Sage Journals: Discover world-class research

Abstract

Background: Studies showed that bowel rehabilitation therapy, including recombinant human growth hormone (rhGH), nutrition support, glutamine, and dietary fiber, promotes intestinal adaptation in patients with short bowel syndrome. The aim of the current study was to determine if enteral nutrition and rhGH are effective in weaning short bowel patients off total parenteral nutrition (TPN). Methods: Thirty-seven patients with short bowel syndrome received bowel rehabilitation therapy for 4 weeks. Thirty-four patients were treated within 2 years after short bowel syndrome. Treatment included nutrition support from enteral nutrition 500 to 1500 kcal/d, oral glutamine 0.6 g/kg/d, plus a high-carbohydrate and low-fat diet. Once patients were in positive nitrogen balance, rhGH 0.05 mg/kg/d was administered for 3 weeks. Results: All patients completed the treatment; there were no deaths caused by malnutrition. Intestinal absorptive capacity and plasma levels of proteins were significantly improved after treatment (p< .05). Of the 23 patients who have been followed for >2 years after bowel rehabilitation therapy, 21 patients (57%) weaned off parenteral nutrition, among which 18 (49%) patients lived on a high-carbohydrate and low-fat diet supplemented with enteral nutrition, and 3 patients were free of enteral nutrition and relied on high-carbohydrate and low-fat diet alone. The minimal intestinal length for these patients was 15 cm with ileocecal valve and intact colon in adults. Conclusions: Providing patients with enteral nutrition, glutamine, dietary fiber, and rhGH during bowel rehabilitation therapy allows weaning from TPN in a significant number of patients.

Thirty-seven patients with short bowel syndrome received bowel rehabilitation therapy with enteral nutrition supplemented with high carbohydrate low fat diet (HCLF diet), glutamine and recombinant human growth hormone, after which 21 patients weaned off total parenteral nutrition and relied on enteral nutrition and HCLF diet. These results suggest that providing patients with enteral nutrition and HCLF diet, glutamine, and recombinant human growth hormone may allow weaning off parenteral nutrition in a significant number of patients.

Get full access to this article

View all access options for this article.

References

Nightingale J. The short bowel. In: Nightingale J, ed.Intestinal Failure. London: Greenwich Medical Media Limited;2001 : 179.

Pennington CR. Parenteral nutrition. In: Nightingale J, ed.Intestinal Failure. London: Greenwich Medical Media Limited;2001 : 497–511.

Byrne TA, Morrissey TB, Nattakom TV, Ziegler TR, Wilmore DW. Growth hormone, glutamine, and a modified diet enhance nutrient absorption in patients with severe short bowel syndrome. JPEN J Parenter Enteral Nutr. 1995;19:296– 302.

Scolapio JS, Camilleri M, Fleming CR, et al. Effect of growth hormone, glutamine, and diet on adaptation in short-bowel syndrome: a randomized, controlled study. Gastroenterology. 1997 ; 113:1074– 1081.

Scolapio JS. Effect of growth hormone, glutamine, and diet on body composition in short bowel syndrome: a randomized, controlled study.JPEN J Parenter Enteral Nutr. 1999 ;23:309– 313.

Zhu W, Li N, Ren J, Gu J, Jiang J, Li J. Rehabilitation therapy for short bowel syndrome. Chin Med J. 2002 ;115:776– 778.

Kjeldahl J. Neue Method Zur Bestimmung der stickstoffs in Organischen Korpern. Z Anal Chem. 1883 ;22:366– 369.

Zhou X, Li YX, Li N, Li JS. Glutamine enhances the gut-trophic effect of growth hormone in rat after massive small bowel resection. J Surg Res. 2001;99:47– 52.

Seguy D, Vahedi K, Kapel N, Souberbielle JC, Messing B. Low-dose growth hormone in adult home parenteral nutrition-dependent short bowel syndrome patients: a positive study. Gastroenterology. 2003 ;124:293– 302.

10.

Ellegard L, Bosaeus I, Nordgren S, Bengtsson BA. Low-dose recombinant human growth hormone increases body weight and lean body mass in patients with short bowel syndrome. Ann Surg. 1997 ;225:88– 96.

11.

Byrne TA, Cox S, Karimbakas M, et al. Bowel rehabilitation: an alternative to long-term parenteral nutrition and intestinal transplantation for some patients with short bowel syndrome. Transplant Proc. 2002 ;34:887– 890.

12.

Wilmore DW, Byrne TA, Persinger RL. Short bowel syndrome: new therapeutic approaches. Curr Prob Surg. 1997 ;34:389– 444.

Effect of Recombinant Human Growth Hormone and Enteral Nutrition on Short Bowel Syndrome

Abstract

Get full access to this article

References