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Growth hormone, glutamine, and an optimal diet reduces parenteral nutrition in patients with short bowel syndrome: a prospective, randomized, placebo-controlled, double-blind clinical trial.
- Source :
-
Annals of surgery [Ann Surg] 2005 Nov; Vol. 242 (5), pp. 655-61. - Publication Year :
- 2005
-
Abstract
- Objective: To determine if growth hormone (GH) and glutamine (Gln) might allow for a reduction in parenteral nutrition (PN) in individuals with short bowel syndrome.<br />Background Data: Following massive intestinal resection, patients frequently sustain severe nutrient malabsorption and are dependent on PN for life. GH treatment with or without Gln might allow for a reduction in PN.<br />Methods: A prospective, double-blind, randomized, placebo-controlled clinical trial performed in 41 adults dependent on PN. Following screening, patients were admitted to an in-house facility for 6 weeks. After 2 weeks of stabilization and dietary optimization, patients were randomized to one of 3 treatment arms (1:2:2 ratio): oral Gln (30 g/day) + GH placebo (control group, n = 9), Gln placebo + GH (0.1 mg/kg per day, n = 16), or Gln + GH (n = 16). Standard criteria based on clinical and laboratory measurements were followed to determine PN volume and content. After 4 weeks of treatment, patients were discharged and monitored; GH and GH placebo were discontinued, but the diet with Gln or Gln placebo was continued for 3 months.<br />Results: Patients receiving GH + Gln placebo + diet showed greater reductions in PN volume (5.9 +/- 3.8 L/wk, mean +/- SD), PN calories (4338 +/- 1858 calories/wk), and PN infusions (3 +/- 2 infusions/wk) than corresponding reductions in the Gln + diet group (3.8 +/- 2.4 L/wk; 2633 +/- 1341 calories/wk; 2 +/- 1 infusions/wk, P < 0.05). Patients who received GH + Gln + diet showed the greatest reductions (7.7 +/- 3.2 L/wk; 5751 +/- 2082 calories/wk; 4 +/- 1 infusions/wk, P < 0.001 versus Gln + diet). At the 3-month follow-up, only patients who had received GH + Gln + diet maintained significant reductions in PN (P < 0.005) compared with the Gln + diet.<br />Conclusions: Treatment with GH + diet or GH + Gln + diet initially permitted significantly more weaning from PN than Gln + diet. Only subjects receiving GH + Gln + diet maintained this effect for at least 3 months.
- Subjects :
- Administration, Oral
Adult
Aged
Analysis of Variance
Combined Modality Therapy
Double-Blind Method
Drug Administration Schedule
Female
Follow-Up Studies
Humans
Injections, Subcutaneous
Male
Middle Aged
Nutritional Requirements
Nutritional Status
Probability
Prospective Studies
Risk Assessment
Severity of Illness Index
Short Bowel Syndrome diagnosis
Treatment Outcome
Diet
Glutamine administration & dosage
Human Growth Hormone administration & dosage
Parenteral Nutrition statistics & numerical data
Short Bowel Syndrome therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0003-4932
- Volume :
- 242
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Annals of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 16244538
- Full Text :
- https://doi.org/10.1097/01.sla.0000186479.53295.14