The effectiveness of growth hormone, glutamine and a low-fat diet containing high-carbohydrate on the enhancement of the function of remnant intestine among patients with short bowel syndrome: a review of published trials.

Many patients who undergo extensive resection of the gastrointestinal tract develop malabsorption which, in the worst cases, requires long-term parenteral nutrition at home, frequently on a permanent basis. Such patients can be defined as having intestinal failure resulting from the short bowel syndrome. In 1995, Wilmore's group hypothesized that the administration of growth factors and nutrients could enhance further adaptation of the remnant intestine and thereby improve absorption. The demonstrated, through controlled clinical trials, the benefit of such treatment among 47 adults with less than 200 cm of small intestine. Over the past few years, similar trials as well as animal experiments have been conducted by the same authors and other groups with conflicting results. We have performed a systematic search on the electronic databases for the purpose of identifying the evidence published so far on this subject. Our analysis suggests that the benefit of administering recombinant human growth hormone alone, or together with glutamine with or without a low-fat diet containing high-carbohydrate (fibre) is, if any, marginal.