Growth factors: possible roles for clinical management of the short bowel syndrome

Abstract

The structural and functional changes during intestinal adaptation are necessary to compensate for the sudden loss of digestive and absorptive capacity after massive intestinal resection. When the adaptive response is inadequate, short bowel syndrome (SBS) ensues and patients are left with the requirement for parenteral nutrition and its associated morbidities. Several hormones have been studied as potential enhancers of the adaptation process. The effects of growth hormone (GH), insulin-like growth factor-1, epidermal growth factor and glucagon-like peptide-2 (GLP-2) on adaptation have been studied extensively in animal models. In addition, GH and GLP-2 have shown promise for the treatment of short bowel syndrome in clinical trials in humans. Several lesser studied hormones, including leptin, corticosteroids, thyroxine, testosterone and estradiol, are also discussed.

Adult zebrafish intestine resection: a novel model of short bowel syndrome, adaptation, and intestinal stem cell regeneration

“…Approximately 20,000 patients in this country are on home TPN. A reduction of just 10% would result in estimated savings of $780,000,000 (27).…”

Teduglutida: revisión de su uso en el síndrome de intestino corto

“…Asimismo, se han utilizado factores de crecimiento y otras hormonas tróficas para mejorar la adaptación intestinal (32). La hormona de crecimiento humana recombinante fue el primer medicamento aprobado por la Food and Drug Administration (FDA) con indicación específica en SIC combinado con glutamina y optimización/modificaciones de la dieta.…”

Short-Bowel Syndrome in Children — An Update in Management Strategies

“…Laboratory studies have shown that GH causes mucosal hyperplasia and increases the adaptive capacity after small resection [83,84]. Other actions of GH include enhancement of the villus height and crypt depth, positive nitrogen balance and bowel growth when rats were given GH combined with glutamine and/or a diet high in protein [85,86].Studies in children with PSBS showed a reduction in PN [87], but after cessation of GH the positive response could not be preserved [88)]. The results in adults are controversial.…”