Glucagon-like peptide 2 improves nutrient absorption and nutritional status in short-bowel patients with no colon.
OBJECTIVE
Glucagon-like peptide 2 (GLP-2) is intestinotrophic, antisecretory, and transit-modulating in rodents, and it is mainly secreted from the intestinal mucosa of the terminal ileum and colon after food ingestion. We assessed the effect of GLP-2 on the gastrointestinal function in patients without a terminal ileum and colon who have functional short-bowel syndrome with severe malabsorption of wet weight (>1.5 kg/day) and energy (>2.3 MJ/day) and no postprandial secretion of GLP-2.


METHODS
Balance studies were performed before and after treatment with GLP-2, 400 microg subcutaneously twice a day for 35 days, in 8 patients (4-17 years from last bowel resection; 6 with Crohn's disease). Four patients received home parenteral nutrition (mean residual jejunum, 83 cm), and 4 did not (mean ileum resection, 106 cm). Biopsy specimens were taken from jejunal/ileal stomas, transit was measured by scintigraphy, and body composition was measured by dual-energy x-ray absorptiometry.


RESULTS
Treatment with GLP-2 improved the intestinal absorption of energy 3.5% +/- 4.0% (mean +/- SD) from 49.9% to 53.4% (P = 0.04), wet weight 11% +/- 12% from 25% to 36% (P = 0.04), and nitrogen 4.7% +/- 5.4% from 47.4% to 52.1% (P = 0.04). Body weight increased 1.2 +/- 1.0 kg (P = 0.01), lean body mass increased 2.9 +/- 1.9 kg (P = 0.004), fat mass decreased 1.8 +/- 1.3 kg (P = 0.007), and 24-hour urine creatinine excretion increased (P = 0.02). The time to 50% gastric emptying of solids increased 30 +/- 16 minutes from 89 to 119 minutes (P < 0.05). Small bowel transit time was not changed. Crypt depth and villus height were increased in 5 and 6 patients, respectively.


CONCLUSIONS
Treatment with GLP-2 improves intestinal absorption and nutritional status in short-bowel patients with impaired postprandial GLP-2 secretion in whom the terminal ileum and the colon have been resected.
Department of Medicine, Section of Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Denmark. Bekker@dadlnet.dk
P B
PB
Jeppesen
B
B
Hartmann
J
J
Thulesen
J
J
Graff
J
J
Lohmann
B S
BS
Hansen
F
F
Tofteng
S S
SS
Poulsen
J L
JL
Madsen
J J
JJ
Holst
P B
PB
Mortensen
D000328:Adult; D001823:Body Composition / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D003404:Creatinine / Q000652:urine; D005260:Female; D005768:Gastrointestinal Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D005772:Gastrointestinal Transit / Q000187:drug effects; D053767:Glucagon-Like Peptide 2; D004763:Glucagon-Like Peptides; D006728:Hormones / Q000097:blood; D006801:Humans; D007279:Injections, Subcutaneous; D007408:Intestinal Absorption / Q000187:drug effects*; D007422:Intestines / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000187:drug effects*; D010349:Patient Compliance; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use*; D012778:Short Bowel Syndrome / Q000188:drug therapy* / Q000473:pathology
D005768:Gastrointestinal Hormones; D053767:Glucagon-Like Peptide 2; D006728:Hormones; D010455:Peptides; D004763:Glucagon-Like Peptides; D003404:Creatinine