Peptide Absorption After Massive Proximal Small Bowel Resection: Mechanisms of Ileal Adaptation

Hisham G. Qandeel, Fernando Alonso, David J. Hernandez, Srivats Madhavan, Judith A. Duenes, Ye Zheng, Michael G. Sarr

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Protein absorption occurs as di- and tri-peptides via H +/peptide co-transporter-1 (PepT1). Aim: The aim of this study is to identify mechanisms of ileal adaptation after massive proximal enterectomy. Hypothesis: Ileal adaptation in uptake of peptides is mediated through upregulation of PepT1 gene expression. Study Design: Rats underwent 70% jejunoileal resection. Total mucosal cellular levels of messenger RNA (mRNA) and protein and transporter-mediated uptake per centimeter of the di-peptide glycyl-sarcosine (Gly-Sar) were compared in remnant ileum 1 and 4 weeks postoperatively to control and to 1-week sham laparotomy rats. Histomorphology, food consumption, and weights of rats were monitored. Results: After 70% resection, although mRNA per cell for PepT1 decreased at 1 week (p = 0. 002), expression of mRNA at 4 weeks and protein at 1 and 4 weeks in remnant ileum were unchanged (p > 0. 1). Ileal Gly-Sar uptake (V max-nanomoles per centimeter per minute, i. e., number of transporters per centimeter) increased at 1 and 4 weeks compared to control and 1-week sham (p < 0. 05 each); K m (i. e., transporter function) was unchanged. Villous heights (millimeters) in remnant ileum increased at 1- and 4-week time points over controls (0. 45 and 0. 57 vs 0. 21, resp; p < 0. 001). Conclusions: Ileal adaptation to proximal resection for peptide absorption occurs through cellular proliferation (hyperplasia) and not through cellular upregulation of PepT1 mRNA or protein per enterocyte.

Original languageEnglish (US)
Pages (from-to)1537-1547
Number of pages11
JournalJournal of Gastrointestinal Surgery
Issue number9
StatePublished - Sep 2011


  • Adaptation
  • PepT1
  • Peptide absorption
  • Short bowel syndrome
  • Small bowel resection

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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