GLUTAMINE AND THE PRESERVATION OF GUT INTEGRITY

Parenteral glutamine dipeptide improves nitrogen balance in postoperat ive patients on total parenteral nutrition (TPM). Animal studies show that the structure and function of the gut is preserved by glutamine. It is not known if this is the case in human beings. 20 patients admit ted to hospital for total parenteral nutrition were randomly allocated to receive parenteral nutrition enriched with glycyl-L-glutamine (Gln TPN), or standard parenteral nutrition (STPN). Mucosal biopsy specime ns were taken from the second part of the duodenum before starting par enteral nutrition, and after two weeks. The ratio between the urine co ncentrations of lactulose and mannitol after enteral administration wa s used to measure intestinal permeability. After two weeks of parenter al nutrition in the GlnTPN group, intestinal permeability was unchange d, whereas permeability in the STPN group increased. Villus height was unaltered in the GlnTPN group but in the STPN group it decreased. The addition of glutamine to parenteral nutrition prevents deterioration of gut permeability and preserves mucosal structure.