The enhancement of the gut barrier function is important for the perioperative management of intra–abdominal infection or high risk surgery patients
The gut barrier plays an essential role in maintaining host homeostasis. The barrier regulates nutrient absorption as well as prevents the invasion of pathogenic bacteria in the host. It is composed of epithelial cells, tight junctions, and a mucus layer. Several factors, such as perioperative fasti...
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| Published in | Journal of Japan Society for Surgical Infection Vol. 17; no. 2; pp. 82 - 88 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Society for Surgical Infection
30.04.2020
一般社団法人 日本外科感染症学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1349-5755 2434-0103 |
| DOI | 10.24679/gekakansen.17.2_82 |
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| Abstract | The gut barrier plays an essential role in maintaining host homeostasis. The barrier regulates nutrient absorption as well as prevents the invasion of pathogenic bacteria in the host. It is composed of epithelial cells, tight junctions, and a mucus layer. Several factors, such as perioperative fasting, antimicrobial therapy and surgical invasion can affect this barrier. These factors have been shown to increase intestinal permeability, inflammation, and translocation of pathogenic bacteria. Bacterial Translocation into portal blood from the small and large intestine with reduced gut barrier function has influence to liver dysfunction. Therefore, enhancing the gut barrier function may play a central role of therapy because target organ is gut in perioperative period. We have devised the combined therapy with Glutamine/BCAA and synbiotics in the perioperative period for patients undergoing high risk surgery or causing intra–abdominal infections. We concluded that this bundle therapy which improving the gut environment during the perioperative period may prevent the perioperative surgical complication. |
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| AbstractList | The gut barrier plays an essential role in maintaining host homeostasis. The barrier regulates nutrient absorption as well as prevents the invasion of pathogenic bacteria in the host. It is composed of epithelial cells, tight junctions, and a mucus layer. Several factors, such as perioperative fasting, antimicrobial therapy and surgical invasion can affect this barrier. These factors have been shown to increase intestinal permeability, inflammation, and translocation of pathogenic bacteria. Bacterial Translocation into portal blood from the small and large intestine with reduced gut barrier function has influence to liver dysfunction. Therefore, enhancing the gut barrier function may play a central role of therapy because target organ is gut in perioperative period. We have devised the combined therapy with Glutamine/BCAA and synbiotics in the perioperative period for patients undergoing high risk surgery or causing intra–abdominal infections. We concluded that this bundle therapy which improving the gut environment during the perioperative period may prevent the perioperative surgical complication.
近年，消化器外科領域では手術手技や周術期管理の進歩とともに治療成績も向上している。一方，縫合不全などの術後腹腔内感染症例での予後は必ずしも改善していない。さらなる成績の向上には病態に沿った周術期管理が重要である。侵襲の大きな手術の周術期には腸管が標的臓器となり，さらに術後腹腔内感染症などが加わると絶食や薬剤の影響により，腸管粘膜防御機構の破錠に加えてDysbiosis状態に陥り，バクテリアルトランスロケーションへと至ることが推測されている。さらに防御機構の破綻は感染部位と異なる肝臓への臓器障害を惹起する可能性がある。そのため腸管粘膜防御機構の強化と共生腸内細菌叢の正常化に主眼をおいたバンドル治療を行う必要があり，とくにグルタミン＋BCAA療法とシンバイオティクス（プロバイオティクスとプレバイオティクス）療法は腸管粘膜バリア機能と腸管免疫機構の保持に有用である。 The gut barrier plays an essential role in maintaining host homeostasis. The barrier regulates nutrient absorption as well as prevents the invasion of pathogenic bacteria in the host. It is composed of epithelial cells, tight junctions, and a mucus layer. Several factors, such as perioperative fasting, antimicrobial therapy and surgical invasion can affect this barrier. These factors have been shown to increase intestinal permeability, inflammation, and translocation of pathogenic bacteria. Bacterial Translocation into portal blood from the small and large intestine with reduced gut barrier function has influence to liver dysfunction. Therefore, enhancing the gut barrier function may play a central role of therapy because target organ is gut in perioperative period. We have devised the combined therapy with Glutamine/BCAA and synbiotics in the perioperative period for patients undergoing high risk surgery or causing intra–abdominal infections. We concluded that this bundle therapy which improving the gut environment during the perioperative period may prevent the perioperative surgical complication. |
| Author | Matsui, Daisuke Futagami, Fumio Ohta, Tetsuo Tajima, Hidehiro Nishijima, Koji Miyashita, Tomoharu Takamura, Hiroyuki |
| Author_FL | 田島 秀浩 宮下 知治 高村 博之 西島 弘二 二上 文夫 太田 哲生 松井 大輔 |
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| Author_xml | – sequence: 1 fullname: Matsui, Daisuke organization: Department of Surgery, Japanese Red Cross Kanazawa Hospital – sequence: 1 fullname: Tajima, Hidehiro organization: Department of Gastroenterological Surgery, Kanazawa University Hospital, Kanazawa – sequence: 1 fullname: Ohta, Tetsuo organization: Department of Gastroenterological Surgery, Kanazawa University Hospital, Kanazawa – sequence: 1 fullname: Takamura, Hiroyuki organization: Department of Surgical Oncology, Kanazawa Medical University Hospital – sequence: 1 fullname: Nishijima, Koji organization: Department of Surgery, Japanese Red Cross Kanazawa Hospital – sequence: 1 fullname: Miyashita, Tomoharu organization: Department of Surgery, Japanese Red Cross Kanazawa Hospital – sequence: 1 fullname: Futagami, Fumio organization: Department of Surgery, Japanese Red Cross Kanazawa Hospital |
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| DocumentTitle_FL | 腹腔内感染症が誘導する臓器障害とその対策：周術期管理からの腸管粘膜防御機構強化の重要性 |
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| PublicationTitle_FL | 日外感染症会誌 J.Jpn.Soc.Surg.Infect Journal of Japan Society for Surgical Infection |
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| Publisher | Japan Society for Surgical Infection 一般社団法人 日本外科感染症学会 |
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| References | 1) 草地信也：術後感染症の治療と管理．2009年（平成21年）度前期日本消化器外科学会教育集会，2009；13–18 29) 宮下知治，大畠慶直，岡本浩一，ほか：周術期における腸内環境の改善とサルコペニア予防の重要性．臨外2018；73：1462–1467 22) 三島英換，阿部高明：見えてきた腸腎連関の存在．日内会誌2017；106：919–925 28) 牧野 勇，田島秀浩，北川裕久，ほか：胆道癌周術期の感染症対策．胆道2013；27：805–810 8) 大野博司：特殊な腸管上皮細胞，M細胞の生物学．生化学2011；83：13–22 17) Miyashita T, Nakanuma S, Ahmed AK, et al: Ischemia reperfusion–facilitated sinusoidal endothelial cell injury in liver transplantation and the resulting impact of extravasated platelet aggregation. Eur Surg 2016; 48: 92–98 12) Lee WS, Sokol RJ: Intestinal Microbiota, Lipids, and the Pathogenesis of Intestinal Failure–Associated Liver Disease. J Pediatr 2015; 167: 519–526 6) Mizuno T, Yokoyama Y, Nishio H, et al: Intraoperative bacterial translocation detected by bacterium–specific ribosomal rna–targeted reverse–transcriptase polymerase chain reaction for the mesenteric lymph node strongly predicts postoperative infectious complications after major hepatectomy for biliary malignancies. Ann Surg 2010; 252: 1013–1019 20) 安藤 朗：腸内細菌の種類と定着：その隠された臓器としての機能．日内会誌2015；104：29–34 25) 種本 俊，筋野智久，金井隆典：腸内細菌叢と免疫の関わり．日臨免疫会誌2017；40：408–415 30) 宮下知治，太田哲生，蒲田亮介，ほか：高齢者に対する腸内環境の改善に主眼を置いた周術期管理．日腹部救急医会誌2019；39：1009–1016 19) Sakurai K, Miyashita T, Okazaki M, et al: Role for neutrophil extracellular traps (NETs) and platelet aggregation in early sepsis–induced hepatic dysfunction. In Vivo 2017; 31: 1051–1058 2) 辻本広紀，平木修一，坂本直子，ほか：周術期感染性合併症が消化器癌術後の予後に与える影響．日消外会誌2010；43：704–709 21) 新井万里，水野慎大，金井隆典：腸内フローラと老化．日老医誌2016；53：318–325 4) 朝原 崇：シンバイオティクスによる感染制御．腸内細菌学雑誌2015；29：76 15) Miyashita T, Ahmed AK, Nakanuma S, et al: A three–phase approach for the early identification of acute lung injury induced by severe sepsis. In Vivo 2016; 30: 341–349 13) 和田 基，工藤博典，天江新太郎，ほか：IFALD（腸管不全合併肝障害）の病因と治療．静脈経腸栄養 2012；27：1217–1222 24) Zhu L, Liu W, Alkhouri R, et al: Structural changes in the gut microbiome of constipated patients. Physiol Genomics 2014; 46: 679–686 16) 宮下知治，櫻井健太郎，太田哲生：敗血症性臓器障害の病態を科学的に再考する．ICUとCCU 2016；40：625–634 14) Brinkmann V, Reichard U, Goosmann C, et al: Neutrophil extracellular traps kill bacteria. Science 2004; 303: 1532–1535 32) Routy B, Le Chatelier E, Derosa L, et al: Gut microbiome influences efficacy of PD–1–based immunotherapy against epithelial tumors. Science 2018; 359: 91–97 10) Khairallah C, Déchanet–Merville J, Capone M: γδ T Cell–Mediated Immunity to Cytomegalovirus Infection. Front Immunol 2017; 8: 105 27) 福島亮治：重症患者のグルタミン投与．外科と代謝・栄2016；50：143–147 18) 宮下知治，櫻井健太郎，野村皓三，ほか：敗血症性臓器障害の病態を科学的に再考する．日腹部救急医会誌2017；37：703–710 23) Moore FA: The role of the gastrointestinal tract in postinjury multiple organ failure. Am J Surg 1999; 178: 449–453 11) Chinen T, Komai K, Muto G, et al: Prostaglandin E2 and SOCS1 have a role in intestinal immune tolerance. Nat Commun 2011; 2: 190 3) 掛地吉弘，宇田川晴司，海野倫明，ほか：National Clinical Database（消化器外科領域）Annual Report 2015. 日消外会誌2017；50：166–176 5) 清水健太郎：ICU患者における腸内細菌叢．モダンメディア2019；65：7–13 26) 大谷直子：肥満による肝がん促進機構と腸内細菌，モダンメディア2016；62：18–22 7) Nishigaki E, Abe T, Yokoyama Y, et al: The detection of intraoperative bacterial translocation in the mesenteric lymph nodes is useful in predicting patients at high risk for postoperative infectious complications after esophagectomy. Ann Surg 2014; 259: 477–484 9) 岡本隆一，渡辺 守：腸上皮機能と炎症性腸疾．Jpn. J. Clin. Immunol 2016；39：522–527 31) 清水健太郎，小倉裕司，朝原 崇，ほか：重症感染症における腸内細菌叢とシンバイオティクス療法．静脈経腸栄養2010；4：9–14 |
| References_xml | – reference: 5) 清水健太郎：ICU患者における腸内細菌叢．モダンメディア2019；65：7–13 – reference: 21) 新井万里，水野慎大，金井隆典：腸内フローラと老化．日老医誌2016；53：318–325 – reference: 6) Mizuno T, Yokoyama Y, Nishio H, et al: Intraoperative bacterial translocation detected by bacterium–specific ribosomal rna–targeted reverse–transcriptase polymerase chain reaction for the mesenteric lymph node strongly predicts postoperative infectious complications after major hepatectomy for biliary malignancies. Ann Surg 2010; 252: 1013–1019 – reference: 14) Brinkmann V, Reichard U, Goosmann C, et al: Neutrophil extracellular traps kill bacteria. Science 2004; 303: 1532–1535 – reference: 10) Khairallah C, Déchanet–Merville J, Capone M: γδ T Cell–Mediated Immunity to Cytomegalovirus Infection. Front Immunol 2017; 8: 105 – reference: 9) 岡本隆一，渡辺 守：腸上皮機能と炎症性腸疾．Jpn. J. Clin. Immunol 2016；39：522–527 – reference: 31) 清水健太郎，小倉裕司，朝原 崇，ほか：重症感染症における腸内細菌叢とシンバイオティクス療法．静脈経腸栄養2010；4：9–14 – reference: 3) 掛地吉弘，宇田川晴司，海野倫明，ほか：National Clinical Database（消化器外科領域）Annual Report 2015. 日消外会誌2017；50：166–176 – reference: 2) 辻本広紀，平木修一，坂本直子，ほか：周術期感染性合併症が消化器癌術後の予後に与える影響．日消外会誌2010；43：704–709 – reference: 11) Chinen T, Komai K, Muto G, et al: Prostaglandin E2 and SOCS1 have a role in intestinal immune tolerance. Nat Commun 2011; 2: 190 – reference: 7) Nishigaki E, Abe T, Yokoyama Y, et al: The detection of intraoperative bacterial translocation in the mesenteric lymph nodes is useful in predicting patients at high risk for postoperative infectious complications after esophagectomy. Ann Surg 2014; 259: 477–484 – reference: 23) Moore FA: The role of the gastrointestinal tract in postinjury multiple organ failure. Am J Surg 1999; 178: 449–453 – reference: 25) 種本 俊，筋野智久，金井隆典：腸内細菌叢と免疫の関わり．日臨免疫会誌2017；40：408–415 – reference: 28) 牧野 勇，田島秀浩，北川裕久，ほか：胆道癌周術期の感染症対策．胆道2013；27：805–810 – reference: 18) 宮下知治，櫻井健太郎，野村皓三，ほか：敗血症性臓器障害の病態を科学的に再考する．日腹部救急医会誌2017；37：703–710 – reference: 27) 福島亮治：重症患者のグルタミン投与．外科と代謝・栄2016；50：143–147 – reference: 30) 宮下知治，太田哲生，蒲田亮介，ほか：高齢者に対する腸内環境の改善に主眼を置いた周術期管理．日腹部救急医会誌2019；39：1009–1016 – reference: 1) 草地信也：術後感染症の治療と管理．2009年（平成21年）度前期日本消化器外科学会教育集会，2009；13–18 – reference: 13) 和田 基，工藤博典，天江新太郎，ほか：IFALD（腸管不全合併肝障害）の病因と治療．静脈経腸栄養 2012；27：1217–1222 – reference: 29) 宮下知治，大畠慶直，岡本浩一，ほか：周術期における腸内環境の改善とサルコペニア予防の重要性．臨外2018；73：1462–1467 – reference: 17) Miyashita T, Nakanuma S, Ahmed AK, et al: Ischemia reperfusion–facilitated sinusoidal endothelial cell injury in liver transplantation and the resulting impact of extravasated platelet aggregation. Eur Surg 2016; 48: 92–98 – reference: 24) Zhu L, Liu W, Alkhouri R, et al: Structural changes in the gut microbiome of constipated patients. Physiol Genomics 2014; 46: 679–686 – reference: 20) 安藤 朗：腸内細菌の種類と定着：その隠された臓器としての機能．日内会誌2015；104：29–34 – reference: 26) 大谷直子：肥満による肝がん促進機構と腸内細菌，モダンメディア2016；62：18–22 – reference: 12) Lee WS, Sokol RJ: Intestinal Microbiota, Lipids, and the Pathogenesis of Intestinal Failure–Associated Liver Disease. J Pediatr 2015; 167: 519–526 – reference: 16) 宮下知治，櫻井健太郎，太田哲生：敗血症性臓器障害の病態を科学的に再考する．ICUとCCU 2016；40：625–634 – reference: 4) 朝原 崇：シンバイオティクスによる感染制御．腸内細菌学雑誌2015；29：76 – reference: 8) 大野博司：特殊な腸管上皮細胞，M細胞の生物学．生化学2011；83：13–22 – reference: 22) 三島英換，阿部高明：見えてきた腸腎連関の存在．日内会誌2017；106：919–925 – reference: 19) Sakurai K, Miyashita T, Okazaki M, et al: Role for neutrophil extracellular traps (NETs) and platelet aggregation in early sepsis–induced hepatic dysfunction. In Vivo 2017; 31: 1051–1058 – reference: 15) Miyashita T, Ahmed AK, Nakanuma S, et al: A three–phase approach for the early identification of acute lung injury induced by severe sepsis. In Vivo 2016; 30: 341–349 – reference: 32) Routy B, Le Chatelier E, Derosa L, et al: Gut microbiome influences efficacy of PD–1–based immunotherapy against epithelial tumors. Science 2018; 359: 91–97 |
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| Title | The enhancement of the gut barrier function is important for the perioperative management of intra–abdominal infection or high risk surgery patients |
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