Description
Animal studies show clear evidence for intestinal adaptation (including both hyperplasia and hypertrophy) after massive intestinal resection. Lesser but definite adaptation occurs in patients with the short bowel syndrome. Unfortunately the ileum, which is better equipped to adapt than the jejunum, is more frequently left unresected and in situ. Encouraging experimental work indicates that the adaptive response may be amenable to pharmacological enhancement. The effects of growth hormone – with or without concurrent glutamine – are still controversial, and the data are still very early for the transforming growth factors, but it appears that the intestinal hormone GLP-2 has the potential to improve adaptation even after years of established short bowel syndrome. More stable analogues should soon be available, and if preliminary results are confirmed their use could transform some aspects of clinical care.
