| A new treatment for patients with short-bowel syndrome. Growth hormone, glutamine, and a modified diet. | |
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MedLine Citation:
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PMID: 7677455 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The purpose of this study was to initially determine if growth hormone or nutrients, given alone or together, could enhance absorption from the remnant small bowel after massive intestinal resection. If clinical improvement were observed, this therapy would then be used to treat patients with the short-bowel syndrome over the long term. SUMMARY BACKGROUND DATA: Patients who undergo extensive resection of the gastrointestinal tract frequently develop malabsorption and require long-term parenteral nutrition. The authors hypothesized that the administration of growth factors and/or nutrients could enhance further compensation of the remnant intestine and thereby improve absorption. Specifically, animal studies have shown that there is enhanced cellularity with the administration of growth hormone (GH) or glutamine (GLN), or a fiber-containing diet. METHODS: Initially, 17 studies were performed in 15 total parenteral nutrition (TPN)-dependent short-bowel patients over 3 to 4 weeks in the clinical research center; the first week served as a control period, and during the next 1 to 3 weeks, the specific treatment was administered and evaluated. Throughout the study, food of known composition was provided and all stool was collected and analyzed to determine absorption across the remaining bowel. The effect of a high-carbohydrate, low-fat diet (DIET), the amino acid glutamine (GLN) and growth hormone (GH) administered alone or in combination with the other therapies (GH + GLN + DIET) was evaluated. The treatment was expanded to 47 adults (25 men, 22 women) with the short-bowel syndrome, dependent on TPN for 6 +/- 1 years. The average age was 46 +/- 2 years, and the average jejunal-ileal length was 50 +/- 7 cm (median 35 cm) in those with all or a portion of colon and 102 +/- 24 cm (median 102 cm) in those with no colon. After 28 days of therapy, the patients were discharged on only GLN + DIET. RESULTS: The initial balance studies indicated improvement in absorption of protein by 39% accompanied by a 33% decrease in stool output with the GH + GLN + DIET. In the long-term study, 40% of the group remain off TPN and an additional 40% have reduced their TPN requirements, with follow-up averaging a year and the longest being over 5 years. CONCLUSION: GH + GLN + DIET offers a potential method for providing cost-effective rehabilitation of surgical patients who have the short-bowel syndrome or other complex problems of the gastrointestinal tract. This therapeutic combination also may be useful to enhance bowel function in patients with other gastrointestinal diseases and those requiring extensive intestinal operations, including transplantation. |
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Authors:
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T A Byrne; R L Persinger; L S Young; T R Ziegler; D W Wilmore |
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Publication Detail:
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Type: Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Annals of surgery Volume: 222 ISSN: 0003-4932 ISO Abbreviation: Ann. Surg. Publication Date: 1995 Sep |
Date Detail:
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Created Date: 1995-10-13 Completed Date: 1995-10-13 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 0372354 Medline TA: Ann Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 243-54; discussion 254-5 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Diet Female Glutamine / therapeutic use* Growth Hormone / therapeutic use* Humans Intestinal Absorption Male Middle Aged Short Bowel Syndrome / physiopathology, therapy* Time Factors |
| Grant Support | |
ID/Acronym/Agency:
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5P50-36428//PHS HHS; M01 RR02635/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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56-85-9/Glutamine; 9002-72-6/Growth Hormone |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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