Cm. Noyer et al., A DOUBLE-BLIND PLACEBO-CONTROLLED PILOT-STUDY OF GLUTAMINE THERAPY FOR ABNORMAL INTESTINAL PERMEABILITY IN PATIENTS WITH AIDS, The American journal of gastroenterology, 93(6), 1998, pp. 972-975
Objectives: Up to 20% of patients with AIDS have abnormal intestinal p
ermeability (IP), Glutamine seems to play an important role in prevent
ing the increase in IP and loss of intestinal mucosal mass associated
with total parenteral nutrition, and may be superior to glucose for or
al rehydration in the setting of intestinal infection, This study was
designed to see if supplemental glutamine could alter the abnormal TP
of AIDS. Methods: Randomly chosen patients with AIDS from the Jacobi M
edical Center human immunodeficiency virus (HIV) clinic underwent IP t
esting using lactulose and mannitol. Those with abnormal TP were enrol
led. Duodenal biopsies were performed with a Crosby capsule and the pa
tients were randomized in a double-blind fashion to receive placebo or
glutamine (4 g/day or 8 g/day) for 28 days, after which intestinal pe
rmeability tests and duodenal biopsies were repeated. Intestinal morph
ology was graded by ratio of villus height to crypt depth, and by degr
ee of inflammation. Results: All patients complied with the therapy an
d there were no dropouts or reported side effects, The results showed
less worsening of IP with the 4 g/day dose, compared,with placebo, At
the 8 g/day dose, there was stabilization of IP and improved absorptio
n of mannitol. Intestinal morphology and inflammation did not change i
n any group. Conclusions: These results, although not significant, sug
gest a trend towards improved IP and enhanced intestinal absorption wi
th glutamine, Glutamine doses of at least 20 g/day may be necessary to
improve IF. We recommend further studies at higher doses and for long
er durations, (Am J Gastroenterol 1998;93:972-975. (C) 1998 by Am, Cel
l. of Gastroenterology).