title: Effect of oral glutamine supplementation on gut permeability and endotoxemia in patients with severe acute pancreatitis: a randomized controlled trial.
abstract: OBJECTIVE
  The aim of this study is to evaluate the effect of oral glutamine (GL) supplementation on gut permeability and endotoxemia (surrogate end point) in patients with severe acute pancreatitis.
  
  
  METHODS
  In a randomized controlled trial, patients were randomized to be given placebo or GL for 7 days. The primary outcome measures include the effect on gut permeability (assessed by lactulose/mannitol excretion in urine and endotoxemia assessed by endotoxin core antibodies type IgG and IgM (EndoCab IgG and IgM). The secondary outcome measures include infectious complications, mortality, total hospital/intensive care unit stay, C-reactive protein, and prealbumin levels.
  
  
  RESULTS
  Patients were assigned to GL (n = 41) and placebo (n = 39) groups. There was no change in gut permeability after the intervention. However, the EndoCab IgM levels increased significantly (33 [4, 175] to 40 [8, 350] GMU/mL; P = 0.0164) and the C-reactive protein levels decreased significantly (133 [1, 287] to 88 [1, 267] ng/mL; P = 0.0236) in the GL group. No difference was observed in infectious complication, prealbumin value, hospital/intensive care unit stay, and mortality in both groups.
  
  
  CONCLUSIONS
  No significant trend was identified for an effect of GL on gut permeability. Decreased inflammation and endotoxemia did not translate into reduced infectious complications in severe acute pancreatitis. However, the study was underpowered to detect the aforementioned difference (trial registration: CTRI/2009/000945).
authors.affiliation: From the Departments of *Gastroenterology and Human Nutrition, and †Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Namrata
authors.initials: N
authors.lastname: Singh
authors.forename: Sushil Kumar
authors.initials: SK
authors.lastname: Mishra
authors.forename: Vikas
authors.initials: V
authors.lastname: Sachdev
authors.forename: Hanish
authors.initials: H
authors.lastname: Sharma
authors.forename: Ashish Datt
authors.initials: AD
authors.lastname: Upadhyay
authors.forename: Indu
authors.initials: I
authors.lastname: Arora
authors.forename: Anoop
authors.initials: A
authors.lastname: Saraya
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D019587:Dietary Supplements; D019446:Endotoxemia / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D041981:Gastrointestinal Tract / Q000187:drug effects* / Q000382:microbiology / Q000502:physiology; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000382:microbiology / Q000503:physiopathology / Q000517:prevention & control*; D010539:Permeability / Q000187:drug effects; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M; D005973:Glutamine; D002097:C-Reactive Protein