Factors Predicting a Successful Outcome After Pharmacologic Bowel Compensation

Wilmore, Douglas W.; Lacey, Janet M.; Soultanakis, Rebecca P; Bosch, Ronald L.; Byrne, Theresa A.

doi:10.1097/00000658-199709000-00008

Cited by 100 publications

(53 citation statements)

References 12 publications

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“…Since Wilmore et al's [27]demonstration that a combination of growth hormone, glutamine and a specialized diet enhanced intestinal compensation and optimized nutrient absorption in patients with intestinal failure, many similar studies have been conducted with inconsistent results. For example, Matarese et al performed a systematic search of electronic databases and the Internet for the purpose of compiling the evidence published to date on this subject.…”

Section: Intestinal Adaptation and Hormonesmentioning

confidence: 99%

Advances in short bowel syndrome: an updated review

et al. 2005

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Short bowel syndrome (SBS) continues to be an important clinical problem due to its high mortality and morbidity as well as its devastating socioeconomic effects. The past 3 years have witnessed many advances in the investigation of this condition, with the aim of elucidating the cellular and molecular mechanisms of intestinal adaptation. Such information may provide opportunities to exploit various factors that act as growth agents for the remaining bowel mucosa and may suggest new therapeutic strategies to maintain gut integrity, eliminate dependence on total parenteral nutrition, and avoid the need for intestinal transplantation. This review summarizes current research on SBS over the last few years.

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Section: Intestinal Adaptation and Hormonesmentioning

confidence: 99%

Advances in short bowel syndrome: an updated review

et al. 2005

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“…Specifically, concerning the effect of Gln on intestinal function, Wilmore et al [117] treated 300 short bowel patients with a combination of GH, Gln and high carbohydrate diet, and reported that 60% of the patients could be weaned from TPN, in 30% TPN could be reduced, and the remaining 10% still required the same quantity of TPN. This result shows the importance of such a combination therapy in the adaptive process of SBS.…”

Section: Glutamine (Gln)mentioning

confidence: 99%

Factors Enhancing Intestinal Adaptation after Bowel Compensation

Botsios

Vasiliadis²

2003

Dig Dis

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Intestinal failure (IF) refers to the condition in which certain causes lead to derangements in nutrient absorption capacity. Gut adaptation occurs in response to IF and it is both morphologic and physiologic in nature and can be mediated by growth factors and nutrients. Our paper reviews certain trophic growth factors that have important interactions relevant for intestinal growth, function and adaptation. Data Source: The literature was reviewed (data from both animal and human studies) and certain trophic factors that modulate intestinal adaptation are summarized. The factors reviewed are: epidermal growth factor, insulin-like growth factor I and II, transforming growth factor α and β, neurotensin, interleukin-11, glucagon-like peptide-2, keratinocyte growth factor, human growth hormone, short-chain fatty acids, and glutamine. Conclusions: Growth factors augment intestinal proliferation, diminish programmed apoptosis, and modulate the adaptive process. They also have the potential to improve nutrient absorption in some bowel disease. The enhancement of gut adaptation may allow patients to transition of parenteral/enteral to normal nutrition, in a shorter period of time, which reduce the rate of adverse effects caused by artificial nutrition and improve quality of life.

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“…Since 1995 Byrne et al have published a series of studies, which demonstrated that a combination of growth hormone, glutamine, and modified fiber-enriched diet can improve nutrient absorption, decrease stool output, and reducte TPN requirement [6][7][8] . These reports are the first to introduce the concept that further bowel adaptation can occur with the use of specialized nutrients and growth factors, and ushered in a new era in the treatment of short bowel syndrome.…”

Section: Introductionmentioning

confidence: 99%

Effect of bowel rehabilitative therapy on structural adaptation of remnant small intestine: animal experiment

Zhou

Li²,

Li³

et al. 2001

WJG

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AIM To investigate the individual and the combined effects of glutamine, dietary fiber, and growth hormone on the structural adaptation of the remnant small bowel. METHODS Forty-two adult male SpragueDawley rats underwent 85% mid-small bowel resection and received total parenteral nutrition ( T P N ) s u p p o r t d u r i n g t h e f i r s t t h r e e p o s t o p e r a t i o n a l d a y s . F r o m t h e 4 t h postoperational day, animals were randomly assigned to receive 7 different treatments for 8 days: TPNcon group, receiving TPN and enteral 20 g·L -1 glycine perfusion; TPN+Gln group, receiving TPN and enteral 20 g·L -1 glutamine perfusion; ENcon group, receiving enteral nutrition (EN) fortified with 20 g·L -1 glycine; EN+Gln group, enteral nutrition fortified with 20 g·L -1 glutamine; EN+Fib group, enteral nutrition and 2 g·L -1 oral soybean fiber; EN+GH group, enteral nutrition and subcutaneous growth hormone (GH) (0.3IU) injection twice daily; and ENint group, glutamine-enriched EN, oral soybean fiber, and subcutaneous GH injection. RESULTS Enteral glutamine perfusion during TPN increased the small intestinal villus height (jejunal villus height 250 µm ± 29 µm in TPNcon vs 330 µm ± 54 µm in TPN+Gln, ileal villus height 260 µm ± 28 µm in TPNcon vs 330 µm ± 22 µm in TPN+Gln, P<0.05) and mucosa thickness (jejunal mucosa thickness 360 µm ± 32 µm in TPNcon vs 460 µm ± 65 µm in TPN+Gln, ileal mucosa thickness 400µm ± 25 µm in TPNcon vs 490 µm ± 11 µm in TPN+Gln, P<0.05) in comparison with the TPNcon group. Either fiber supplementation or GH administration improved body mass gain (end body weight 270 g ± 3.6 g in EN+Fib, 265.7 g ± 3.3 g in EN+GH, vs 257 g ± 3.3 g in ENcon, P<0.05), elevated plasma insulinlike growth factor (IGF-I) level (880 µg·L -1 ± 52 µg·L -1 in EN+Fib, 1 200 µg·L -1 ± 96 µg·L -1 in EN ± GH, vs 620 µg·L -1 ± 43 µg·L -1 in ENcon, P<0.05), and increased the villus height (jejunum 560 µm ± 44 µm in EN ± Fib, 530 µm ± 30 µm in EN ± GH, vs 450 µm ± 44 µm in ENcon, ileum 400 µm ± 30 µm in EN+Fib, 380 µm ± 49 µm in EN ± GH, vs 320 µm ± 16 µm in ENcon, P<0.05) and the mucosa thickness (jejunum 740 µm ± 66 µm in EN ± Fib, 705 µm ± 27 µm in ENGH, vs 608 µm ± 58 µm in ENcon, ileum 570 µm ± 27 µm in EN ± Fib, 560 µm ± 56 µm in EN ± GH, vs 480 µm ± 40 µm in ENcon, P<0.05) in remnant jejunum and ileum. Glutamine-enriched EN produced little effect in body mass, plasma IGF-I level, and remnant small bowel mucosal structure. The ENint group had greater body mass (280 g ± 2. 2 g), plasma IGF-I level (1450 µg·L -1 ± 137 µg·L -1 ), and villus height (jejunum 620 µm ± 56 µm, ileum 450 µm ± 31 µm) and mucosal thickness (jejunum 800 µm ± 52 µm, ileum 633 µm ± 33 µm) than those in ENcon,EN+Gln (jejunum villus height and mucosa thickness 450 µm ± 47 µm and 610 µm ± 63 µm, ileum villus height and mucosa thickness 330 µm ± 39 µm and 500 µm ± 52 µm), EN+GH groups (P<0.05), and than those in EN+Fib group although no statistical significance was attained. CONCLUSION Both dietary fiber and GH when used separately c...

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Factors Predicting a Successful Outcome After Pharmacologic Bowel Compensation

Cited by 100 publications

References 12 publications

Advances in short bowel syndrome: an updated review

Advances in short bowel syndrome: an updated review

Factors Enhancing Intestinal Adaptation after Bowel Compensation

Effect of bowel rehabilitative therapy on structural adaptation of remnant small intestine: animal experiment

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