Effects of Glutamine, Growth Hormone and Modified Diet in Short Bowel Syndrome: A Systematic Review

Abstract

Rehabilitation therapy for short bowel syndrome (SBS) may improve patients' nutritional status and promote intestinal adaptation. In this systematic review, we assessed the efficacy of growth hormone (GH) and glutamine (GLN) with a modified diet (high-carbohydrate-lowfat, HCLF) in patients with SBS. Electronic searches were performed to identify all publications describing clinical trials on the use of GH, GLN and diet for the treatment of patients with SBS, from the following databases: PubMed, Embase and Cochrane until December 2018, without any time and design restriction. Also, a manual search was performed to find extra relevant articles. Our research included sixteen trials involving 323 patients. These trials evaluated improvement of SBS through intervention by using GH, GLN and modified diet with different outcomes such as body weight (BW), lean body mass (LBM), fat mass, stool output, absorption of carbohydrates, fat, energy, nitrogen, and D-xylose and off total parenteral nutrition (TPN). It was shown that in all studies that were performed with a combination of GH, GLN and HCLF diet, there was a positive treatment effect on body weight, lean body mass, stool output, absorption of carbohydrates, nitrogen, and D-xylose and off TPN, but there were no improvements in absorption of fat, and energy and fat mass. Based on this s review, treatment with a combination of GH, GLN and modified diet can be more effective in improvement of adaptation of the small intestine than when they are used alone. Finally, further trials suggested the combination of these three factors.