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Wilkinson-Smith, Victoria C. and Major, Giles and Ashleigh, Lucy and Murray, Kathryn and Hoad, Caroline L. and Marciani, Luca and Gowland, Penny A. and Spiller, Robin C. (2018) Insights into the different effects of food on intestinal secretion using magnetic resonance imaging. Journal of Parenteral and Enteral Nutrition . ISSN 1941-2444

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Abstract

Background

Ileostomy output determines need for parenteral fluid support. Plant foods may contain chemicals that stimulate intestinal secretion eg. lactucins in lettuce and rhein in rhubarb. These may account for increases in ileostomy output but experimental demonstration of this is burdensome for patients.

Objective

Determine the effect of different foods on intestinal water content in healthy volunteers using Magnetic Resonance Imaging (MRI).

Design

Crossover trial of three isocaloric meals in healthy adults. Subjects underwent MRI scans fasting and hourly to 180min postprandial. Meals: 2 slices white bread with 10g butter; 300g rhubarb with 60mL lactose-free cream; 300g lettuce with 30mL mayonnaise. Visits one week apart. Primary outcome: small bowel water content (SBWC) using MRI. Secondary outcomes: ascending colon water content; T1 relaxation time of ascending colon (T1AC); gastric volume; visual analogue scales of bloating and satiety (0-100) scored half-hourly.

Results

15 subjects completed the study. 9 female, 6 male, median age 21(IQR 20,

22). Bread induced a fall in SBWC compared to a rise after lettuce and greater rise after rhubarb, with significant differences in the area under the curve (0-

3 hours) of the change from baseline (P<0.01, paired t-test). Rhubarb increased T1AC but differences at 3 hours were not significant (P=0.06). Symptom scores were higher for lettuce >rhubarb >bread.

Conclusion

Lettuce and rhubarb meals increased intestinal water content, demonstrating how different foods can alter small bowel secretion. MRI can be used to evaluate the effects of diet, enteral feed and pharmaceuticals on intestinal content and function.

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