Impaired meal stimulated glucagon-like peptide 2 response in ileal resected short bowel patients with intestinal failure

Background-Glucagon-like peptide 2 (GLP-2) is a growth factor for the intes tinal epithelium in rodents and may affect intestinal transit. Aims-To study the GLP-2, response to nutrient ingestion in seven short bowe l patients with intestinal failure and seven controls. Methods-The patients and controls were admitted twice for two test meals af ter a night of fasting. Meal A was liquid (300 ml 1.88 MJ); meal B was a re gular breakfast (755 g, 3.92 MJ). Plasma samples were collected for 180 min utes; GLP-2 immunoreactivity was measured with an NH, terminal specific rad ioimmunoassay. Results-Both meals elicited significant increases in plasma GLP-2 in contro ls. The magnitude and duration of the responses were dependent on the meal size: the maximum median (25-75%) increases after meal A and B were 24 (3-2 8) and 48 (33-56) pmol/l. Plasma GLP-2 returned to basal concentrations 180 minutes after meal A, but remained at 50% of peak values after meal B. In the patients neither meal significantly changed the GLP-2 concentration; th e maximum median elevation after meal B was 5 (2-8) pmol/l. There were sign ificant differences between patients and controls with respect to the GLP-2 responses to meals A and B. Conclusion-Identification of GLP-2 as a tissue specific intestinal growth f actor and demonstration of an impaired meal stimulated GLP-2 response in sh ort bowel patients raises the possibility that GLP-2 administration may con stitute a new therapeutic strategy, enhancing jejunal adaptation in ileum r esected short bowel patients with intestinal failure.