Glucagon-like peptide 2 improves nutrient absorption and nutritional status in short-bowel patients with no colon

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 120; no. 4; pp. 806 - 815
• Main Authors: Jeppesen, Palle Bekker, Hartmann, Bolette, Thulesen, Jesper, Graff, Jesper, Lohmann, Jette, Hansen, Birthe Stenbæk, Tofteng, Flemming, Poulsen, Steen Seier, Madsen, Jan Lysgaard, Holst, Jens Juul, Mortensen, Per Brøbech
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2001; Elsevier
• Subjects: Adult; Biological and medical sciences; Body Composition - drug effects; Body Weight - drug effects; Creatinine - urine; Digestive system; Female; Gastrointestinal Hormones - adverse effects; Gastrointestinal Hormones - therapeutic use; Gastrointestinal Transit - drug effects; Glucagon-Like Peptide 2; Glucagon-Like Peptides; Hormones - blood; Humans; Injections, Subcutaneous; Intestinal Absorption - drug effects; Intestines - pathology; Male; Medical sciences; Middle Aged; Nutritional Status - drug effects; Patient Compliance; Peptides - adverse effects; Peptides - therapeutic use; Pharmacology. Drug treatments; Short Bowel Syndrome - drug therapy; Short Bowel Syndrome - pathology; PGDP; GLP; HPN; Human; Secretion; Deficiency; Gut; Colectomy; Short bowel syndrome; Biological activity; Colonic disease; Concomitant disease; Absorption; Glucagon like peptide; Intestinal malabsorption; Surgery; Digestive diseases; Intestinal disease; Colon
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1053/gast.2001.22555

Background & Aims: Glucagon-like peptide 2 (GLP-2) is intestinotrophic, antisecretory, and transit-modulating in rodents, and it is mainly secreted from the intestinal mucosa of the terminal ileum and colon after food ingestion. We assessed the effect of GLP-2 on the gastrointestinal function in patients without a terminal ileum and colon who have functional short-bowel syndrome with severe malabsorption of wet weight (>1.5 kg/day) and energy (>2.3 MJ/day) and no postprandial secretion of GLP-2. Methods: Balance studies were performed before and after treatment with GLP-2, 400 μg subcutaneously twice a day for 35 days, in 8 patients (4–17 years from last bowel resection; 6 with Crohn's disease). Four patients received home parenteral nutrition (mean residual jejunum, 83 cm), and 4 did not (mean ileum resection, 106 cm). Biopsy specimens were taken from jejunal/ileal stomas, transit was measured by scintigraphy, and body composition was measured by dual-energy x-ray absorptiometry. Results: Treatment with GLP-2 improved the intestinal absorption of energy 3.5% ± 4.0% (mean ± SD) from 49.9% to 53.4% (P = 0.04), wet weight 11% ± 12% from 25% to 36% (P = 0.04), and nitrogen 4.7% ± 5.4% from 47.4% to 52.1% (P = 0.04). Body weight increased 1.2 ± 1.0 kg (P = 0.01), lean body mass increased 2.9 ± 1.9 kg (P = 0.004), fat mass decreased 1.8 ± 1.3 kg (P = 0.007), and 24-hour urine creatinine excretion increased (P = 0.02). The time to 50% gastric emptying of solids increased 30 ± 16 minutes from 89 to 119 minutes (P < 0.05). Small bowel transit time was not changed. Crypt depth and villus height were increased in 5 and 6 patients, respectively. Conclusions: Treatment with GLP-2 improves intestinal absorption and nutritional status in short-bowel patients with impaired postprandial GLP-2 secretion in whom the terminal ileum and the colon have been resected.
GASTROENTEROLOGY 2001;120:806-815