Short bowel syndrome is a malabsorption disorder caused by the surgical removal of the small intestine, or by the complete dysfunction of a large segment of bowel. It is a challenging health problem to treat. Several small studies have assessed the benefit of providing drugs such as human growth hormone and glutamine in an attempt to improve intestinal function and wean intravenous nutrition (liquid food). The results of this review of 5 small studies suggest that human growth hormone used with or without glutamine may provide short term benefit for patients with short bowel syndrome in terms of weight gain and intestinal absorption of nutrients. However the benefits of treatment do not continue after treatment is stopped. Common side effects of treatment include peripheral edema (swelling of tissues, usually in the lower limbs), and carpal tunnel syndrome (numbness and muscle weakness in the hand). Conclusive evidence is not available to recommend this treatment. Further studies that evaluate human growth hormone treatment during the immediate phase of bowel adaptation are needed.
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.
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.
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.
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.
Randomised controlled trials of human growth hormone with or without glutamine for patients with short bowel syndrome were considered for inclusion.
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.
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.