crohn disease complicated with gastrointestinal fistulae].

OBJECTIVE: To investigate the diagnosis and treatment of patients with Crohn disease (CD) complicated with gastrointestinal fistulae. METHODS: Clinical data of sixty-two cases with CD complicated with gastrointestinal fistula e from 1978 to 2004 were analyzed. RESULTS: These were 68 external fistulae in 6 2 patients including recurrent fistulae in 6 cases, internal fistulae in 8 cases . Twenty- seven fistulae were located in the terminal ileum and 21 fistulae wer e located in ileocolic anastomosis site. The main surgery included 14 ileocecal resections with primary anastomosis and 26 resections of original ileocolic anastomosis with fistula and re-anastomosis. The incidence of recurrence was lower (15.4% ) in patients with postoperative medication including sulfasalazine and immunomodulator than that (34.8% ) in patients without postoperative immunomodulator,but the recurrence time was longer [(40+/- 17) months] in patients with postoperative medication than that [(8+/- 3)months] in the patients without postoperative specific medication. CONCLUSIONS: Most CD fistulae are external fistulae,most of the external fistulae are treated by resection of the fistula and anastomosis. Specific medication including sulfasalazine,mesalamine and immunomodulators should be used to prevent postoperative complications and CD recurrence.