New treatment for patients with short-bowel syndrome: growth hormone, glutamine and a modified diet.

After massive enterectomy, the remnant bowel must undergo both morphologic and physiologic adaptation if the patient is to wean to volitional enteral support. Those patients who are unable to adapt require long-term total parenteral nutrition (TPN) with its concomitant high cost and metabolic anomalies. Previously, it was believed that adaptation ceased after a period of 1 to 2 years. In 1992, Byrne et al presented the theory that further adaptation could be elicited in a group of 8 patients who had been on TPN for up to 6 years by treatment with a combination of growth hormone, free glutamine, and a diet high in fiber and low in fat. 1 This paper did not delineate the specific mechanisms or present long-term results. The current study involves 47 patients with short-bowel syndrome dependent on TPN for an average of 6 years. Average age was 46 with a mean jejunoileal length of 50 ± 7 cm. Half of the patients had <35 cm of small bowel. Etiologies included volvulus, SMA thromboses, or adhesions in the vast ...