A pilot study of the use of epidermal growth factor in pediatric short bowel syndrome.
BACKGROUND
This study examined the effects of enterally administered epidermal growth factor (EGF) on nutrient absorption and tolerance of enteral feeds in pediatric patients with short bowel syndrome (SBS).


METHODS
Patients identified with severe SBS (<25% bowel length predicted for age) were prospectively enrolled in treatment using human recombinant EGF (1-53); 100 microg/kg per day given mixed with enteral feeds and patients were treated for 6 weeks. End points followed were patient weight, tolerance of enteral feeds, nutrient absorption, and intestinal permeability as determined using carbohydrate probes and hematologic values for liver function parameters.


RESULTS
Five patients were treated with EGF; all showed a significant improvement in carbohydrate absorption (3-0 methylglucose): absorption 24.7% +/- 9.7% pretreatment vs 34.1% +/- 13.8% posttreatment and improved tolerance of enteral feeds (enteral energy as % of total energy, 25% +/- 28% pretreatment vs 36% +/- 24% posttreatment; mean +/- SD; P < .05 by Wilcoxon's signed rank test). Epidermal growth factor treatment was not associated with significant changes in intestinal permeability, the rate of weight gain, or liver function tests. During the treatment phase, no patients developed episodes of sepsis; however, within 2 weeks of discontinuation of EGF treatment, 3 patients developed septic episodes. No adverse effects of EGF administration were noted.


CONCLUSIONS
These results suggest that enteral treatment with EGF in pediatric SBS improves nutrient absorption, increases tolerance with enteral feeds, and may improve the infection rate. Further studies exploring treatment strategies including the timing and duration of EGF administration are indicated.
Sigalet
David L
DL
GI Research Group, University of Calgary, Calgary, Alberta, Canada TZT SC7. sigalet@ucalgary.ca
Martin
Gary R
GR
Butzner
J Decker
JD
Buret
Andre
A
Meddings
Jonathan B
JB
D019325:3-O-Methylglucose / Q000493:pharmacokinetics; D002675:Child, Preschool; D004040:Dietary Carbohydrates / Q000493:pharmacokinetics; D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000601:surgery; D004815:Epidermal Growth Factor / Q000235:genetics / Q000627:therapeutic use*; D020139:Gastroschisis / Q000601:surgery; D006801:Humans; D007223:Infant; D007225:Infant Food; D007408:Intestinal Absorption / Q000187:drug effects; D045822:Intestinal Volvulus / Q000601:surgery; D007792:Lactulose / Q000493:pharmacokinetics; D008111:Liver Function Tests; D008297:Male; D008353:Mannitol / Q000493:pharmacokinetics; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology; D011994:Recombinant Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000453:epidemiology; D012778:Short Bowel Syndrome / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D015430:Weight Gain
D004040:Dietary Carbohydrates; D011994:Recombinant Proteins; D019325:3-O-Methylglucose; D008353:Mannitol; D007792:Lactulose; D004815:Epidermal Growth Factor