Rehabilitative therapy of short bowel syndrome: experimental study and clinical trial.
OBJECTIVE
To investigate the effect of growth hormone on proliferative activity of the residual small intestinal mucosa after massive small intestinal resection and to evaluate the clinical efficacy of bowel rehabilitative therapy for short bowel syndrome.


METHODS
Small intestinal mucosa proliferative activity were compared in rats from control group (sham operation), short bowel group (80% small bowel resection) and growth hormone treatment group (80% small bowel resection + growth hormone 1 U x kg(-1) x d(-1) for 28 days) with the aid of histology image analysis, flow cytometric assay, immunohistochemistry analysis and RT-PCR assay. The nutritional status, D-xylose absorption and stool nitrogen output were observed in 9 consecutive parenteral nutrition dependent patients with short bowel syndrome after intestinal rehabilitative therapy (growth hormone 8 - 12 U x kg(-1) x d(-1) im + glutamine 0.6 g x kg(-1) x d(-1) iv + special diet) for 21 continuous days.


RESULTS
Growth hormone administration significantly increased rat small intestinal mucosal villous height, mucosal thickness, proliferative index, and the expression of proliferating cell nuclear antigen and c-jun mRNA. Rehabilitative therapy increased the body weight, serum total protein and album in concentrations in patients. Their D-xylose absorption indices increased and fecal nitrogen losses decreased. Follow-up data showed that 6 of the 9 patients sustained on enteral nutrition.


CONCLUSIONS
Growth hormone enhances the proliferative activity of the mucosal epithelium and bowel rehabilitative therapy may benefit the patients with short bowel syndrome.
Li
N
N
Institute of General Surgery, Nanjing General Hospital of People's Liberation Army, China.
Zhu
W
W
Guo
F
F
Ren
J
J
Li
Y
Y
Wang
X
X
Li
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002455:Cell Division / Q000187:drug effects; D002648:Child; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D005973:Glutamine / Q000627:therapeutic use*; D013006:Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007273:Injections, Intramuscular; D007413:Intestinal Mucosa / Q000166:cytology / Q000187:drug effects*; D007421:Intestine, Small; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D051381:Rats; D017207:Rats, Sprague-Dawley; D012778:Short Bowel Syndrome / Q000188:drug therapy / Q000534:rehabilitation*; D016896:Treatment Outcome
D005973:Glutamine; D013006:Growth Hormone