The management of patients with the short bowel syndrome

Table 4 The effect of glutamine, growth hormone, and a modified diet on patients with short-bowel syndrome

Authors	Design of Study	Treatment	Number and Type of Patients	Average Length of Remnant Bowel 43	Results
Byrne et al[65].	Uncontrolled study.	GH 0.11 mg·kg-1·d-1, glutamine	47 patients that were	patients with a	At the end of the study 57% of the
	Patients admitted to	0.16 g·kg-1·d-1ªª by the parenteral	chronically dependent	colonic remnant	patients no longer needed TPN, 30%
	hospital and treated for	route with up to 30 g·d-1 by the	on parenteral nutrition	had(50 ± 7)cm[4].	had reduced TPN requirements, and
	21 d.	enteral route, and a diet containing		patients with	6% required approximately the same
		60% of total calories as		no colon had	amount of TPN as they did at the start
		carbohydrate, 20% as fat and 20%		(102 ± 24)cm.	of the study.
		from protein.			One year later 40% of the patients no
					longer needed TPN, 40% had reduced
					TPN requirements, and 20% required
					approximately the same amount of TPN
					as they did at the start of the study
Scolapio[66]	Double-blind, placebo	GH 0.14 mg·kg-1·d-1, glutamine	8 patients that were	71 cm2 patients	Treatment led to a significant increase
Scolapio et al[67].	controlled, randomized	0.63 g·kg-1·d-1 by oral route, and a	dependent on parenteral	had colonic	in bodyweight and lean body mass, a
	crossover study. Patients	diet containing 60% total calories	nutrition for an average	continuity.	significant decrease in percent body fat
	were treated for 21 d as	as carbohydrate, 20% as fat and	of 12.9 years.		and induced peripheral edema.
	out-patients.	20% as protein.			All parameters returned to baseline
					levels within 14 d of stopping treatment.
					Treatment had no significant effect on
					intestinal villus height or crypt depth.
Szkudlarek et al[68].	Double-blind, placebo	GH 0.14 mg·kg-1·d-1, glutamine	8 patients that were	104 cm.4 patients	No significant effect of treat ment on
	controlled, randomized	30 g·d-1 by oral route and	dependent on parenteral	had colonic	absorption of energy, carbohydrate,
	crossover study. Patients	glutamine-enriched parenteral	nutrition for an average	continuity.	nitrogen, wet weight, sodium, potassium,
	were treated for 28 d as	nutrition (17% of nitrogen	of 7 years .		calcium or magnesium. Treatment induced
	out-patients.	as glutamine).			adverse effects.