“Colostrum Supplement and Intestinal Adaptation after Intestinal Surgery and Short Bowel Syndrome: Review of the Literature”

Introduction: Colostrum is a source of immune/growth factors, hormones and nutrients which aids the newborn in its adaption to extrauterine life. Its clinical use has been investigated as an immunological component, for use in infectious diseases and to lower the risk of bacterial translocation and sepsis in abdominal surgery. This article aims to investigate the current knowledge about the value of colostrum in enhancing mechanisms of adaptation in the resected bowel. Methods: A MEDLINE systematic search was conducted following the queries of: “colostrumANDshort bowel syndrome”, “colostrumANDintestinal adaptation”, “colostrumANDintestineANDsurgery”. After duplicate removal, abstracts were selected by inclusion criteria (“English”, “trials about colostrum in short/resected bowel patients reporting an outcome analysis on the intestinal function”). Results: From a total of 105 papers, 18 duplicates were rejected, 8 trials matched eligibility. The trial populations were: “humans” (n=3) and “piglets” (n=6), with one article running experiments on both. Among humans, n=2 trials were on neonates and n=1 on adults. In all trials, prior surgery had led to massive bowel resection and individuals were tested either with bovine colostrum or control. Intestinal function was investigated by diverse clinical, morphological, and functional measures. Human studies demonstrated that neonates tolerated well the diet, whereas in adults it enhanced fecal output. No benefits of colostrum supplementation on intestinal function were observed in humans. In piglets, n=3 trials reported encouraging data, while n=2 described a similar outcome to controls. N=1 piglet trial showed preterms having a lower outcome compared to terms. Conclusion: The outcome of colostrum clinical use in short bowel has still to be determined. Available trials are scarce, with limited populations and heterogenous conditions. One essential aspect for short bowel patients is colostrum tolerability which has been reported as feasible in the neonate although not in the adult due to increased diarrhoea. Secondary to the recent detection of breast milk stem cells and their healing potential (similar to the ones contained in amniotic fluid), this seems a promising future research area. Our concerns are about the quality of bovine colostrum and its storage conditions. Other studies are needed to investigate colostrum great potential in neonatal diseases.