Glucagon-like peptide 2 improves nutrient absorption and nutritional status in short-bowel patients with no colon

Background & Aims: Glucagon-like peptide 2 (GLP-2) is intestinotrophic, ant isecretory, and transit-modulating in rodents, and it is mainly secreted fr om the intestinal mucosa of the terminal ileum and colon after food ingesti on. We assessed the effect of GLP-2 on the gastrointestinal function in pat ients without a terminal ileum and colon who have functional short-bower sy ndrome with severe malabsorption of wet weight (>1.5 kg/day) and energy (>2 .3 MJ/day) and no postprandial secretion of GLP-2. Methods: Balance studies were performed before and after treatment with GLP-2, 400 mug subcutaneous ly twice a day for 35 days, in 8 patients (4-17 years from last bowel resec tion; 6 with Crohn's disease). Four patients received home parenteral nutri tion (mean residual jejunum, 83 cm), and 4 did not (mean ileum resection, 1 06 cm). Biopsy specimens were taken from jejunal/ileal stomas, transit was measured by scintigraphy, and body composition was measured by dual-energy x-ray absorptiometry. Results: Treatment with GLP-2 improved the intestinal absorption of energy 3.5% +/- 4.0% (mean +/- SD) from 49.9% to 53.4% (P = 0.04), wet weight 11% +/- 12% from 25% to 36% (P = 0.04), and nitrogen 4.7% +/- 5.4% from 47.4% to 52.1% (P = 0.04). Body weight increased 1.2 +/- 1.0 kg (P = 0.01), lean body mass increased 2.9 +/- 1.9 kg (P = 0.004), fat ma ss decreased 1.8 +/- 1.3 kg (P 0.007), and 24-hour urine creatinine excreti on increased (P = 0.02). The time to 50% gastric emptying of solids increas ed 30 +/- 16 minutes from 89 to 119 minutes (P < 0.05). Small bowel transit time was not changed. Crypt depth and villus height were increased in 5 an d 6 patients, respectively. Conclusions: Treatment with GLP-2 improves inte stinal absorption and nutritional status in short-bowel patients with impai red postprandial GLP-2 secretion in whom the terminal ileum and the colon h ave been resected.