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Evidence summaries

Human Growth Hormone and Glutamine for Short Bowel Syndrome

Human growth hormone used with or without glutamine may provide a short term positive effect on weight gain and energy absorption in patients with short bowel syndrome, but the benefits seem not to continue after treatment is stopped. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 5 studies with a total of 79 subjects; 4 cross-over studies and 1 parallel study. Data were pooled from 3 studies (30 patients) for the purpose of meta-analysis. Human growth hormone (HGH) with or without glutamine increased weight (MD 1.66 kg, 95% CI 0.69 to 2.63), lean body mass (MD 1.93 kg, 95% CI 0.97 to 2.90), energy absorption (MD 4.42 kcal, 95% CI 0.26 to 8.58; statistical heterogeneity I2 =60%), and nitrogen absorption (MD 4.85 g, 95% CI 0.20 to 9.49; I2 =51%) 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. Common side effects of treatment included peripheral edema (in 77% of the patients), usually in the lower limbs, and carpal tunnel syndrome (in 32% of the patients).

Comment: The quality of evidence is downgraded by indirectness (lack of long-term studies), and by imprecise results (limited study size for each comparison).

    References

    • Wales PW, Nasr A, de Silva N, Yamada J. Human growth hormone and glutamine for patients with short bowel syndrome. Cochrane Database Syst Rev 2010;(6):CD006321. [PubMed]

Primary/Secondary Keywords