Effects of bowel rehabilitation and combined trophic therapy on intestinal adaptation in short bowel patients.

Aim: To evaluate the effects of bowel rehabilitation and combined trophic therapy on intestinal adaptation in short bowel patients.

Methods: Thirty-eight patients with severe short-bowel syndrome (SBS) were employed in the present study, whose average length of jejunum-ileum was 35.8+/-21.2 cm. The TPN treatment was initiated early to attain positive nitrogen balance and prevent severe weight loss. The TPN composition was designated to be individualized and altered when necessary. Enteral feeding was given as soon as possible after resection and increased gradually. Meals were distributed throughout the day. Eight patients received treatment of growth hormone (0.14 mg/kg.day) and glutamine (0.3 g/kg.day) for 3 weeks. D-xylose test, 15N-Gly trace test and 13C-palmitic acid breath test were done to determine the patients' absorption capability.

Results: Thirty-three patients maintained well body weight and serum albumin concentration. The average time of follow-up for 33 survival patients was 5.9+/-4.3 years. Twenty-two patients weaned from TPN with an average TPN time of 9.5+/-6.6 months. Two patients, whose whole small bowel, ascending and transverse colon were resected received home TPN. An other 9 patients received parenteral or enteral nutritional support partly as well as oral diet. Three week rhGH+GLN therapy increased nutrients absorption but the effects were transient.

Conclusion: By rehabilitation therapy, most short bowel patients could wean from parenteral nutrition. Dietary manipulation is an integral part of the treatment of SBS. Treatment with growth hormone and glutamine may increase nutrients absorption but the effects are not sustained beyond the treatment period.