EFFECT OF GROWTH-HORMONE, GLUTAMINE, AND DIET ON ADAPTATION IN SHORT-BOWEL SYNDROME - A RANDOMIZED, CONTROLLED-STUDY

Background & Aims: The effects of parenteral growth hormone, glutamine supplementation, and a high carbohydrate-low fat (HCLF) diet on gut a daptation in short-bowel syndrome are unclear. The aim of this study w as to compare effects of this treatment regimen and placebo in patient s with short-bowel syndrome, Methods: A randomized, 6-week, double-bli nd, placebo-controlled, crossover study in 8 patients with short-bower syndrome (average small bowel length, 71 cm; mean duration, 12.9 year s) was performed. Active treatment was growth hormone (0.14 mg.kg(-1). day(-1)), oral glutamine (0.63 g.kg(-1).day(-1)), and the HCLF diet fo r 21 days. The weight, basal metabolic rate, nutrient and electrolyte balance, serum insulin-like growth factor I levels, D-xylose absorptio n, morphology and DNA proliferation of small intestinal mucosa, and ga strointestinal transit were evaluated. Treatments were compared by pai red t test. Results: Active treatment transiently increased body weigh t, significantly but modestly increased the absorption of sodium and p otassium, and decreased gastric emptying. The assimilation of macronut rients, stool volumes, and morphometry of small bowel mucosa were not statistically different in the two treatment arms, Conclusions: Althou gh treatment with growth hormone, glutamine, and HCLF diet for 3 weeks resulted in modest improvements in electrolyte absorption and delayed gastric emptying, there were no improvements in small bowel morpholog y, stool losses, or macronutrient absorption.