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Taghizadeh B, Jaafari MR, Zarghami N. New insight into the importance of formulation variables on parenteral growth hormone preparations: potential effect on the injection-site pain. Front Endocrinol (Lausanne) 2022; 13:963336. [PMID: 36263321 PMCID: PMC9576007 DOI: 10.3389/fendo.2022.963336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Reducing injection-site pain (ISP) in patients with chronic conditions such as growth hormone deficiency is a valuable strategy to improve patient compliance and therapeutic efficiency. Thus understanding different aspects of pain induction following subcutaneous injection of biotherapeutics and identifying the responsible factors are vital. Here we have discussed the effects of formulation's viscosity, concentration, osmolality, buffering agents, pH, and temperature as well as injection volume, dosing frequency, and different excipients on ISP following subcutaneous injection of commercially available recombinant human growth hormone products. Our literature review found limited available data on the effects of different components of parenteral rhGH products on ISP. This may be due to high cost associated with conducting various clinical trials to assess each excipient in the formulation or to determine the complex interactions of different components and its impact on ISP. Recently, conducting molecular dynamics simulation studies before formulation design has been recommended as an alternative and less-expensive approach. On the other hand, the observed inconsistencies in the available data is mainly due to different pain measurement approaches used in each study. Moreover, it is difficult to translate data obtained from animal studies to human subjects. Despite all these limitations, our investigation showed that components of parenteral rhGH products can significantly contribute to ISP. We suggest further investigation is required for development of long acting, buffer-free, preservative-free formulations. Besides, various excipients are currently being investigated for reducing ISP which can be used as alternatives for common buffers, surfactants or preservatives in designing future rhGH formulations.
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Affiliation(s)
- Bita Taghizadeh
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Reza Jaafari
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nosratollah Zarghami
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Biochemistry and Laboratory Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- *Correspondence: Nosratollah Zarghami,
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Solar H, Doeyo M, Ortega M, De Barrio S, Olano E, Moreira E, Buncuga M, Manzur A, Crivelli A, Gondolesi G. Postsurgical Intestinal Rehabilitation Using Semisynthetic Glucagon‐Like Peptide‐2 Analogue (sGLP‐2) at a Referral Center: Can Patients Achieve Parenteral Nutrition and sGLP‐2 Independency? JPEN J Parenter Enteral Nutr 2020; 45:1072-1082. [DOI: 10.1002/jpen.1983] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Hector Solar
- Intestinal Failure, Rehabilitation and Transplant Unit, Favaloro Foundation University Hospital Buenos Aires Argentina
- Translational Medicine, Transplantation and Bioengineering Research Institute (IMeTTyB) Favaloro University Buenos Aires Argentina
| | - Mariana Doeyo
- Intestinal Failure, Rehabilitation and Transplant Unit, Favaloro Foundation University Hospital Buenos Aires Argentina
- Translational Medicine, Transplantation and Bioengineering Research Institute (IMeTTyB) Favaloro University Buenos Aires Argentina
| | - Mariana Ortega
- Intestinal Failure, Rehabilitation and Transplant Unit, Favaloro Foundation University Hospital Buenos Aires Argentina
- Translational Medicine, Transplantation and Bioengineering Research Institute (IMeTTyB) Favaloro University Buenos Aires Argentina
| | - Silvia De Barrio
- Nutritional Support and Malabsorptive Disorders Unit San Martin Hospital La Plata Argentina
| | - Estela Olano
- Special Nutrition Unit Maciel Hospital Montevideo Uruguay
| | | | - Martin Buncuga
- Nutritional Support Unit Delta Hospital Rosario Argentina
| | - Alejandra Manzur
- Organ and Tissue Transplant Department Central Hospital Mendoza Argentina
| | - Adriana Crivelli
- Intestinal Failure, Rehabilitation and Transplant Unit, Favaloro Foundation University Hospital Buenos Aires Argentina
- Translational Medicine, Transplantation and Bioengineering Research Institute (IMeTTyB) Favaloro University Buenos Aires Argentina
| | - Gabriel Gondolesi
- Intestinal Failure, Rehabilitation and Transplant Unit, Favaloro Foundation University Hospital Buenos Aires Argentina
- Translational Medicine, Transplantation and Bioengineering Research Institute (IMeTTyB) Favaloro University Buenos Aires Argentina
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Extensive Intestinal Resection Triggers Behavioral Adaptation, Intestinal Remodeling and Microbiota Transition in Short Bowel Syndrome. Microorganisms 2016; 4:microorganisms4010016. [PMID: 27681910 PMCID: PMC5029521 DOI: 10.3390/microorganisms4010016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/22/2016] [Accepted: 03/02/2016] [Indexed: 02/06/2023] Open
Abstract
Extensive resection of small bowel often leads to short bowel syndrome (SBS). SBS patients develop clinical mal-absorption and dehydration relative to the reduction of absorptive area, acceleration of gastrointestinal transit time and modifications of the gastrointestinal intra-luminal environment. As a consequence of severe mal-absorption, patients require parenteral nutrition (PN). In adults, the overall adaptation following intestinal resection includes spontaneous and complex compensatory processes such as hyperphagia, mucosal remodeling of the remaining part of the intestine and major modifications of the microbiota. SBS patients, with colon in continuity, harbor a specific fecal microbiota that we called “lactobiota” because it is enriched in the Lactobacillus/Leuconostoc group and depleted in anaerobic micro-organisms (especially Clostridium and Bacteroides). In some patients, the lactobiota-driven fermentative activities lead to an accumulation of fecal d/l-lactates and an increased risk of d-encephalopathy. Better knowledge of clinical parameters and lactobiota characteristics has made it possible to stratify patients and define group at risk for d-encephalopathy crises.
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Musumeci G, Imbesi R, Trovato FM, Szychlinska MA, Aiello FC, Buffa P, Castrogiovanni P. Importance of serotonin (5-HT) and its precursor l-tryptophan for homeostasis and function of skeletal muscle in rats. A morphological and endocrinological study. Acta Histochem 2015; 117:267-74. [PMID: 25805417 DOI: 10.1016/j.acthis.2015.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 01/08/2023]
Abstract
Serotonin (5-HT) is a neurotransmitter, synthesized in serotonergic neurons of the central nervous system and in enterochromaffin cells of the gastrointestinal tract, which is involved in the regulation of several body functions, including muscle tissue development and growth and its contractile response. l-Tryptophan (l-Trp) is an essential amino acid and precursor of 5-HT. The aim of the present study was to better understand the mechanisms that govern neuroendocrine homeostasis of muscle tissue and emphasize the importance of a diet, complete in all its elements, referring specifically to the essential amino acids such as l-Trp, crucial in several neuroendocrine functions.We analyzed the possible consequences of l-Trp-free diet on 5-HT production and on skeletal muscle morphology and function in young female rats. We also evaluated the eventual alterations of hormone production such as growth hormone (GH), thyroid stimulating hormone (TSH) and thyroid hormones (T3 and T4) that control and regulate growth, metabolism and efficiency of the skeletal muscle. Our results showed a strong decrease of 5-HT, GH, TSH, T3 and T4 levels associated to a clear difference in body weight between experimental and control rats. Moreover, the muscle samples of experimental rats showed histological and ultrastructural alterations. These findings thus supported a strong link between l-Trp, serotonergic system, hormone secretion and morphology of skeletal muscle tissue and thus, the importance of a balanced daily diet.
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Affiliation(s)
- Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy.
| | - Rosa Imbesi
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy
| | - Francesca Maria Trovato
- Department of Clinical and Experimental Medicine, Internal Medicine Division, University of Catania, Via S. Sofia 78, 95123 Catania, Italy
| | - Marta Anna Szychlinska
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy
| | - Flavia Concetta Aiello
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy
| | - Pietro Buffa
- Randall Division of Cell and Molecular Biophysics, King's College London, London, UK
| | - Paola Castrogiovanni
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy
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Sangild PT, Ney DM, Sigalet DL, Vegge A, Burrin D. Animal models of gastrointestinal and liver diseases. Animal models of infant short bowel syndrome: translational relevance and challenges. Am J Physiol Gastrointest Liver Physiol 2014; 307:G1147-68. [PMID: 25342047 PMCID: PMC4269678 DOI: 10.1152/ajpgi.00088.2014] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Intestinal failure (IF), due to short bowel syndrome (SBS), results from surgical resection of a major portion of the intestine, leading to reduced nutrient absorption and need for parenteral nutrition (PN). The incidence is highest in infants and relates to preterm birth, necrotizing enterocolitis, atresia, gastroschisis, volvulus, and aganglionosis. Patient outcomes have improved, but there is a need to develop new therapies for SBS and to understand intestinal adaptation after different diseases, resection types, and nutritional and pharmacological interventions. Animal studies are needed to carefully evaluate the cellular mechanisms, safety, and translational relevance of new procedures. Distal intestinal resection, without a functioning colon, results in the most severe complications and adaptation may depend on the age at resection (preterm, term, young, adult). Clinically relevant therapies have recently been suggested from studies in preterm and term PN-dependent SBS piglets, with or without a functional colon. Studies in rats and mice have specifically addressed the fundamental physiological processes underlying adaptation at the cellular level, such as regulation of mucosal proliferation, apoptosis, transport, and digestive enzyme expression, and easily allow exogenous or genetic manipulation of growth factors and their receptors (e.g., glucagon-like peptide 2, growth hormone, insulin-like growth factor 1, epidermal growth factor, keratinocyte growth factor). The greater size of rats, and especially young pigs, is an advantage for testing surgical procedures and nutritional interventions (e.g., PN, milk diets, long-/short-chain lipids, pre- and probiotics). Conversely, newborn pigs (preterm or term) and weanling rats provide better insights into the developmental aspects of treatment for SBS in infants owing to their immature intestines. The review shows that a balance among practical, economical, experimental, and ethical constraints will determine the choice of SBS model for each clinical or basic research question.
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Affiliation(s)
- Per T. Sangild
- 1Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark; ,2Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark;
| | - Denise M. Ney
- 3Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin;
| | | | - Andreas Vegge
- 1Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark; ,5Diabetes Pharmacology, Novo Nordisk, Måløv, Denmark; and
| | - Douglas Burrin
- 6USDA-ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
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Adas G, Adas M, Arikan S, Sarvan AK, Toklu AS, Mert S, Barut G, Kamali S, Koc B, Tutal F. Effect of growth hormone, hyperbaric oxygen and combined therapy on the gastric serosa. World J Gastroenterol 2013; 19:2904-2912. [PMID: 23704823 PMCID: PMC3660815 DOI: 10.3748/wjg.v19.i19.2904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/13/2012] [Accepted: 01/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the role of growth hormone (GH), hyperbaric oxygen therapy (HBOT) and combined therapy on the intestinal neomucosa formation of the gastric serosa.
METHODS: Forty-eight male Wistar-albino rats, weighing 250-280 g, were used in this study. The rats were divided into four groups (n = 12): Group 1, control, gastric serosal patch; Group 2, gastric serosal patch + GH; Group 3, gastric serosal patch + HBOT; and Group 4, gastric serosal patch + GH + HBOT. Abdominal access was achieved through a midline incision, and after the 1-cm-long defect was created in the jejunum, a 1 cm × 1 cm patch of the gastric corpus was anastomosed to the jejunal defect. Venous blood samples were taken to determine the insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) basal levels. HBOT was performed in Groups 3 and 4. In Groups 2 and 4, human GH was given subcutaneously at a dose of 2 mg per kg/d for 28 d, beginning on the operation day. All animals were sacrificed 60 d after surgery. The jejunal segment and the gastric anastomotic area were excised for histological examination. The inflammatory process, granulation, collagen deposition and fibroblast activity at the neomucosa formation were studied and scored. Additionally, the villus density, villus height, and crypt depth were counted and recorded. The measurements of villus height and crypt depth were calculated with an ocular micrometer. New vessel growth was determined by calculatingeach new vessel in a 1 mm2 area.
RESULTS: In the histological comparison of groups, no significant differences were observed between the control group and Groups 2 and 3 with respect to epithelialization, granulation, fibroblastic activity and the inflammatory process, but significant differences were present between the control group and all others groups (Groups 2-4) with respect to angiogenesis (P < 0.01) and collagen deposition (P < 0.05, P < 0.01). Significant differences between the control group and Group 4 were also observed with respect to epithelialization and fibroblastic activity (P < 0.01 and P < 0.05, respectively). There were significant differences in villus density in all of groups compared with the control group (P < 0.05). Crypt depth was significantly greater in Group 4 than in the control group (P < 0.05), but no other groups had deeper crypts. However, villus height was significantly longer in Groups 2 and 4 than in the control group (P < 0.05). The comparison of groups revealed, significant difference between control group and Groups 2 and 4) with respect to the levels of IGF-1 and IGFBP-3 (P < 0.01) 3 wk after the operation.
CONCLUSION: HBOT or GH and combined therapy augmented on neomucosal formation. The use of combined therapy produced a synergistic effect on the histological, morphological and functional parameters.
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Mayeur C, Gratadoux JJ, Bridonneau C, Chegdani F, Larroque B, Kapel N, Corcos O, Thomas M, Joly F. Faecal D/L lactate ratio is a metabolic signature of microbiota imbalance in patients with short bowel syndrome. PLoS One 2013; 8:e54335. [PMID: 23372709 PMCID: PMC3553129 DOI: 10.1371/journal.pone.0054335] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 12/11/2012] [Indexed: 01/28/2023] Open
Abstract
Our objective was to understand the functional link between the composition of faecal microbiota and the clinical characteristics of adults with short bowel syndrome (SBS). Sixteen patients suffering from type II SBS were included in the study. They displayed a total oral intake of 2661±1005 Kcal/day with superior sugar absorption (83±12%) than protein (42±13%) or fat (39±26%). These patients displayed a marked dysbiosis in faecal microbiota, with a predominance of Lactobacillus/Leuconostoc group, while Clostridium and Bacteroides were under-represented. Each patient exhibited a diverse lactic acid bacteria composition (L. delbrueckii subsp. bulgaricus, L. crispatus, L. gasseri, L. johnsonii, L. reuteri, L. mucosae), displaying specific D and L-lactate production profiles in vitro. Of 16 patients, 9/16 (56%) accumulated lactates in their faecal samples, from 2 to 110 mM of D-lactate and from 2 to 80 mM of L-lactate. The presence of lactates in faeces (56% patients) was used to define the Lactate-accumulator group (LA), while absence of faecal lactates (44% patients) defines the Non lactate-accumulator group (NLA). The LA group had a lower plasma HCO3− concentration (17.1±2.8 mM) than the NLA group (22.8±4.6 mM), indicating that LA and NLA groups are clinically relevant sub–types. Two patients, belonging to the LA group and who particularly accumulated faecal D-lactate, were at risk of D-encephalopathic reactions. Furthermore, all patients of the NLA group and those accumulating preferentially L isoform in the LA group had never developed D-acidosis. The D/L faecal lactate ratio seems to be the most relevant index for a higher D- encephalopathy risk, rather than D- and L-lactate faecal concentrations per se. Testing criteria that take into account HCO3− value, total faecal lactate and the faecal D/L lactate ratio may become useful tools for identifying SBS patients at risk for D-encephalopathy.
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Affiliation(s)
- Camille Mayeur
- INRA, UMR1319 MICALIS, Commensal and Probiotics-Host interactions Laboratory, Jouy-en-Josas, France
- AgroParisTech, UMR1319 MICALIS, Commensal and Probiotics-Host interactions Laboratory, Jouy-en-Josas, France
| | - Jean-Jacques Gratadoux
- INRA, UMR1319 MICALIS, Commensal and Probiotics-Host interactions Laboratory, Jouy-en-Josas, France
- AgroParisTech, UMR1319 MICALIS, Commensal and Probiotics-Host interactions Laboratory, Jouy-en-Josas, France
| | - Chantal Bridonneau
- INRA, UMR1319 MICALIS, Commensal and Probiotics-Host interactions Laboratory, Jouy-en-Josas, France
- AgroParisTech, UMR1319 MICALIS, Commensal and Probiotics-Host interactions Laboratory, Jouy-en-Josas, France
| | - Fatima Chegdani
- INRA, UMR1319 MICALIS, Commensal and Probiotics-Host interactions Laboratory, Jouy-en-Josas, France
- AgroParisTech, UMR1319 MICALIS, Commensal and Probiotics-Host interactions Laboratory, Jouy-en-Josas, France
| | - Béatrice Larroque
- Epidemiological and Clinical Research Unit, Hôpital Beaujon, Clichy, France
| | - Nathalie Kapel
- Service de Gastroentérologie et Assistance Nutritive, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Clichy, France
| | - Olivier Corcos
- Service de Gastroentérologie et Assistance Nutritive, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Clichy, France
| | - Muriel Thomas
- INRA, UMR1319 MICALIS, Commensal and Probiotics-Host interactions Laboratory, Jouy-en-Josas, France
- AgroParisTech, UMR1319 MICALIS, Commensal and Probiotics-Host interactions Laboratory, Jouy-en-Josas, France
- * E-mail: (MT); (FJ)
| | - Francisca Joly
- Service de Gastroentérologie et Assistance Nutritive, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Clichy, France
- * E-mail: (MT); (FJ)
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8
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Abstract
Growth hormone is a widely used hormone. This article describes its historical use, current indications and studies for possible future uses.
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9
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Franklin SL, Geffner ME. Growth hormone: the expansion of available products and indications. Endocrinol Metab Clin North Am 2009; 38:587-611. [PMID: 19717006 DOI: 10.1016/j.ecl.2009.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Growth hormone is a widely used hormone. This article describes its historical use, current indications and studies for possible future uses.
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Affiliation(s)
- Sherry L Franklin
- University of California San Diego School of Medicine, Rady Childrens Hospital of San Diego, 7910 Frost Street, Suite 435, San Diego, CA 92123, USA.
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10
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Messing B, Corcos O, Amiot A, Joly F. Insuffisance intestinale : de l’adaptation à la transplantation. ACTA ACUST UNITED AC 2009; 33:648-59. [DOI: 10.1016/j.gcb.2009.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Van Gossum A, Cabre E, Hébuterne X, Jeppesen P, Krznaric Z, Messing B, Powell-Tuck J, Staun M, Nightingale J. ESPEN Guidelines on Parenteral Nutrition: gastroenterology. Clin Nutr 2009; 28:415-27. [PMID: 19515465 DOI: 10.1016/j.clnu.2009.04.022] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 04/29/2009] [Indexed: 12/14/2022]
Abstract
Undernutrition as well as specific nutrient deficiencies has been described in patients with Crohn's disease (CD), ulcerative colitis (UC) and short bowel syndrome. In the latter, water and electrolytes disturbances may be a major problem. The present guidelines provide evidence-based recommendations for the indications, application and type of parenteral formula to be used in acute and chronic phases of illness. Parenteral nutrition is not recommended as a primary treatment in CD and UC. The use of parenteral nutrition is however reliable when oral/enteral feeding is not possible. There is a lack of data supporting specific nutrients in these conditions. Parenteral nutrition is mandatory in case of intestinal failure, at least in the acute period. In patients with short bowel, specific attention should be paid to water and electrolyte supplementation. Currently, the use of growth hormone, glutamine and GLP-2 cannot be recommended in patients with short bowel.
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Affiliation(s)
- André Van Gossum
- Hôpital Erasme, Clinic of Intestinal Diseases and Nutrition Support, Brussels, Belgium
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12
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Affiliation(s)
- Dileep N Lobo
- Division of Gastrointestinal Surgery, E Floor, West Block, Wolfson Digestive Diseases Centre, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
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13
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Horbach T. [Short bowel syndrome]. Chirurg 2006; 77:1169-81; quiz 1182. [PMID: 17131099 DOI: 10.1007/s00104-006-1261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Short bowel syndrome (SBS) is defined in adults as a malabsorption disorder as a result of shortening the bowel to <200 cm. The severity of symptoms is less dependent on the amount of residual intestine than on the anatomical position of the resected bowel, the type of operative reconstruction, and the type and quality of nutritional, medical, and surgical treatment. Numerous complications and deficiency symptoms are associated with SBS. The extent of deficient nutrition should be determined. The need to create accesses for enteral and parenteral delivery, to supply supplementation as needed, perform pharmacological therapy, and in individual cases surgical treatment all necessitate a broad knowledge of nutritional medicine. The goals of therapy are correction and prevention of malnourishment, restoration of a normal nutritional status, and the normal thriving of children. Complications should be avoided, particularly those problems associated with parenteral nutrition. The frequency of diarrhea should be reduced. Overall, the aim is to achieve an optimized quality of life.
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Affiliation(s)
- T Horbach
- Chirurgische Klinik, Universitätsklinikum Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Deutschland.
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14
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Messing B, Joly F. Insuffisance intestinale chronique : passé, présent, avenir. NUTR CLIN METAB 2006. [DOI: 10.1016/s0985-0562(06)80021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Steiger E, DiBaise JK, Messing B, Matarese LE, Blethen S. Indications and recommendations for the use of recombinant human growth hormone in adult short bowel syndrome patients dependent on parenteral nutrition. J Clin Gastroenterol 2006; 40 Suppl 2:S99-106. [PMID: 16770169 DOI: 10.1097/01.mcg.0000212680.52290.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Given the lack of published guidelines regarding the use of trophic factors to treat patients with short bowel syndrome (SBS), a group of experts in the field convened to discuss best-practice strategies. Trophic factors, such as recombinant human growth hormone (r-hGH) and glucagon-like peptide-2 (GLP-2), may enhance intestinal adaptation and decrease parenteral nutrition (PN) requirements; therefore, their utility in treating SBS patients was evaluated. Available clinical data on use of r-hGH therapy in SBS patients were discussed, as were the utility of r-hGH in the PN weaning process, the optimal timing of r-hGH therapy, and how to select appropriate patients for r-hGH therapy. In addition, contraindications and precautions as well as adverse effects of r-hGH treatment were discussed. The meeting culminated with the development of a treatment algorithm to summarize best-practice recommendations for the management of SBS in adult patients. This algorithm involves attempting to wean patients off PN without the use of trophic factors. If this is unsuccessful, it is recommended that patients be treated with an r-hGH regimen or participate in investigational studies using other trophic factors.
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Affiliation(s)
- Ezra Steiger
- Intestinal Rehabilitation Program, Nutrition Support and Vascular Access Department, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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DiBaise JK, Matarese LE, Messing B, Steiger E. Strategies for parenteral nutrition weaning in adult patients with short bowel syndrome. J Clin Gastroenterol 2006; 40 Suppl 2:S94-8. [PMID: 16770168 DOI: 10.1097/01.mcg.0000212679.14172.33] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The development of parenteral nutrition (PN) was an important, life-saving advance in the care of patients with short bowel syndrome (SBS). Nevertheless, its long-term use is often associated with complications. Therefore, it is desirable, when possible, to wean SBS patients to an oral diet. Given the complexity of PN weaning and the lack of published guidelines, the purpose of this article is to describe strategies of PN weaning and illustrate important clinical considerations during the weaning process. Patient education and motivation are key factors in successful PN weaning. The patient should have clearly defined care protocols and understand the importance of each aspect of the weaning program. Other factors likely to influence weaning success include the length and health of the remnant bowel, the presence of a colon, and the degree to which bowel adaptation has occurred. It is imperative that daily oral fluid and caloric intake goals are met prior to initiating PN weaning and that the patient receives an optimized dietary and medication plan. During weaning, the most practical measures for assessing adequate hydration and nutritional status are oral intake, stool and urine output, serum electrolytes and visceral proteins, and body weight. PN reductions can be made by either decreasing the days of PN infusion per week or decreasing the PN infusion volume equally across all days of the week. Use of recombinant human growth hormone, with or without glutamine, may play a role in facilitating the PN weaning process.
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Affiliation(s)
- John K DiBaise
- Division of Gastroenterology and Hepatology, Mayo Clinic Scottsdale, Scottsdale, AZ 85259, USA.
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