Effect of high dose growth hormone with glutamine and no change in diet on intestinal absorption in short bowel patients: a randomised, double blind, crossover, placebo controlled study

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 eVects. Conclusions-Combinedhigh 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.

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

“…In contrast to the 2 double-blind, randomized studies using high-dose growth hormone and glutamine, 33,34 treatment with GLP-2 significantly increased overall energy absorption in this study. In another open-labeled study, 32 the combination of growth hormone, glutamine, and high-carbohydrate diet improved energy absorption approximately 590 KJ/day in 8 short-bowel patients who all had preserved colonic continuity, which possibly was a result of the increase in carbohydrate intake known to increase energy absorption in patients with a colon.…”

“…32 The 2 blinded studies using growth hormone and glutamine resulted in symptoms of fluid retention known to occur during treatment with growth hormone, but a beneficial effect on intestinal absorption of wet weight was not documented. 33,34 The observed effects on body weight and body composition resembled effects obtained in studies using growth hormone, 40,41 but in contrast to findings after treatment with growth hormone, no clinical signs of edema occurred during GLP-2 treatment. Furthermore, GLP-2 increased urinary creatinine excretion, indicating that GLP-2 increased muscle mass and did not just change hydration.…”

“…However, their encouraging results have been disputed in later randomized, double-blinded studies. [33][34][35] The recent discoveries of the tissue-specific intestinotrophic, antisecretory, and transit-modulating effects of GLP-2 have been followed with great interest. 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.…”

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

“…The net intestinal macronutrient absorption values in our subjects are within the range of those reported in other studies of PN-dependent SBS patients (12)(13)(14)(15)(16). This broad range of nutrient absorption is related to the remaining small bowel length but also to the underlying disease and the anatomy of remnant intestine.…”

“…Furthermore, conventional PN may provide inadequate amounts of certain nutrients for the needs of some individuals, such as essential fatty acids (39), vitamin E (40), vitamin D or calcium (2,41). Patients with SBS require high doses of oral calcium, not only for total body function and bone metabolism but also to prevent oxalate absorption and oxalate renal stone formation, and as others and we have observed there is also active secretion of calcium in stools (14,37). Doses of vitamin D and calcium in PN may also be inadequate to prevent vitamin D deficiency and progressive osteopenia, especially in certain groups such as black patients with poor sun exposure.…”