Disturbed gastric emptying in the short bowel syndrome. Evidence for a 'colonic brake'.

Nightingale, J. M. D.; Kamm, Michael A.; Sijp, Joost R.M. van der; Morris, Greg; Walker, Ed; Mather, S. J.; Britton, K. E.; Lennard‐Jones, J. E.

doi:10.1136/gut.34.9.1171

Cited by 112 publications

(66 citation statements)

References 31 publications

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“…36,37 GLP-2 is secreted from the intestinal mucosa in response to food ingestion, and we recently found that postprandial GLP-2 secretion is impaired in patients with no terminal ileum and no colon. 17 The well-known concomitant poor intestinal adaptation 14 and the rapid gastric and intestinal transit described in these patients who have jejunostomies 15,16 prompted us to evaluate the effect of GLP-2 in this subgroup of short-bowel patients. As expected, none of the patients studied had a preserved meal-stimulated GLP-2 response.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, GLP-2 has received much attention as a potential therapeutic agent in the treatment of patients with short-bowel syndrome. In contrast to short-bowel patients with a preserved colon, patients with a jejunostomy have poor intestinal adaptation, 14 rapid gastric and intestinal transit, 15,16 and impaired postprandial GLP-2 secretion. 17 The present study evaluated the effects of subcutaneous GLP-2 administration on intestinal function in 8 patients with functional short-bowel syndrome and no colon in continuity and extensive resections of the small bowel.…”

Section: Background and Aimsmentioning

confidence: 96%

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

et al. 2001

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Background & Aims: Glucagon-like peptide 2 (GLP-2) is intestinotrophic, antisecretory, and transit-modulating in rodents, and it is mainly secreted from the intestinal mucosa of the terminal ileum and colon after food ingestion. We assessed the effect of GLP-2 on the gastrointestinal function in patients without a terminal ileum and colon who have functional short-bowel syndrome with severe malabsorption of wet weight (>1.5 kg/day) and energy (>2.3 MJ/day) and no postprandial secretion of GLP-2. Methods: Balance studies were performed before and after treatment with GLP-2, 400 g subcutaneously twice a day for 35 days, in 8 patients (4 -17 years from last bowel resection; 6 with Crohn's disease). Four patients received home parenteral nutrition (mean residual jejunum, 83 cm), and 4 did not (mean ileum resection, 106 cm). Biopsy specimens were taken from jejunal/ileal stomas, transit was measured by scintigraphy, and body composition was measured by dual-energy x-ray absorptiometry. Results: Treatment with GLP-2 improved the intestinal absorption of energy 3.5% ؎ 4.0% (mean ؎ SD) from 49.9% to 53.4% (P ‫؍‬ 0.04), wet weight 11% ؎ 12% from 25% to 36% (P ‫؍‬ 0.04), and nitrogen 4.7% ؎ 5.4% from 47.4% to 52.1% (P ‫؍‬ 0.04). Body weight increased 1.2 ؎ 1.0 kg (P ‫؍‬ 0.01), lean body mass increased 2.9 ؎ 1.9 kg (P ‫؍‬ 0.004), fat mass decreased 1.8 ؎ 1.3 kg (P ‫؍‬ 0.007), and 24-hour urine creatinine excretion increased (P ‫؍‬ 0.02). The time to 50% gastric emptying of solids increased 30 ؎ 16 minutes from 89 to 119 minutes (P < 0.05). Small bowel transit time was not changed. Crypt depth and villus height were increased in 5 and 6 patients, respectively. Conclusions: Treatment with GLP-2 improves intestinal absorption and nutritional status in short-bowel patients with impaired postprandial GLP-2 secretion in whom the terminal ileum and the colon have been resected.

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Section: Discussionmentioning

confidence: 99%

Section: Background and Aimsmentioning

confidence: 96%

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

et al. 2001

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“…Limited information is available about degradation and absorption of milk proteins in SBS patients, 40 and besides differences in pH, also gastric emptying and transit time may influence effects of specific bioactive factors. In general, SBS is characterised by rapid gastric emptying 41 and short intestinal transit time. 42 Together these factors may have resulted in a low exposure of the intestinal epithelial lining to the bioactive factors in colostrum, and thus preventing their effects on intestinal adaptation beyond the effects induced by the additional nutrient input.…”

Section: Discussionmentioning

confidence: 99%

Randomised controlled trial of colostrum to improve intestinal function in patients with short bowel syndrome

et al. 2012

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BACKGROUND/OBJECTIVES: Colostrum is rich in immunoregulatory, antimicrobial and trophic components supporting intestinal development and function in newborns. We assessed whether bovine colostrum could enhance intestinal adaptation and function in adult short bowel syndrome (SBS) patients. SUBJECTS/METHODS: Twelve SBS patients in this randomised cross-over study received 4 weeks oral supplement of bovine colostrum or an iso-energetic and iso-proteinaceous control (2.4 MJ/d, 500 ml/day) separated by a 4-week washout period. Patients were admitted four times for 72-h periods of fluid, electrolyte and nutrient balance studies. Meals, faeces and urine were weighed, and energy, macronutrient and electrolyte contents were analysed to calculate net nutrient uptake. Body composition was measured by dual-energy X-ray absorptiometry scans, and functional tests of handgrip strength and lung functions were performed. Eight patients completed the study and were included in the analysis. RESULTS: Both supplements (colostrum and control) not only increased protein (0.96±0.42 MJ/d, P ¼ 0.004 1.03±0.44 MJ/d, P ¼ 0.003) and energy (1.46±1.02 MJ/d, P ¼ 0.005, 1.76±1.46 MJ/d, P ¼ 0.01) absorption but also absolute faecal wet weight excretions (231 ± 248 g/d, P ¼ 0.002, 319 ± 299 g/d, P ¼ 0.03), compared with baseline measurements. Both supplements improved handgrip strength (P ¼ 0.03) while only the control supplement increased lean body mass (1.12±1.33 kg, Po0.049). Colostrum was not found to be superior to the control. CONCLUSION: Intake of high-protein milk supplements increased net nutrient absorption for adult SBS patients, but at the expense of increased diarrhoea. Despite high contents of bioactive factors, colostrum did not significantly improve intestinal absorption, body composition or functional tests compared with the control.

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“…Only two jejunostomy patients and three patients with a retained colon were unable to work or help at home but they coped with their own treatment and went out occasionally. One patient with a jejunostomy and a hemiplegia was housebound and needed help with treatment (Nightingale, 1993).…”

Section: Rehabilitationmentioning

confidence: 99%

Clinical problems of a short bowel and their treatment

Nightingale

1994

Proc. Nutr. Soc.

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Sir David Cutherbertson was a chemist before qualifying in medicine. During his first job as a clinical biochemist at the Royal Infirmary in Glasgow, a clinician asked him if he could help solve the problem of the non-union of fractures of the lower third of the tibia. He accepted this challenge and set up a six-bedded metabolic ward. There he performed careful balance studies on patients who had experienced trauma. It was from this work that he described an initial period of reduced metabolism and hyperglycaemia following injury (ebb period); this was followed by a period of increased metabolism and increased protein catabolism (flow phase). His work did not stop there. He went on to show that the magnitude of the N loss during the flow period could be reduced by giving protein and nutrient supplements (Widdowson, 1991).The work presented here follows his example. I shall describe the clinical problems experienced by patients with a short bowel. With the use of balance studies the problems of water, electrolyte and energy absorption are demonstrated and appropriate treatments are evaluated. WHAT I S A SHORT B O W E L ? Small-bowel length in normal subjectsSmall-intestinal length has been measured surgically, radiologically and at autopsy. Bryant (1924) very carefully measured the small-intestinal length from the duodenojejunal flexure to the ileo-caecal valve at 160 autopsies. The mean small-bowel length was 6.2 m, with the mean for women being shorter than that for men. He showed a wide variation in normal human small-intestinal length from 3.0 to 8.5 m. The results he obtained are similar to those obtained at surgery (Backman & Hallberg, 1974;Slater & Aufses, 1991), but slightly longer than those obtained radiologically (Hirsch et al. 1956;Fanucci et al. 1984).In a patient with a total small-intestinal length of 8.5 m a resection of 2.0 m will make little difference, but if the starting length is 3-0 m the same resection may cause major problems. Thus, it is important to refer to the residual length of small intestine rather than to the amount resected.

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Disturbed gastric emptying in the short bowel syndrome. Evidence for a 'colonic brake'.

Cited by 112 publications

References 31 publications

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

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

Randomised controlled trial of colostrum to improve intestinal function in patients with short bowel syndrome

Clinical problems of a short bowel and their treatment

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