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Background: Positive effects of high dose growth hormone and glutamine (GH + GLN) on body composition in short bowel patients have been described. Lack of effects on intestinal absorption found in some studies has been ascribed to concomitant essential fatty acid (EFA) deficiency. This study describes changes in body weight (BW) and composition, 24-h urine creatinine excretion, intestinal fatty acid absorption (total, saturated, unsaturated and EFA), and EFA status in relation to treatment with GH + GLN in 8 short bowel patients. Methods: A double-blind, crossover study between placebo and growth hormone (mean, 0.12 mg/kg/day) plus oral (mean, 28 g/day) and parenteral glutamine (mean, 5.2 g/day) for 28 days. Body composition was measured by dual-energy absorptiometry (DEXA) scans. Intestinal fatty acid absorption was evaluated in balance studies, and EFAs were measured in plasma phospholipids by gas liquid chromatography. Results: Active treatment did not increase BW, lean body mass (LBM), fat mass (FM) and bone mass significantly compared with placebo treatment, but BW increased 1.03 kg (1.7%, P < 0.05), LBM 2.93 kg (8.7%, P < 0.001) and FM decreased 2.41 kg (10.6%, P < 0.001) in comparison with baseline. Twenty-four-hour urine creatinine excretion did not differ between study periods. No changes in intestinal absorption of fatty acids were seen, and no changes in EFAs measured in plasma phospholipids were observed. Only 1 of 8 patients, who did not receive parenteral lipids, had a Holman index above 0.2, indicative of EFA deficiency. All developed peripheral oedema. Conclusions: Combined high dose growth hormone and glutamine administered for 4 weeks, did not improve absorption of fatty acids or EFA status in short bowel patients. No changes in BW or composition were seen when comparing treatment to placebo periods. The increase in LBM measured by DEXA scan, comparing treatment and baseline periods, was not accompanied by an increase in the 24-h urinary creatinine excretion and is suspected to be associated with an accumulation in extracellular fluids. [ABSTRACT FROM AUTHOR]

Background: Current knowledge on the colonorectal absorption of medium-chain fatty acids is limited. The purpose of the present study was to evaluate and compare the human rectal absorption of short- and medium-chain C[sub 2]-C[sub 10] fatty acids in healthy volunteers. Methods: Dialysis bags containing 20 mmol·l[sup -1] of the fatty acids acetate, butyrate, hexanoate, octanoate, or decanoate in a phosphate-buffered (pH neutral) isoosmotic electrolyte solution were placed in the rectum for 30 min in 14 healthy volunteers. Absorption rates were calculated for all fatty acids, sodium, potassium, and water. Results: Absorption rates of the fatty acids acetate, butyrate, hexanoate, octanoate or decanoate were the same (1.9 ± 0.1 = 2.5 ± 0.2 = 1.7 ± 0.2 = 1.9 ± 0.2 = 2.2 ± 0.1 μmol·cm[sup -2]·h[sup -1] (mean ± standard error of the mean), respectively; P = 0.24). Conclusions: Medium-chain fatty acids were absorbed in the human rectum at a rate similar to that for short-chain fatty acids. If results can be applied to the human colon, colonic absorption of medium-chain fatty acids could possibly become an important secondary site of absorption in abnormal intestinal conditions such as massive small-intestinal resection or malabsorption syndromes. [ABSTRACT FROM AUTHOR]

Background: Fat malabsorption in the short-bowel syndrome (SBS) may in part be caused by decreased bile secretion. Cholylsarcosine is a synthetic conjugated bile acid resistant to bacterial degradation with no cathartic activity., Methods: Metabolic balance studies were performed in four patients with SBS, two with a colon and two with a jejunostomy., Results: Treatment with cholylsarcosine, 6 and 12 g/day, increased fat absorption by 17 +/- 3 g/day (0.7 MJ/day; P <0.05) and 20+/-1 g/day (0.8 MJ/day; P <0.001; mean +/- standard error), respectively, to a total absorption of energy from fat of 2.0-2.2 MJ/day. Total absorption of energy increased from 11.0 MJ/day to 11.7 MJ/day (bomb calorimetry). Energy absorbed from carbohydrates (6.5 MJ/day) did not change. Faecal output increased in one of the patients with a colon and was unchanged in the other three patients. A higher percentage of the medium-chain and the unsaturated fatty acids were absorbed in comparison with the long-chain and the saturated fatty acids (100% of C8:0, 92% of C10:0, 74% of C12:0, 52% of C14:0, 30% of C16:0, 16% of C18:0, and 47% of unsaturated C18 fatty acids). Treatment with cholylsarcosine increased absorption of C14:0 by 23%-29%, of C16:0 by 59%-74%, of C18:0 by 125%-138%, and of unsaturated C18-fatty acids by 36%-45%. A fifth patient (without a colon) was enrolled in the study but had to be excluded because cholylsarcosine, 6 g/day, resulted in nausea and anorexia., Conclusion: Cholylsarcosine increased fat absorption in SBS. The effect was relatively more pronounced on absorption of the low-absorbable, longer-chained, and saturated fatty acids. The overall gain in absorption of energy was small (6%) because energy absorption from carbohydrates was threefold higher than that from fat. Cholylsarcosine may have cathartic effects on some SBS patients with a colon. The maximal efficacy of cholylsarcosine was reached at a dose of 6 g/day, compared with 12 g/day in three of four patients.

Background: Colonic digestion has been reported to salvage up to 3-4 MJ/day in short-bowel patients (approximately 50% of the daily requirements)., Methods: A cross-sectional study of the parenteral support given to a total cohort of 73 patients receiving home parenteral nutrition (HPN) in Denmark on 31 December 1995 was performed to evaluate the significance of a preserved colon for the prevalence of short-bowel patients in need of HPN and the requirements of energy given as HPN. The number of HPN patients with a substantial remnant colon (> or =50%) was compared with the number with no colonic function (0%) in subgroups of patients with remnant small bowels of <100 cm (group 1), 100-200 cm (group 2), and >200 cm (group 3). Patients with pseudo-obstruction (n = 8) and patients with <50% colon remaining (n = 11) were excluded from the analysis. The impact of a substantial preserved colonic function (> or =50%) on the parenteral energy requirements was evaluated in patients with comparable lengths of small bowel., Results: Twelve and 8 patients in group 1 had no colon and > or =50% colon in function, respectively, in contrast to patients in group 2, in which 21 had no colon in function and only 2 had >50% in function (Fisher's exact test, P = 0.028). In patients in group 1 the need for parenteral energy in percentage of basal energy expenditure (HPN/BEE%, mean +/- standard deviation) was 110 +/- 31% in patients with no colon and 59 +/- 31% in patients with a preserved colon (P = 0.001). In patients without a colon in groups 2 and 3 the HPN/BEE% was 58 +/- 45% and 33 +/- 47%, respectively., Conclusions: Preservation of a substantial colonic function (> or =50%) is rare in patients in need of HPN with >100 cm remnant small bowel and results in a reduction in the parenteral energy requirements of approximately 3 MJ/day (51% of BEE) in patients with <100 cm small bowel. These data reinforce the reports of the colon as an energy-salvaging organ (approximately 3-4 MJ/day), which makes HPN unnecessary in most patients in whom small-bowel length is sufficient (>100 cm) to absorb another 3-4 MJ/day.

Background: Small-bowel transplantation is an alternative to home parenteral nutrition (HPN) in patients with gut failure. Our aim was to report the indication, diagnosis, morbidity, mortality, and intestinal adaptation in the total cohort of Danish patients receiving HPN at any time during the 5 years between 1 January 1991 and 31 December 1995. The data were analysed against the option of transplantation., Results: HPN was given to 129 patients; 59 (46%) had inflammatory bowel disease (15% died), 26 (20%) had cured cancers (42% died), and 44 (34%) had other diseases (dysmotility, surgical complications, infarcts, and so forth; 27% died). Of these, 60% were new in the HPN program, but only 19% received HPN all 5 years; 31 % had terminated HPN, 19% permanently, and 25% died. Only four deaths were HPN-related. In December 1995, 73 patients were receiving HPN in Denmark, for a prevalence of 13.9 per million, which is the highest in Europe but 10-fold lower than in the United States., Conclusions: Gut failure was the only indication for HPN in Denmark. Weight loss without gut failure, such as disseminated cancer and acquired immunodeficiency syndrome, was not an indication for HPN. Survival after small-bowel transplantation should be assessed against a sizeable mortality among candidates receiving HPN, and this depends on diagnosis and age. In an HPN population comparable with the Danish, a quarter is likely to die within a period of 5 years, a quarter will terminate HPN, and the others survive with HPN. Small-bowel transplantation can be a lifesaving procedure in the small fraction of foreseeable HPN-related deaths, mainly caused by liver failure. Transplantation will not improve survival in most adult HPN patients, and only an improved quality of life after transplantation justifies this procedure in most HPN patients.