GROWTH-HORMONE, GLUTAMINE, AND A MODIFIED DIET ENHANCE NUTRIENT ABSORPTION IN PATIENTS WITH SEVERE SHORT-BOWEL SYNDROME

Background: Massive loss of intestinal surface area results in the sho rt bowel syndrome characterized by malabsorption of fluid, electrolyte s, and other nutrients. Although the remaining bowel undergoes morphol ogical and functional adaptation, often these changes are inadequate t o support the individual by enteral feedings, and parenteral nutrition is required to prevent dehydration, electrolyte disturbances, and mal nutrition Substances such as growth hormone, glutamine, acid fiber exe rt bowel-specific trophic effects and either directly or indirectly in fluence nutrient absorption. This study was undertaken to determine wh ether the co-administration of exogenous growth hormone, supplemental glutamine, and a modified fiber-containing diet could enhance nutrient absorption in patients who had undergone massive intestinal resection . Methods: Ten patients: (5 men, 5 women, aged 43 +/- 4 years) with sh ort bowel syndrome were studied 6 +/- I years after surgical resection All patients were admitted to the Clinical Research Center for a 28-d ay period; the first week served as a control period when nutritional (enteral and parenteral) and medical management simulated usual home t herapy. Thereafter, eight patients received exogenous growth hormone, supplemental glutamine, and a modified high-carbohydrate, high-fiber d iet. Two patients were treated with the modified diet alone. The effic iency of net nutrient absorbtion (percent absorbed) for total calories , protein, fat, carbohydrate, water, and sodium wits calculated from t he measured nutrient intake and stool losses. Results: Three weeks of treatment with growth hormone, glutamine, and a modified diet increase d total caloric absorption from 60.1 +/- 6.0% to 74.3 +/- 5.0% (p less than or equal to .003), protein absorption from 48.8 +/- 4.8% to 63.0 +/- 5.4% (p less than or equal to .006), and carbohydrate absorption from 60.0 +/- 9.8% to 81.5 +/- 5.3% (p less than or equal to .02). Fat absorption did not change (61.0 +/- 5.3% to 60.3 +/- 7.9%, p = NS). W ater and sodium absorption increased from 45.7 +/- 6.7% to 65.0 +/- 7. 3% (p less than or equal to .002) and hom 49.0 +/- 9.8% to 69.6 +/- 6. 5% (p less than or equal to .04), respectively. These absorptive chang es resulted in a decrease in stool output (1,783 +/- 414 g/d control p eriod vs 1,308 +/- 404 g/d third week of treatment, p less than or equ al to .05). Treatment with diet alone did not influence nutrient absor ption or stool output. Conclusions: The combined administration of gro wth hormone, glutamine, and a modified diet enhanced nutrient absorpti on from the remnant bowel after massive intestinal resection. These ch anges occurred in a group of patients that had previously failed to ad apt to the provision of enteral nutrients. This therapy may offer an a lternative to long-term dependence on total parenteral nutrition for p atients with severe short bowel syndrome.