This is a multi-center prospective study to evaluate the effects of recombinant growth hormone (GH) on effecting intestinal adaptation in children with short bowel syndrome (SBS). The objectives are to define the effects of 3 months of treatment with growth hormone on body growth and composition and gut tissue and function by fat and carbohydrate absorption studies, small bowel biopsies for histologic examination for expression of IGF-I and II receptor and IGFR, and need for nutrition support, in patients with short bowel syndrome. Additionally, to define the metabolic actions of growth hormone used in conjunctin with total parenteral nutrition and/or enteral nutrition, with specific reference to the following: protein (whole body protein synthesis and proteolysis), carbohydrate (hepatic glucose production and glucose disposal), and fat (lipolysis). Background: Mortality rates among infants with short bowel syndrome have been reduced substantially by the use of parenteral nutrition (PN). Unfortunately, PN is primarily a supportive therapy, since it fails to correct the fundamental defect of SBS: inadequate mucosal surface area. Use of PN has also been associated with significant morbidites, including life-threatening sepsis, thrombotic disorders, inadequate bone mineralization and chronic liver disease. Surgical therapy for SBS has evolved to include small intestine transplantation, but success rates have been modest. A major advance in the field would be the design of new medical therapies to enhance the capacity of the bowel to adapt following extensive resection. Growth hormone has been postulated as an important hormone in intestinal adaptation. GH increases crypt cell proliferation of human duodenal mucosa in vitro and increases body weight, distal ileal weight and mucosal height in rats undergoing extensive small intestine resection. GH recetors have been located in both animal and human gastrointestinal tract tissues. GH potentiates protein anabolism associated with TPN in adult patients and, in conjunction with the amino acid glutamine and a modified diet, has been shown to improve nutrient absorption in adults with SBS. It has been postulated that adults who are many years past their intestinal resection might be less susceptible to its benefits than young children.
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