Effect of growth hormone, glutamine, and enteral nutrition on intestinal adaptation in patients with short bowel syndrome.

BACKGROUND/AIMS In the management of short bowel syndrome, the benefits of treatment with growth hormone, glutamine, and enteral nutrition for intestinal adaptation is still controversial. The aim of the current study was to determine whether growth hormone, glutamine, and enteral nutrition had positive effect on intestinal adaptation. MATERIALS AND METHOD Twelve patients with short bowel syndrome (small-bowel remnant length, 59±9 cm; mean±SEM) received growth hormone (0.05 mg/kg/day), oral glutamine (30 g/day), plus enteral nutrition for 4 weeks. Intestinal absorptive capacity and biochemical parameters were investigated before treatment and after treatment. Body composition was determined by bioelectric impedance analysis. RESULT All patients completed the treatment. Intestinal absorptive capacity and plasma levels of proteins were significantly improved after treatment. Body weight, lean body mass, total body water, and body cell mass also increased without any major adverse effects. At the 3-month follow-up, the nutritional status of patients was also well maintained, and there was no death during this period. CONCLUSION Four weeks of intestinal rehabilitation therapy significantly improved intestinal absorption if appropriate patient with short bowel syndrome was selected.

[1]  A. Coran,et al.  Dietary palmitic acid modulates intestinal re-growth after massive small bowel resection in a rat , 2008, Pediatric Surgery International.

[2]  A. Buchman,et al.  Short bowel syndrome and intestinal failure: consensus definitions and overview. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[3]  K. Iyer,et al.  Growth Hormone, Glutamine, and an Optimal Diet Reduces Parenteral Nutrition in Patients With Short Bowel Syndrome: A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial , 2005, Annals of surgery.

[4]  N. Kapel,et al.  Low-dose growth hormone in adult home parenteral nutrition-dependent short bowel syndrome patients: a positive study. , 2003, Gastroenterology.

[5]  M. Candusso,et al.  Outcome and quality of life in paediatric home parenteral nutrition , 2002, Current opinion in clinical nutrition and metabolic care.

[6]  D. Wilmore,et al.  Bowel rehabilitation: an alternative to long-term parenteral nutrition and intestinal transplantation for some patients with short bowel syndrome. , 2002, Transplantation proceedings.

[7]  P. Mortensen,et al.  Effect of high-dose growth hormone and glutamine on body composition, urine creatinine excretion, fatty acid absorption, and essential fatty acids status in short bowel patients: a randomized, double-blind, crossover, placebo-controlled study. , 2001, Scandinavian journal of gastroenterology.

[8]  J. Gama-Rodrigues,et al.  Remaining Small Bowel Length: Association with Catheter Sepsis in Patients Receiving Home Total Parenteral Nutrition: Evidence of Bacterial Translocation , 2000, World Journal of Surgery.

[9]  G. Jensen,et al.  Abnormal liver functions as a result of total parenteral nutrition in a patient with short-bowel syndrome. , 2000, Nutrition.

[10]  J. Scolapio.  Effect of growth hormone, glutamine, and diet on body composition in short bowel syndrome: a randomized, controlled study. , 1999, JPEN. Journal of parenteral and enteral nutrition.

[11]  M. Wasa,et al.  Long-term outcome of short bowel syndrome in adult and pediatric patients. , 1999, JPEN. Journal of parenteral and enteral nutrition.

[12]  M. Cadnapaphornchai,et al.  Infection and cholestasis in neonates with intestinal resection and long-term parenteral nutrition. , 1998, Journal of pediatric gastroenterology and nutrition.

[13]  K. Batts,et al.  Effect of growth hormone, glutamine, and diet on adaptation in short-bowel syndrome: a randomized, controlled study. , 1997, Gastroenterology.

[14]  D. Wilmore,et al.  Short bowel syndrome: new therapeutic approaches. , 1997, Current problems in surgery.

[15]  T. Ziegler,et al.  A New Treatment for Patients with Short‐Bowel Syndrome Growth Hormone, Glutamine, and a Modified Diet , 1995, Annals of surgery.

[16]  J. Buts,et al.  Influence of dietary components on intestinal adaptation after small bowel resection in rats. , 1979, Clinical and investigative medicine. Medecine clinique et experimentale.

[17]  W. James,et al.  Role of the colon in ileal-resection diarrhoea. , 1973, Lancet.

[18]  J. Kjeldahl,et al.  Neue Methode zur Bestimmung des Stickstoffs in organischen Körpern , 1883 .