Human growth hormone and glutamine for patients with short bowel syndrome.
BACKGROUND
There has been clinical enthusiasm for treating short bowel patients with human recombinant growth hormone and/or glutamine in hopes of reducing parenteral nutrition dependency. It has been more than a decade since Byrne and colleagues reported enhanced absorption of nutrients, improved weight gain, and reduction in parenteral nutrition requirements with the administration of a combination of human growth hormone (HGH) and glutamine in patients with short bowel syndrome. Other studies have reported inconsistent results.


OBJECTIVE
The purpose of this systematic review was to evaluate the efficacy of growth hormone with or without glutamine supplementation for adult patients with short bowel syndrome.


METHODS
Electronic searches were performed to identify all publications describing randomised controlled trials of the use of human growth hormone with or without glutamine for the treatment of patients with short bowel syndrome.


METHODS
Randomised controlled trials of human growth hormone with or without glutamine for patients with short bowel syndrome were considered for inclusion.


METHODS
Two authors independently extracted data from the published studies. The statistical analyses were performed using RevMan 5 software. Follmann's method was used for cross-over studies.


RESULTS
Five studies were included in the review. Human growth hormone with or without glutamine appears to provide benefit in terms of increased weight (MD 1.66 Kg; 95% CI 0.69 to 2.63;P = 0.0008), lean body mass (MD 1.93 Kg; 95% CI 0.97 to 2.90; P = 0.0001) energy absorption (MD 4.42 Kcal; 95% CI 0.26 to 8.58; P = 0.04) and nitrogen absorption (MD 44.85 g; 95%CI 0.20 to 9.49; P = 0.04) for patients with short bowel syndrome. The single RCT that focused on parenteral nutrition (PN) requirements demonstrated decreased PN volume and calories and number of infusions in patients who received HGH with or without glutamine supplementation. Only patients who received HGH with glutamine maintained statistically significant PN reductions at 3 month follow-up.


CONCLUSIONS
The results suggest a positive effect of human growth hormone on weight gain and energy absorption. However, in the majority of trials, the effects are short-lived returning to baseline shortly after cessation of therapy. The temporary benefit calls into question the clinical utility of this treatment. To date, the evidence is inconclusive to recommend this therapy. Consideration should be made to studying patients during the active phase of intestinal adaptation rather than in the setting of chronic intestinal failure. The role of HGH in paediatric short bowel syndrome remains unknown.
Wales
Paul W
PW
Division of General Surgery and Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Rm 1526, 555 University Ave, Toronto, Ontario, Canada, M5G 1X8.
Nasr
Ahmed
A
de Silva
Nicole
N
Yamada
Janet
J
D000328:Adult; D002648:Child; D005973:Glutamine / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007408:Intestinal Absorption; D009751:Nutritional Requirements; D010288:Parenteral Nutrition / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D012778:Short Bowel Syndrome / Q000188:drug therapy*; D015430:Weight Gain
D011994:Recombinant Proteins; D005973:Glutamine; D019382:Human Growth Hormone