Glutamine and whey protein improve intestinal permeability and morphology in patients with Crohn's disease: a randomized controlled trial.
BACKGROUND
Increased intestinal permeability (IP) has been implicated in the etiopathogenesis, disease activity and relapse of Crohn's disease (CD). Glutamine, the major fuel for the enterocytes, may improve IP.


OBJECTIVE
We evaluated the effect of oral glutamine on IP and intestinal morphology in patients with CD.


METHODS
In a randomized controlled trial, consecutive patients with CD in remission phase with an abnormal IP were randomized to a glutamine group (GG) or active control group (ACG) and were given oral glutamine or whey protein, respectively, as 0.5 g/kg ideal body weight/day for 2 months. IP was assessed by the lactulose mannitol excretion ratio (LMR) in urine, and morphometry was performed by computerized image analysis system.


RESULTS
Patients (age 34.5 ± 10.5 years; 20 males) were assigned to the GG (n = 15) or ACG (n = 15). Fourteen patients in each group completed the trial. The LMR [median (range)] in GG and ACG at 2 months was 0.029 (0.006-0.090) and 0.033 (0.009-0.077), respectively, with P = 0.6133. IP normalized in 8 (57.1%) patients in each group (P = 1.000). The villous crypt ratio (VCR) [mean (SD)] in GG and ACG at 2 months was 2.68 (1.02) and 2.49 (0.67), respectively, (P = 0.347). At the end of 2 months LMR improved significantly in GG from 0.071 (0.041-0.254) to 0.029 (0.006-0.090) (P = 0.0012) and in ACG from 0.067 (0.040-0.136) to 0.033 (0.009-0.077) (P = 0.0063). VCR improved in the GG from 2.33 (0.77) to 2.68 (1.02) (P = 0.001), and in ACG from 2.26 (0.57) to 2.49 (0.67) (P = 0.009).


CONCLUSIONS
Intestinal permeability and morphology improved significantly in both glutamine and ACG.
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. jayabenjamin2@rediffmail.com
Jaya
J
Benjamin
Govind
G
Makharia
Vineet
V
Ahuja
K D
KD
Anand Rajan
Mani
M
Kalaivani
Siddhartha Datta
SD
Gupta
Yogendra Kumar
YK
Joshi
D000284:Administration, Oral; D000328:Adult; D003424:Crohn Disease / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D004386:Duodenum / Q000473:pathology; D005260:Female; D005973:Glutamine / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism*; D007792:Lactulose; D008297:Male; D008353:Mannitol; D008894:Milk Proteins / Q000008:administration & dosage* / Q000009:adverse effects; D010539:Permeability; D000067816:Whey Proteins
D008894:Milk Proteins; D000067816:Whey Proteins; D005973:Glutamine; D008353:Mannitol; D007792:Lactulose