Effect of recombinant human growth hormone and enteral nutrition on short bowel syndrome.

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 howel rehabilitation therapy allows weaning from TPN in a sign;ficant number of patients.