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Digestive Diseases and Sciences

, Volume 57, Issue 4, pp 1000–1012 | Cite as

Glutamine and Whey Protein Improve Intestinal Permeability and Morphology in Patients with Crohn’s Disease: A Randomized Controlled Trial

  • Jaya Benjamin
  • Govind Makharia
  • Vineet Ahuja
  • K. D. Anand Rajan
  • Mani Kalaivani
  • Siddhartha Datta Gupta
  • Yogendra Kumar JoshiEmail author
Original Article

Abstract

Background

Increased intestinal permeability (IP) has been implicated in the etiopathogenesis, disease activity and relapse of Crohn’s disease (CD). Glutamine, the major fuel for the enterocytes, may improve IP.

Aim

We evaluated the effect of oral glutamine on IP and intestinal morphology in patients with CD.

Methods

In a randomized controlled trial, consecutive patients with CD in remission phase with an abnormal IP were randomized to a glutamine group (GG) or active control group (ACG) and were given oral glutamine or whey protein, respectively, as 0.5 g/kg ideal body weight/day for 2 months. IP was assessed by the lactulose mannitol excretion ratio (LMR) in urine, and morphometry was performed by computerized image analysis system.

Results

Patients (age 34.5 ± 10.5 years; 20 males) were assigned to the GG (n = 15) or ACG (n = 15). Fourteen patients in each group completed the trial. The LMR [median (range)] in GG and ACG at 2 months was 0.029 (0.006–0.090) and 0.033 (0.009–0.077), respectively, with P = 0.6133. IP normalized in 8 (57.1%) patients in each group (P = 1.000). The villous crypt ratio (VCR) [mean (SD)] in GG and ACG at 2 months was 2.68 (1.02) and 2.49 (0.67), respectively, (P = 0.347). At the end of 2 months LMR improved significantly in GG from 0.071 (0.041–0.254) to 0.029 (0.006–0.090) (P = 0.0012) and in ACG from 0.067 (0.040–0.136) to 0.033 (0.009–0.077) (P = 0.0063). VCR improved in the GG from 2.33 (0.77) to 2.68 (1.02) (P = 0.001), and in ACG from 2.26 (0.57) to 2.49 (0.67) (P = 0.009).

Conclusions

Intestinal permeability and morphology improved significantly in both glutamine and ACG.

Keywords

Crohn’s disease Glutamine Intestinal morphology Intestinal permeability Lactulose mannitol ratio Villous crypt ratio 

Notes

Acknowledgments

We acknowledge the Indian Council of Medical Research (ICMR) for providing a research grant to carry out this work, Claris lifesciences Ltd. India, for providing glutamine for 15 patients for 2 months and Mahaan Proteins Ltd, India, for providing whey protein for 15 patients for 2 months.

Conflict of interest

There is no conflict of interest in this work.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Jaya Benjamin
    • 1
  • Govind Makharia
    • 1
  • Vineet Ahuja
    • 1
  • K. D. Anand Rajan
    • 2
  • Mani Kalaivani
    • 3
  • Siddhartha Datta Gupta
    • 2
  • Yogendra Kumar Joshi
    • 1
    Email author
  1. 1.Department of Gastroenterology and Human NutritionAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of PathologyAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia

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