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A pilot study of the use of epidermal growth factor in pediatric short bowel syndrome
David L Sigalet1, Gary R Martin, J Decker Butzner
1GI Research Group, University of Calgary, Calgary, Alberta, Canada TZT SC7. sigalet@ucalgary.ca
Insights
Enteral epidermal growth factor (EGF) significantly improved nutrient absorption and feed tolerance in pediatric patients with short bowel syndrome (SBS). EGF treatment also potentially reduced sepsis episodes, warranting further investigation.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility and Absorption
- Regenerative Medicine
Background:
- Short bowel syndrome (SBS) poses challenges in nutrient absorption and enteral feeding tolerance in pediatric patients.
- Enteral nutrition is crucial for managing SBS, but suboptimal absorption and tolerance can complicate treatment.
- Epidermal growth factor (EGF) is a key regulator of intestinal growth and repair, suggesting potential therapeutic benefits in SBS.
Purpose of the Study:
- To evaluate the efficacy of enterally administered human recombinant EGF in improving nutrient absorption and enteral feed tolerance in pediatric SBS.
- To assess the impact of EGF on intestinal permeability, weight gain, and liver function in this patient population.
- To investigate the safety and potential effects of EGF on infection rates in pediatric SBS.
Main Methods:
- A prospective study involving pediatric patients with severe SBS (<25% predicted bowel length).
- Treatment with human recombinant EGF (100 microg/kg/day) mixed with enteral feeds for 6 weeks.
- Assessment of endpoints including weight, enteral feed tolerance, nutrient absorption (3-0 methylglucose), intestinal permeability, and hematologic liver function parameters.
Main Results:
- Significant improvements observed in carbohydrate absorption (24.7% to 34.1%) and enteral feed tolerance (25% to 36% of total energy).
- No significant changes noted in intestinal permeability, weight gain rate, or liver function tests.
- A notable decrease in sepsis episodes during EGF treatment, with 3 cases occurring within 2 weeks of discontinuation; no adverse effects reported.
Conclusions:
- Enteral EGF administration demonstrates potential to enhance nutrient absorption and improve tolerance to enteral feeds in pediatric SBS.
- The findings suggest a possible beneficial effect of EGF on reducing infection rates, although further research is needed.
- Further studies are recommended to optimize EGF treatment strategies, including administration timing and duration, for pediatric SBS management.
Background:
This study examined the effects of enterally administered epidermal growth factor (EGF) on nutrient absorption and tolerance of enteral feeds in pediatric patients with short bowel syndrome (SBS).
Methods:
Patients identified with severe SBS (<25% bowel length predicted for age) were prospectively enrolled in treatment using human recombinant EGF (1-53); 100 microg/kg per day given mixed with enteral feeds and patients were treated for 6 weeks. End points followed were patient weight, tolerance of enteral feeds, nutrient absorption, and intestinal permeability as determined using carbohydrate probes and hematologic values for liver function parameters.
Results:
Five patients were treated with EGF; all showed a significant improvement in carbohydrate absorption (3-0 methylglucose): absorption 24.7% +/- 9.7% pretreatment vs 34.1% +/- 13.8% posttreatment and improved tolerance of enteral feeds (enteral energy as % of total energy, 25% +/- 28% pretreatment vs 36% +/- 24% posttreatment; mean +/- SD; P < .05 by Wilcoxon's signed rank test). Epidermal growth factor treatment was not associated with significant changes in intestinal permeability, the rate of weight gain, or liver function tests. During the treatment phase, no patients developed episodes of sepsis; however, within 2 weeks of discontinuation of EGF treatment, 3 patients developed septic episodes. No adverse effects of EGF administration were noted.
Conclusions:
These results suggest that enteral treatment with EGF in pediatric SBS improves nutrient absorption, increases tolerance with enteral feeds, and may improve the infection rate. Further studies exploring treatment strategies including the timing and duration of EGF administration are indicated.
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