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

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.

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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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Correspondence to Yogendra Kumar Joshi.

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Benjamin, J., Makharia, G., Ahuja, V. et al. Glutamine and Whey Protein Improve Intestinal Permeability and Morphology in Patients with Crohn’s Disease: A Randomized Controlled Trial. Dig Dis Sci 57, 1000–1012 (2012). https://doi.org/10.1007/s10620-011-1947-9

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Keywords

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