Epidermal growth factor and the short bowel syndrome

Because epidermal growth factor (EGF) has multiple effects on the intestinal epithelium and endogenous EGF plays an important role in maintaining normal intestinal structure and the response to injury, EGF should be important in the intestinal adaptive response to resection. The accumulated data in the literature support a role for endogenous EGF in the intestinal adaptive response. Endogenous EGF is increased in saliva and diminished in urine after intestinal resection. This suggests increased tissue utilization of endogenous EGF during adaptation. Intestinal EGF receptor activity is increased after resection. Intestinal adaptation is impaired in animals with defective EGF receptors. Thus EGF receptor activity also is important during adaptation. The results of experimental studies suggest that EGF administered at the time of resection enhances the intestinal adaptive response. Both structural and functional adaptation are augmented. The route, dose, and timing of EGF administration are important factors. EGF has additive effects with glutamine and growth hormone on adaptation. Several observations from these reports have relevance to the potential clinical application of EGF therapy: (1) EGF should be given soon after resection; (2) early transient administration may lead to a substantial effect on adaptation; (3) both systemic and enteral therapy may be effective; (4) luminal nutrients are important but not essential in mediating EGF-stimulated adaptation; and (5) combined therapy with other nutrients and growth factors may have merit. In conclusion, endogenous EGF plays an important role in intestinal adaptation. Furthermore, experimental results suggest the potential clinical usefulness of EGF to stimulate intestinal adaptation after massive intestinal resection. There is currently no evidence to support the use of EGF in patients with well-adapted short bowel syndrome.