A DOUBLE-BLIND PLACEBO-CONTROLLED PILOT-STUDY OF GLUTAMINE THERAPY FOR ABNORMAL INTESTINAL PERMEABILITY IN PATIENTS WITH AIDS

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).