Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion

Year 2017 Vol. 25 No 5

REVIEWS

I.N. KLIMOVICH, S.S. MASKIN, P.V. ABPAMOV

DIAGNOSIS AND TREATMENT OF SYNDROME OF INTESTINAL INSUFFICIENCY IN ACUTE BLEEDING FROM UPPER GASTROINTESTINAL TRACT

FSBEE HE “Volgograd State Medical University”, Volgograd,
The Russian Federation

Acute massive bleeding from the gastroduodenal zone leads to the development of the syndrome of intestinal insufficiency (SII), due to ischemia/reperfusion injury of the intestinal wall. Violation of the barrier functions of the intestinal wall causes a massive inflow of the toxins from the intestine to the portal circulation and intestinal lymphatic collector that triggers multiple organ failure. As a result the issue of early diagnosis of the SII arises urgently, which currently represent a wide range of invasive biochemical studies, studying of myoelectric parameters and sonography data. However, taking into consideration the complicated, multilateral nature of the pathogenesis of intestinal insufficiency, it is extremely difficult to differentiate the most informative one. At a result, in the clinical practice there is no established strategy of SII treatment in the gastrointestinal bleeding (GIB). The main tendencies of SII therapy are limited by intraintestinal detoxification and correction of oxidative stress. This explains a large number of experimental studies in which using the modeling of hemorrhagic hypotension and intestinal ischemia/reperfusion lesions, the possibilities of supporting its secretory and kinetic functions, the correction of metabolic disorders and regenerating mechanisms, the enhancement of antioxidant and anti-inflammatory abilities are studied.
However, despite the large arsenal of experimental and clinical investigations, the issues of early detection and etiopathogenetic treatment of SII are far from being solved and require further study.

Keywords: syndrome of intestinal insufficiency, gastrointestinal bleeding, ischemia, diagnostics of intestinal insufficiency, treatment of intestinal insufficiency, intestinal wall
p. 518-524 of the original issue
References
  1. Feinman M, Haut ER. Upper gastrointestinal bleeding. Surg Clin North Am. 2014 Feb;94(1):43-53. doi: 10.1016/j.suc.2013.10.004.
  2. Gel’fand BR, Saltanov AI, red. Intensivnaia terapiia [Intensive therapy]: nats ruk. Moscow, RF: GEOTAR-Media; 2009;1. 960 p.
  3. Sarsu SB, Ozokutan BH, Tarakcioglu M, Sar? I, Bağc? C. Effects of Leptin on Intestinal Ischemia-Reperfusion Injury. Indian J Surg. 2015 Dec;77(Suppl 2):351-55. doi: 10.1007/s12262-013-0836-1.
  4. Stepanov IuM, Zalevskii VI, Kosinskii AV. Zheludochno-kishechnye krovotecheniia [Gastrointestinal bleeding]. Dnepropetrovsk, Ukraina: Lira; 2011. 270 p.
  5. Khadaroo RG, Fortis S, Salim SY, Streutker C, Churchill TA, Zhang H. I-FABP as biomarker for the early diagnosis of acute mesenteric ischemia and resultant lung injury. PLoS One. 2014 Dec 26;9(12):e115242. doi: 10.1371/journal.pone.0115242. eCollection 2014.
  6. Savel’ev VS, Petukhov VA, Karalkin AV, Son DA, Podachin PV, Romanenko KV, i dr. Sindrom kishechnoi nedostatochnosti v urgentnoi abdominal’noi khirurgii: novye metodicheskie podkhody k lecheniiu [Syndrome of intestinal failure in urgent abdominal surgery: new methodical approaches to treatment]. Trud Patsient. 2005;3(4):30-37.
  7. Kocsis D, Papp M, Tornai T, Tulassay Z, Herszényi L, Tóth M, et al. Intestinal fatty acid binding protein: marker of enterocyte damage in acute and chronic gastroenterological diseases. Orv Hetil. 2016 Jan 10;157(2):59-64. doi: 10.1556/650.2016.30336. [Article in Hungarian]
  8. Aydin B, Ozban M, Serinken M, Kaptanoglu B, Demirkan NC, Aydin C. The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia. Bratisl Lek Listy. 2015;116(5):343-50.
  9. Tun-Abraham ME, Martínez-Ordaz JL, Vargas-Rivas A, Sánchez-Fuentes JJ, Pérez-Cerna E, Zaleta-González O. L-lactate as a serum marker of intestinal ischemia in patients with complicated intestinal obstruction. Cir Cir. 2015 Jan-Feb;83(1):65-9. doi: 10.1016/j.circir.2015.04.027. [Article in Spanish]
  10. Cosse C, Sabbagh C, Kamel S, Galmiche A, Regimbeau JM. Procalcitonin and intestinal ischemia: a review of the literature. World J Gastroenterol. 2014 Dec 21;20(47):17773-78. doi: 10.3748/wjg.v20.i47.17773.
  11. Markogiannakis H, Memos N, Messaris E, Dardamanis D, Larentzakis A, Papanikolaou D, et al. Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. Surgery. 2011 Mar;149(3):394-403. doi: 10.1016/j.surg.2010.08.007.
  12. Cakmaz R, Büyükaş?k O, Kahramansoy N, Erkol H, Cöl C, Boran C, et al. A combination of plasma DAO and citrulline levels as a potential marker for acute mesenteric ischemia. Libyan J Med. 2013 Mar 26;8:1-6. doi: 10.3402/ljm.v8i0.20596.
  13. Fahrner R, Beyoğlu D, Beldi G, Idle JR. Metabolomic markers for intestinal ischemia in a mouse model. J Surg Res. 2012Dec;178(2):879-87. doi: 10.1016/j.jss.2012.08.011.
  14. Strand-Amundsen RJ, Tronstad C, Kalvøy H, Gundersen Y, Krohn CD, Aasen AO, et al. In vivo characterization of ischemic small intestine using bioimpedance measurements. Physiol Meas. 2016 Feb;37(2):257-75. doi: 10.1088/0967-3334/37/2/257.
  15. Liu XH, Yang YW, Dai HT, Cai SW, Chen RH, Ye ZQ. Protective role of adiponectin in a rat model of intestinal ischemia reperfusion injury. World J Gastroenterol. 2015 Dec 21;21(47):13250-58. doi: 10.3748/wjg.v21.i47.13250.
  16. Tas U, Ayan M, Sogut E, Kuloglu T, Uysal M, Tanriverdi HI, et al. Protective effects of thymoquinone and melatonin on intestinal ischemia-reperfusion injury. Saudi J Gastroenterol. 2015 Sep-Oct;21(5):284-89. doi: 10.4103/1319-3767.166203.
  17. Qian ZY, Yang MF, Zuo KQ, Xiao HB, Ding WX, Cheng J. Protective effects of ulinastatin on intestinal injury during the perioperative period of acutesuperior mesenteric artery ischemia. Eur Rev Med Pharmacol Sci.2014;18(23):3726-32.
  18. Wu S, Zhu X, Jin Z, Tong X, Zhu L, Hong X, et al. The protective role of montelukast against intestinal ischemia-reperfusion injury in rats. Sci Rep. 2015;26(5):15787. doi: 10.1038/srep15787.
  19. Akinrinmade FJ, Akinrinde AS, Soyemi OO, Oyagbemi AA. Antioxidant potential of the methanol extract of parquetina nigrescens mediates protection against intestinal ischemia-reperfusion injury in rats. J Diet Suppl. 2016;13(4):420-32. doi: 10.3109/19390211.2015.1103828.
  20. Gordeeva AE, Temnov AA, Charnagalov AA, Sharapov MG, Fesenko EE, Novoselov VI. Protective effect of peroxiredoxin 6 in ischemia/reperfusion-induced damage of small intestine. Dig Dis Sci. 2015 Dec;60(12):3610-9. doi: 10.1007/s10620-015-3809-3.
  21. Isik A, Peker K, Gursul C, Sayar I, Firat D, Yilmaz I, et al. The effect of ozone and naringin on intestinal ischemia/reperfusion injury in an experimental model. Int J Surg. 2015 Sep;21:38-44. doi: 10.1016/j.ijsu.2015.07.012.
  22. Onal O, Yetisir F, Sarer AE, Zeybek ND, Onal CO, Yurekli B, et al. Prophylactic ozone administration reduces intestinal mucosa injury induced by intestinal ischemia-reperfusion in the rat. Mediators Inflamm. 2015;2015:792016. doi: 10.1155/2015/792016.
  23. Sayan-Ozacmak H, Ozacmak VH, Turan I, Barut F3, Hanci V. Pretreatment with remifentanil protects against the reduced-intestinal contractility related to the ischemia and reperfusion injury in rat. Braz J Anesthesiol. 2015 Nov-Dec;65(6):483-90. doi: 10.1016/j.bjane.2013.09.007.
  24. Cho SS, Rudloff I, Berger PJ, Irwin MG, Nold MF, Cheng W, et al. Remifentanil ameliorates intestinal ischemia-reperfusion injury. BMC Gastroenterol. 2013 Apr 22;13:69. doi: 10.1186/1471-230X-13-69.
  25. Polat H, Türk ö, Yaşar B, Uysal O. The effect of ligustrazinin intestinal ischemia reperfusion injury generated on rats. Ulus Travma Acil Cerrahi Derg. 2015,21(3):163-67. doi: 10.5505/tjtes.2015.55212.
  26. Tuboly E, Futakuchi M, Varga G, érces D, Tokés T, Mészáros A, et al. C5a inhibitor protects against ischemia/reperfusion injury in rat small intestine. Microbiol Immunol. 2016 Jan;60(1):35-46. doi: 10.1111/1348-0421.12338.
  27. Qiao Y, Qian J, Lu Q, Tian Y, Chen Q, Zhang Y. Protective effects of butyrate on intestinal ischemia-reperfusion injury in rats. J Surg Res. 2015 Aug;197(2):324-30. doi: 10.1016/j.jss.2015.04.031.
  28. Cai Y, Xu H, Yan J, Zhang L, Lu Y. Molecular targets and mechanism of action of dexmedetomidine in treatment of ischemia/reperfusion injury. Mol Med Rep. 2014 May;9(5):1542-50. doi: 10.3892/mmr.2014.2034.
  29. Zhang XK, Zhou XP, Zhang Q, Zhu F. The preventive effects of dexmedetomidine against intestinal ischemia-reperfusion injury in Wistar rats. Iran J Basic Med Sci. 2015; 2015 Jun;18(6):604-9.
  30. Peng Z, Ban K, Wawrose RA, Gover AG, Kozar RA. Protection by enteral glutamine is mediated by intestinal epithelial cell peroxisome proliferator-activated receptor-γ during intestinal ischemia/reperfusion. Shock. 2015 Apr;43(4):327-33. doi: 10.1097/SHK.0000000000000297.
  31. Gobbetti T, Ducheix S, le Faouder P, Perez T, Riols F, Boue J, et al. Protective effects of n-6 fatty acids-enriched diet on intestinal ischaemia/reperfusion injury involve lipoxin A4 and its receptor. Br J Pharmacol. 2015 Feb;172(3):910-23. doi: 10.1111/bph.12957.
  32. Sukhotnik I, Aranovich I, Ben Shahar Y, Bitterman N, Pollak Y, Berkowitz D, et al. Effect of taurine on intestinal recovery following intestinal ischemia-reperfusion injury in a rat. Pediatr Surg Int. 2016 Feb;32(2):161-68. doi: 10.1007/s00383-015-3828-3.
  33. Cagin YF, Atayan Y, Sahin N, Parlakpinar H, Polat A, Vardi N, et al. Beneficial effects of dexpanthenol on mesenteric ischemia and reperfusion injury in experimental rat model. Free Radic Res. 2016;50(3):354-65. doi: 10.3109/10715762.2015.1126834.
  34. Brasileiro JL, Ramalho RT, Aydos RD, Silva IS, Takita LC, Marks G, et al. Pentoxifylline and prostaglandin E1 action on ischemia and reperfusion of small intestine tissue in rats. An immunohistochemical study. Acta Cir Bras. 2015 Feb;30(2):115-19. doi: 10.1590/S0102-86502015002000005.
  35. Marques GM, Rasslan R, Belon AR, Carvalho JG, Felice Neto, Rasslan S, et al. Pentoxifylline associated to hypertonic saline solution attenuates inflammatory process and apoptosis after intestinal ischemia/reperfusion in rats. Acta Cir Bras. 2014;29(11):735-41. doi: 10.1590/S0102-86502014001800007.
  36. Diebel ME, Diebel LN, Manke CW, Liberati DM, Whittaker JR. Early tranexamic acid administration: A protective effect on gut barrier function following ischemia/reperfusion injury. J Trauma Acute Care Surg. 2015 Dec;79(6):1015-22. doi: 10.1097/TA.0000000000000703.
  37. Bashirov SR, Bashirov RS, Seleznev IuA, Skochilova OE, Arsen’ev DV, Domnich OIu, Siverin VV. Sposob zondovogo enteral’nogo pitaniia posle operatsii po povodu gastroduodenal’nykh krovotechenii u patsientov s «patologicheskim rezervuarom krovi» v zheludochno-kishechnom trakte [The method of probe enteral nutrition after surgery for gastroduodenal bleeding in patients with a “pathological blood reservoir” in the gastrointestinal tract]. Patent Ros Federatsii ¹2344842. 27.09.2009.
Address for correspondence:
400131, Russian Federation,
Volgograd, Fallen Fighters Sq., 1,
FGBOU VO «Volgograd State
Medical University»,
department of Hospital Surgery,
Tel.: + 905 336-23-69,
E-mail: klimovichigor1122@yandex.ru
Igor N. Klimovich
Information about the authors:
Klimovich I.N., MD, Associate Professor of the Hospital Surgery Department of FSBEE HE “Volgograd State Medical University”.
Maskin S.S., MD, Professor, Head of the Hospital Surgery Department of FSBEE HE “Volgograd State Medical University”.
Abramov P.V., Post-Graduate Student of the Hospital Surgery Department of FSBEE HE “Volgograd State Medical University”.
Contacts | ©Vitebsk State Medical University, 2007-2023