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

Abstract

Aim: To compare the effects of a standard oral rehydration solution with a polymeric glucose isotonic solution enriched with glutamine on water and sodium absorption in the short bowel. Methods: Six patients with high jejunostomy were tested in a random order on 2 consecutive days with the standard solution (20 g/L glucose, 94 mmol/L sodium, 292 mOsm/kg osmolality) and a solution containing maltodextrins (18 g/L Glucidex 12; hydrolysis of 18 g of Glucidex 12 yields 20 g glucose) enriched with 14.6 g/L of glutamine (94 mmol/L sodium, 282 mOsm/kg osmolality). Solutions were administered via a naso‐gastric tube at a rate of 2 mL/min. Jejunal effluent for each solution was collected during an 8‐h period, after a 14‐h equilibrium period. Results: The net 8‐h fluid absorption was not significantly different between the standard solution and the solution with glutamine (333 ± 195 and 213 ± 251 mL, respectively (mean ± S.E.M.)). Net sodium absorption was higher for the standard solution than for the solution with glutamine (15 ± 15 vs. 2 ± 20 mmol, P < 0.05). The rate of glucose absorption was not different between the solutions. Conclusion: The replacement of glucose by maltodextrins and the addition of glutamine to the standard oral rehydration solution, without changing its sodium content or osmolality, results in a reduction of sodium absorption in the short‐bowel syndrome.

The Roles of Glutamine in the Intestine and Its Implication in Intestinal Diseases

“…Similarly, no significant effect of oral glutamine supplements (21 g/day for 4 weeks) was observed in 14 Crohn’s disease patients [122]. In short bowel syndrome patients, six studies have examined the effect of glutamine support, but no improvement in the surrogate parameters was found [123,124,125,126,127,128]. Although some studies showed favorable effects, the clinical efficacy of glutamine supplementation in intestinal diseases remains a controversial issue.…”

“…Second, a wide variety of dose, time, and mode of supplementation was used. Dose of glutamine used in the studies varied up to 5-fold [121,122,136], and treatment period varied from 2 days [124] to 8 weeks [128]. As glutamine couples with alanine and glycine, glutamine complex with alanine and glycine is less susceptible to degradation than free glutamine.…”

Management of patients with a short bowel

“…Little advantage comes from taking a diet of watersoluble medium chain triglycerides in place of normal fat [148] . The addition of glutamine (15 gm) to a litre of rehydration solution in patients with jejunostomy resulted in no additional benefit in terms of water or sodium absorption [152] . The fibre content of the diet plays only a minor role in determining jejunal output [93] .…”

Small intestine transplantation today

“…Enteroglucagon, glucagon-like peptide (GLP)-II, epidermal growth factor, growth hormone, cholecystokinin, gastrin, insulin, and neurotensin mediate the adaptive response [16]. Glutamine supplementation neither enhances intestinal adaptation nor improves fluid or nutrient absorption [39][40][41]. Intestinotrophic effects are reported for the synthetic GLP-II analogue tedugluide, but this effects are transient and disappear when treatment is discontinued [42,43].…”