Gastroenterology

Gastroenterology

Volume 120, Issue 4, March 2001, Pages 806-815
Gastroenterology

Alimentary Tract
Glucagon-like peptide 2 improves nutrient absorption and nutritional status in short-bowel patients with no colon,☆☆

https://doi.org/10.1053/gast.2001.22555Get rights and content

Abstract

Background & Aims: Glucagon-like peptide 2 (GLP-2) is intestinotrophic, antisecretory, and transit-modulating in rodents, and it is mainly secreted from the intestinal mucosa of the terminal ileum and colon after food ingestion. We assessed the effect of GLP-2 on the gastrointestinal function in patients without a terminal ileum and colon who have functional short-bowel syndrome with severe malabsorption of wet weight (>1.5 kg/day) and energy (>2.3 MJ/day) and no postprandial secretion of GLP-2. Methods: Balance studies were performed before and after treatment with GLP-2, 400 μg subcutaneously twice a day for 35 days, in 8 patients (4–17 years from last bowel resection; 6 with Crohn's disease). Four patients received home parenteral nutrition (mean residual jejunum, 83 cm), and 4 did not (mean ileum resection, 106 cm). Biopsy specimens were taken from jejunal/ileal stomas, transit was measured by scintigraphy, and body composition was measured by dual-energy x-ray absorptiometry. Results: Treatment with GLP-2 improved the intestinal absorption of energy 3.5% ± 4.0% (mean ± SD) from 49.9% to 53.4% (P = 0.04), wet weight 11% ± 12% from 25% to 36% (P = 0.04), and nitrogen 4.7% ± 5.4% from 47.4% to 52.1% (P = 0.04). Body weight increased 1.2 ± 1.0 kg (P = 0.01), lean body mass increased 2.9 ± 1.9 kg (P = 0.004), fat mass decreased 1.8 ± 1.3 kg (P = 0.007), and 24-hour urine creatinine excretion increased (P = 0.02). The time to 50% gastric emptying of solids increased 30 ± 16 minutes from 89 to 119 minutes (P < 0.05). Small bowel transit time was not changed. Crypt depth and villus height were increased in 5 and 6 patients, respectively. Conclusions: Treatment with GLP-2 improves intestinal absorption and nutritional status in short-bowel patients with impaired postprandial GLP-2 secretion in whom the terminal ileum and the colon have been resected.

GASTROENTEROLOGY 2001;120:806-815

Section snippets

Patients

Eight patients (5 women and 3 men; mean age 49.2 years; range, 32–62 years) participated in the study. Four patients with intestinal failure had been receiving home parenteral nutrition (HPN) for 8.0 years (range, 4–14 years), had an end-jejunostomy, and had residual jejunum measured intraoperatively from the ligament of Treitz of 30, 40, 90, and 170 cm. The other 4 patients were not receiving HPN, had no colon in continuation, and had 65, 85, 103, and 170 cm of the terminal ileum resected.

Intestinal absorption

The absolute amounts of diet intake, stomal output (i.e., what was malabsorbed) and the calculated amount absorbed (diet minus output) of energy (MJ/day), macronutrients (MJ/day), wet weight (kg/day), and electrolytes (mmol/day) before and after treatment with GLP-2 are shown in Table 1.The relative absorption of these parameters is shown in Figures 1 and 2.

. Relative absorption of energy and macronutrients before and after 5 weeks of GLP-2 treatment in 8 patients with the short-bowel syndrome.

Discussion

Patients with intestinal failure frequently require life-long parenteral nutrition. Although providing good nutritional recovery, the complex technology of HPN reduces the quality of life,26 and serious side effects, such as sepsis, venous thrombosis, and liver disease may occur.27, 28, 29, 30 Small bowel transplantation is an exciting alternative, but many still consider it experimental for most short-bowel patients until it has proven superior to parenteral nutrition in terms of quality of

Acknowledgements

The authors thank Jette Christiansen, Dorte Christensen, Bodil Petersen, Hardi Hansen, and Jan Borg Rasmussen for technical assistance.

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    Supported financially by the European Society of Parenteral and Enteral Nutrition Scientific Committee, the Danish Colitis-Crohn Association, Mimi & Victor Larsens Foundation, Løvens Research Foundation, Dr. Sofus Carl Emil Friis & Hustru Olga Doris Friis Foundation, and the Ferring A/S Gastro Prize 2000.

    ☆☆

    Address requests for reprints to: Palle Bekker Jeppesen, MD., Ph.D., Department of Medicine CA-2121, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. e-mail: [email protected]; fax: (45) 35452913.

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