Abstract
BACKGROUND—High dose growth hormone, glutamine, and a high carbohydrate diet may improve intestinal function in short bowel patients. AIMS—To investigate if growth hormone with glutamine and no change in diet improved intestinal function. PATIENTS AND METHODS—Eight short bowel patients were randomised in a double blind crossover study between placebo and growth hormone (mean 0.12 mg/kg/day) with oral (mean 28 g/day) and parenteral glutamine (mean 5.2 g/day) for 28 days. Balance studies were performed at baseline and five days after placebo and treatment were terminated. Dietary energy, carbohydrate, and fat were maintained as usual. RESULTS—Growth hormone with glutamine did not improve intestinal absorption of energy (baseline, placebo, treatment, mean: 46%, 48%, 46% of oral intake, respectively), carbohydrate (71%, 70%, 71%), fat (20%, 15%, 18%), nitrogen (27%, 18%, 19%), wet weight (37%, 39%, 31%), sodium (−16%, −16%, −36%), potassium (43%, 47%, 33%), calcium (−16%, −16%, −15%) or magnesium (−3%, 4%, 2%) compared with placebo or baseline (p>0.05) five days after treatment was terminated. All patients experienced adverse effects. CONCLUSIONS—Combined high dose growth hormone and glutamine administered for four weeks did not improve intestinal absorption five days after treatment was terminated in short bowel patients on their usual diet. Keywords: growth hormone; glutamine; short bowel syndrome; intestinal failure; intestinal absorption; parenteral nutrition
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- Ameen V. Z., Powell G. K., Jones L. A. Quantitation of fecal carbohydrate excretion in patients with short bowel syndrome. Gastroenterology. 1987 Feb;92(2):493–500. doi: 10.1016/0016-5085(87)90147-8. [DOI] [PubMed] [Google Scholar]
- Byrne T. A., Morrissey T. B., Nattakom T. V., Ziegler T. R., Wilmore D. W. Growth hormone, glutamine, and a modified diet enhance nutrient absorption in patients with severe short bowel syndrome. JPEN J Parenter Enteral Nutr. 1995 Jul-Aug;19(4):296–302. doi: 10.1177/0148607195019004296. [DOI] [PubMed] [Google Scholar]
- Byrne T. A., Persinger R. L., Young L. S., Ziegler T. R., Wilmore D. W. A new treatment for patients with short-bowel syndrome. Growth hormone, glutamine, and a modified diet. Ann Surg. 1995 Sep;222(3):243–255. doi: 10.1097/00000658-199509000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Byrne T., Wilmore D. Does growth hormone and glutamine enhance bowel absorption? Gastroenterology. 1998 May;114(5):1110–1112. doi: 10.1016/s0016-5085(98)70342-7. [DOI] [PubMed] [Google Scholar]
- Cummings J. H., James W. P., Wiggins H. S. Role of the colon in ileal-resection diarrhoea. Lancet. 1973 Feb 17;1(7799):344–347. doi: 10.1016/s0140-6736(73)90131-1. [DOI] [PubMed] [Google Scholar]
- Ellegård L., Bosaeus I., Nordgren S., Bengtsson B. A. Low-dose recombinant human growth hormone increases body weight and lean body mass in patients with short bowel syndrome. Ann Surg. 1997 Jan;225(1):88–96. doi: 10.1097/00000658-199701000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gardemann A., Watanabe Y., Grosse V., Hesse S., Jungermann K. Increases in intestinal glucose absorption and hepatic glucose uptake elicited by luminal but not vascular glutamine in the jointly perfused small intestine and liver of the rat. Biochem J. 1992 May 1;283(Pt 3):759–765. doi: 10.1042/bj2830759. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Guarino A., Canani R. B., Iafusco M., Casola A., Russo R., Rubino A. In vivo and in vitro effects of human growth hormone on rat intestinal ion transport. Pediatr Res. 1995 May;37(5):576–580. doi: 10.1203/00006450-199505000-00003. [DOI] [PubMed] [Google Scholar]
- Jeppesen P. B., Mortensen P. B. Intestinal failure defined by measurements of intestinal energy and wet weight absorption. Gut. 2000 May;46(5):701–706. doi: 10.1136/gut.46.5.701. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jeppesen P. B., Mortensen P. B. The influence of a preserved colon on the absorption of medium chain fat in patients with small bowel resection. Gut. 1998 Oct;43(4):478–483. doi: 10.1136/gut.43.4.478. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nordgaard I., Hansen B. S., Mortensen P. B. Colon as a digestive organ in patients with short bowel. Lancet. 1994 Feb 12;343(8894):373–376. doi: 10.1016/s0140-6736(94)91220-3. [DOI] [PubMed] [Google Scholar]
- Nordgaard I., Hansen B. S., Mortensen P. B. Importance of colonic support for energy absorption as small-bowel failure proceeds. Am J Clin Nutr. 1996 Aug;64(2):222–231. doi: 10.1093/ajcn/64.2.222. [DOI] [PubMed] [Google Scholar]
- Royall D., Wolever T. M., Jeejeebhoy K. N. Evidence for colonic conservation of malabsorbed carbohydrate in short bowel syndrome. Am J Gastroenterol. 1992 Jun;87(6):751–756. [PubMed] [Google Scholar]
- Scolapio J. S., Camilleri M., Fleming C. R., Oenning L. V., Burton D. D., Sebo T. J., Batts K. P., Kelly D. G. Effect of growth hormone, glutamine, and diet on adaptation in short-bowel syndrome: a randomized, controlled study. Gastroenterology. 1997 Oct;113(4):1074–1081. doi: 10.1053/gast.1997.v113.pm9322500. [DOI] [PubMed] [Google Scholar]
- Souba W. W., Klimberg V. S., Plumley D. A., Salloum R. M., Flynn T. C., Bland K. I., Copeland E. M., 3rd The role of glutamine in maintaining a healthy gut and supporting the metabolic response to injury and infection. J Surg Res. 1990 Apr;48(4):383–391. doi: 10.1016/0022-4804(90)90080-l. [DOI] [PubMed] [Google Scholar]