A New Treatment for Patients with Short-Bowel Syndrome Growth Hormone, Glutamine, and a Modified Diet

Abstract

ObjectiveThe purpose of this study was to initially determine if growth hormone or nutrients, given alone or together, could enhance absorption from the remnant small bowel after massive intestinal resection. If clinical improvement were observed, this therapy would then be used to treat patients with the short-bowel syndrome over the long term. Summary Background DataPatients who undergo extensive resection of the gastrointestinal tract frequently develop malabsorption and require long-term parenteral nutrition. The authors hypothesized that the administration of growth factors and/or nutrients could enhance further compensation of the remnant intestine and thereby improve absorption. Specifically, animal studies have shown that there is enhanced cellularity with the administration of growth hormone (GH) or glutamine (GLN), or a fiber-containing diet. MethodsInitially, 17 studies were performed in 15 total parenteral nutrition (TPN)-dependent short-bowel patients over 3 to 4 weeks in the clinical research center; the first week served as a control period, and during the next 1 to 3 weeks, the specific treatment was administered and evaluated. Throughout the study, food of known composition was provided and all stool was collected and analyzed to determine absorption across the remaining bowel. The effect of a high-carbohydrate, low-fat diet (DIET), the amino acid glutamine (GLN) and growth hormone (GH) administered alone or in combination with the other therapies (GH + GLN + DIET) was evaluated. The treatment was expanded to 47 adults (25 men, 22 women) with the short-bowel syndrome, dependent on TPN for 6 ± 1 years. The average age was 46 ± 2 years, and the average jejunal-ileal length was 50 + 7 cm (median 35 cm) in those with all or a portion of colon and 102 ± 24 cm (median 102 cm) in those with no colon. After 28 days of therapy, the patients were discharged on only GLN + DIET. ResultsThe initial balance studies indicated improvement in absorption of protein by 39% accompanied by a 33% decrease in stool output with the GH + GLN + DIET. In the long-term study, 40% of the group remain off TPN and an additional 40% have reduced their TPN requirements, with follow-up averaging a year and the longest being over 5 years. 243

Glucagon-like peptide 2 improves nutrient absorption and nutritional status in short-bowel patients with no colon

“…27 Therefore, the search for factors to enhance small bowel adaptation and to increase the assimilation of macronutrients and absorption of water and electrolytes, thereby decreasing the need for parenteral nutrition, has been intensive. The concept of "bowel rehabilitation" was introduced by Byrne et al 31,32 with the introduction of growth hormone and glutamine in the treatment of short-bowel patients. However, their encouraging results have been disputed in later randomized, double-blinded studies.…”

Nutrient intake from habitual oral diet in patients with severe short bowel syndrome living in the southeastern United States

“…Previous studies indicate that intensive and individualized nutrition and diet counseling can facilitate intestinal rehabilitation and PN independence in many patients with severe SBS (6)(7)(8). This small group of SBS patients who live in the Southeastern United States habitually follow diets that are deficient in many essential micro-and macronutrients, including protein, calcium, iron and lipid soluble vitamins.…”

“…Intestinal rehabilitation programs typically incorporate individualized modification of oral diet is a cornerstone of therapy, in addition to optimization of anti-diarrheal medications, particularly as use of PN is weaned (6,17). Dietary modifications typically involve smaller, more frequent feedings, use of oral rehydration solutions and soluble fiber, avoidance of simple sugars, oxalate, and, in some cases, lactose and modification of fat intake and consumption of specific foods based on individual tolerance (2,(6)(7)(8).…”

“…Dietary modifications typically involve smaller, more frequent feedings, use of oral rehydration solutions and soluble fiber, avoidance of simple sugars, oxalate, and, in some cases, lactose and modification of fat intake and consumption of specific foods based on individual tolerance (2,(6)(7)(8). Based on clinical observations and limited experimental evidence, the type and pattern or oral food/fluid intake can dramatically affect the overall nutritional status and stool output volume of SBS subjects (7)(8).…”

Effects of an isotonic oral rehydration solution, enriched with glutamine, on fluid and sodium absorption in patients with short‐bowel syndrome

“…Moreover, our shortterm study cannot exclude a bene®cial effect of glutamine on long-term mucosal integrity or hypothetical adaptation that should be tested in speci®c studies. 30 …”