The use of hormonal growth factors in the treatment of patients with short-bowel syndrome.
To date, the hormonal factors used in the treatment of patients with short-bowel syndrome have been growth hormone and glucagon-like peptide (GLP)-2. In high-dose growth hormone studies, the effects on wet-weight absorption of approximately 0.7 kg/day have mainly been described in short-bowel syndrome patients with a preserved colon who also received oral rehydration solutions. Treatment with high doses of growth hormone is associated with severe adverse effects in the majority of patients. Low-dose growth hormone increased energy absorption by approximately 1.8 MJ/day in a group of 12 short-bowel syndrome patients (9 with a preserved colon), but it did not affect wet-weight absorption. Growth hormone does not seem to affect either wet-weight or energy absorption in patients with a jejunostomy. GLP-2 and the analogue teduglutide mainly affect wet-weight absorption, resulting in a mean increase in wet-weight absorption of 0.4-0.7 kg/day. The effects on energy absorption are minor at 0.4-0.8 MJ/day. However, these effects are seen in all short-bowel syndrome patients, regardless of anatomy, and the adverse effects are minor. In all studies employing growth hormone or GLP-2, the effects are transient, disappearing when treatments are discontinued. With the need for long-term treatment, adverse effects and safety issues become important. Therefore, it is recommended that treatment is initiated in research settings only and that close monitoring of the long-term effects is a part of the protocol.
Jeppesen
Palle B
PB
Department of Medical Gastroenterology Section, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark. palle.bekker.jeppesen@rh.hosp.dk
D001823:Body Composition / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D003404:Creatinine / Q000652:urine; D016903:Drug Monitoring; D002149:Energy Intake; D053767:Glucagon-Like Peptide 2; D004763:Glucagon-Like Peptides / Q000009:adverse effects / Q000627:therapeutic use*; D005973:Glutamine / Q000627:therapeutic use; D013006:Growth Hormone / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006965:Hyperplasia; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000187:drug effects / Q000473:pathology; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012778:Short Bowel Syndrome / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D013997:Time Factors
D053767:Glucagon-Like Peptide 2; D010455:Peptides; D005973:Glutamine; D004763:Glucagon-Like Peptides; C494910:teduglutide; D013006:Growth Hormone; D003404:Creatinine