Glucagon-like peptide-2 stimulates mucosal microcirculation measured by laser Doppler flowmetry in end-jejunostomy short bowel syndrome patients

Høyerup, Peter; Hellström, Per M.; Schmidt, P; Brandt, Claus; Askov-Hansen, C.; Mortensen, Per Brøbech; Jeppesen, Palle Bekker

doi:10.1016/j.regpep.2012.10.002

Cited by 26 publications

(16 citation statements)

References 23 publications

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“…A synthetic trophic hormone acting on intestinal villi – glucagon-like peptide-2 – appears very promising for the prevention of metabolic complications of end stoma syndromes. Multicenter clinical trials have shown significant metabolic benefits in patients who received this drug [12]. Clinical experience in studying the effects of glucagon-like peptide-2 in multicenter clinical trials shows a reduction in stoma output, associated with a mechanism of increased intestinal absorption.…”

Section: Discussionmentioning

confidence: 99%

Strategies for early metabolic disturbances in patients with an end jejunostomy or end ileostomy. Experience from a specialized Home Parenteral Nutrition (HPN) center

Ławiński

Haraszczuk

Gradowska

et al. 2017

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IntroductionAn end stoma syndrome is usually the result of an intentional surgical intervention in the course of staged treatment or a complication of surgery. These patients most frequently suffer from water and electrolyte disturbances, malnutrition syndromes caused by malabsorption of trace elements and/or vitamins, and undernutrition.AimTo present early metabolic disturbances observed in patients with an end jejunostomy or end ileostomy syndrome on the first day of their hospitalization in a specialist Home Parenteral Nutrition (HPN) center.Material and methodsThe study included 142 patients with an end stoma syndrome (76 women and 66 men), hospitalized between 2004 and 2014. Patients were divided into two main groups. Group A consisted of 90 patients with an end jejunostomy and group B consisted of 52 patients with an end ileostomy.ResultsAfter comparing the patients with an end jejunostomy vs. those with an end ileostomy, significant differences were found as regards pH (7.34 vs. 7.39, p = 0.043) and BE (3.24 vs. –0.86, p = 0.005). Depending on the lack or possibility of oral food intake, patients in the end jejunostomy group had different levels of the markers phosphate, Mg, Ca, urea, and creatinine, with all of these parameters within normal laboratory limits. When the end ileostomy group was divided into subgroups depending on the lack or possibility of oral food intake, differences in C-reactive protein activity were found (55.6 vs. 25.7, p = 0.041).ConclusionsPatients with an end jejunostomy syndrome are more prone to metabolic acidosis with significant alkali deficiencies.

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Section: Discussionmentioning

confidence: 99%

Strategies for early metabolic disturbances in patients with an end jejunostomy or end ileostomy. Experience from a specialized Home Parenteral Nutrition (HPN) center

Ławiński

Haraszczuk

Gradowska

et al. 2017

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“…GLP-2 has also been shown to raise jejunal microcirculatory flow in SBS patients with an enterostomy(37). While flow has been examined, actual growth of intestinal vascularity has not been examined.…”

Section: Discussionmentioning

confidence: 99%

Glucagon-like peptide 2 increases efficacy of distraction enterogenesis

Sueyoshi

Ralls

Teitelbaum

2013

Journal of Surgical Research

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Background Application of distractive forces to small bowel induces intestinal growth, or enterogenesis. This emerging area of research may provide treatment for short bowel syndrome (SBS). Glucagon-like peptide 2(GLP-2) has also been reported to induce small bowel growth after bowel resection. We hypothesized that exogenous GLP-2 will result in enhanced distraction-induced enterogenesis. Methods Distraction-induced model was performed in 10-week-old C57B6 mice using osmotic forces with high molecular weight polyethylene glycol (PEG-stretch). Four groups were studied: Control group (PEG−/GLP-2−); PEG-stretch (PEG+/GLP-2−); GLP-2 control (PEG−/GLP-2+); and GLP-2 stretch (PEG+/GLP-2+). GLP-2 was given via subcutaneous osmotic pump over the 5 days of experiment. Morphology was measured by histomicrography. Epithelial cell (EC) proliferation was measured with PCNA immunofluorescent staining. Total intestinal growth and blood vessel volume was assessed with Micro CT volumetry. VEGF, FGF1 and 2, and PDGF were measured by RT-PCR. Results EC proliferation increased significantly in all groups compared to Controls, but was greatest in the GLP-2 stretch group. Diameter and length significantly increased in the PEG stretch and GLP-2 stretch groups. Moreover, there was statistically greater diameter, crypt depth and EC proliferation in the GLP-2 stretch vs. PEG stretch groups. GLP-2 stretch vessel volume was greater than all other groups and was significantly increased compared to controls. The relative expression of PDGF increased significantly in the PEG stretch group vs. the control group. Conclusions GLP-2 had an additive effect on EC proliferation, tissue growth, histomorphology and vascularization. The combination of enterogenesis and GLP-2 may yield an improved approach to treat SBS.

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“…GLP-2 has been shown to stimulate intestinal blood flow (22) and increase portal blood flow(24) through a nitric oxide-dependent pathway (36). GLP-2 has also been shown to raise jejunal microcirculatory flow in SBS patients with an enterostomy (37). While flow has been examined, actual growth of intestinal vascularity has not been examined.…”

Section: Discussionmentioning

confidence: 99%