Long-acting somatostatin analogue therapy and protein metabolism in patients with jejunostomies

O'Keefe, Stephen J.D.; Haymond, Morey W.; Bennet, W. M.; Oswald, Barbara; Nelson, Daniel K.; Shorter, Roy G.

doi:10.1016/0016-5085(94)90162-7

Cited by 128 publications

(77 citation statements)

References 42 publications

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“…Gastric acid hypersecretion could increase the incidence of peptic ulceration [50] ; impair nutrient absorption by causing bile salt precipitation [51] ; reduced pancreatic enzyme function and increased jejunal motility. However although there may be an increase in gastric acid secretion in the first 2 wk after a small bowel resection [52] , there is no good evidence for gastric acid hypersecretion in man in the long-term, especially in those with a jejunostomy [53] . Pancreatic function is reduced by undernutrition [54] and if there is no oral intake [55] , but not after a small bowel resection leaving the colon [56] .…”

Section: Gastrointestinal Secretionsmentioning

confidence: 99%

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Management of patients with a short bowel

Nightingale

1999

Nutrition

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Section: Gastrointestinal Secretionsmentioning

confidence: 99%

“…Jejunostomy Although adaptation occurs in the months after the creation of an ileostomy, there is no evidence for any structural [53] or functional [25,68,] adaptation at any time in patients with a jejunostomy. This may be because patients with a jejunostomy have low circulating plasma levels of GLP-2 and peptide YY [40,69,70] .…”

Section: Jejunum-colonmentioning

confidence: 99%

Management of patients with a short bowel

Nightingale

1999

Nutrition

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“…This adaptive phase occurs between the postoperative and sequela phases both in animals and humans. In humans, an adaptive process has never been convincingly demonstrated in the remnant small or large intestine (3,39,41). At the colonic level, absorptive changes in humans are significant through hyperfermentation of malabsorbed carbohydrates attributable to changes in the bacterial microflora (7).…”

mentioning

confidence: 99%

Morphological adaptation with preserved proliferation/transporter content in the colon of patients with short bowel syndrome

Joly¹,

Mayeur²,

Messing³

et al. 2009

American Journal of Physiology-Gastrointestinal and Liver Physi

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, although a remaining colon improves patient outcome, there is no direct evidence of a mucosal colonic adaptation in humans. This prospective study evaluates morphology, proliferation status, and transporter expression level in the epithelium of the remaining colon of adult patients compared with controls. The targeted transporters were Na ϩ /H ϩ exchangers (NHE2 and 3) and oligopeptide transporter (PepT1). Twelve adult patients with a jejuno-colonic anastomosis were studied at least 2 yr after the last surgery and compared with 11 healthy controls. The depth of crypts and number of epithelial cells per crypt were quantified. The proliferating and apoptotic cell contents were evaluated by revealing Ki67, PCNA, and caspase-3. NHE2, NHE3, PepT1 mRNAs, and PepT1 protein were quantified by quantitative RT-PCR and Western blot, respectively. In patients with SBS compared with controls, 1) hyperphagia and severe malabsorption were documented, 2) crypt depth and number of cells per crypt were 35% and 22% higher, respectively (P Ͻ 0.005), whereas the proliferation and apoptotic levels per crypt were unchanged, and 3) NHE2 mRNA was unmodified; NHE3 mRNA was downregulated near the anastomosis and unmodified distally, and PepT1 mRNA and protein were unmodified. We concluded that, in hyperphagic patients with SBS with severe malabsorption, adaptive colonic changes include an increased absorptive surface with an unchanged proliferative/apoptotic ratio and well-preserved absorptive NHE2, NHE3, and PepT1 transporters. This is the first study showing a controlled nonpharmacological hyperplasia in the colon of patients with SBS.

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“…For instance, it has recently been suggested that genes involved in the development of serotoninergic pathways are affected in PWS, which could potentially influence appetite (24,25). Finally, while Oct decreases plasma concentrations of ghrelin, an orexigenic hormone, it also decreases the concentrations of anorexigenic hormones, such as insulin (26) and PYY (27). Because PYY regulation was previously shown to be abnormal in PWS (28), we focused on PYY, which increases rapidly in the circulation in response to a meal to signal satiety (3).…”

Section: Discussionmentioning

confidence: 99%

Long-acting octreotide treatment causes a sustained decrease in ghrelin concentrations but does not affect weight, behaviour and appetite in subjects with Prader–Willi syndrome

Waele

Ishkanian

Bogarin

et al. 2008

European Journal of Endocrinology

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Objective: Ghrelin is secreted primarily by the stomach and circulates as both acylated and desacyl ghrelin. Acylated (but not desacyl) ghrelin stimulates appetite. Both concentrations are elevated in Prader-Willi syndrome (PWS), suggesting that ghrelin may contribute to hyperphagia and overweight in these subjects. We evaluated whether long-acting octreotide (Oct) decreases acylated and desacyl ghrelin concentrations, body mass, appetite and compulsive behaviour towards food in adolescents with PWS. Design: A 56-week prospective, randomized, cross-over trial. Methods: Nine subjects with PWS (age 14.6 (10.8-18.9) years, body mass index (BMI) Z-score C1.9 (0.6-3.0)) received either Oct (30 mg) or saline i.m. every 4 weeks for 16 weeks and were switched over to the other treatment after a 24-week washout period. Results: Eight subjects completed the study. Oct caused a decrease in both acylated (K53%) and desacyl (K54%) fasting ghrelin concentrations (P!0.05) but did not significantly affect BMI. Oct had no significant effect on peptide YY concentrations, appetite or compulsive behaviour towards food. Oct caused a decrease in insulin-like growth factor-I concentrations, an increase in HbA1c and transient elevation of blood glucose in two subjects. Three subjects developed gallstones. Conclusions: Oct treatment caused a prolonged decrease in ghrelin concentrations in adolescents with PWS but did not improve body mass or appetite. Future intervention studies aiming at clarifying the role of ghrelin in PWS should focus on the administration of specific inhibitors of ghrelin secretion or ghrelin receptor activity that do not interfere with other appetite-regulating peptides.

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Long-acting somatostatin analogue therapy and protein metabolism in patients with jejunostomies

Cited by 128 publications

References 42 publications

Management of patients with a short bowel

Management of patients with a short bowel

Morphological adaptation with preserved proliferation/transporter content in the colon of patients with short bowel syndrome

Long-acting octreotide treatment causes a sustained decrease in ghrelin concentrations but does not affect weight, behaviour and appetite in subjects with Prader–Willi syndrome

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