Use of Glutamine in Crohn’s Disease Needs More Evaluation, Review Finds

Use of Glutamine in Crohn’s Disease Needs More Evaluation, Review Finds

A review published by the The Cochrane Library reported that there is not enough evidence to draw conclusions about the efficacy and safety of glutamine for inducing remission in patients with Crohn’s disease. The review is titled Glutamine for induction of remission in Crohn’s disease.”

“Considering that glutamine may have positive nutritional, metabolic and immunologic benefits with respect to Crohn’s disease, it has been trialed for the treatment of people with the disease,” researchers from Sidra Medical and Research Center wrote in a press release. The team analyzed relevant studies published before Nov. 15, 2015.

In addition, two small randomized controlled clinical trials were included in the review. The first trial was a double-blind, single-center study conducted in the United Kingdom, and included 18 patients with active Crohn’s disease, all younger than 16 years of age. Patients received either a standard polymeric diet with low glutamine content – corresponding to 4 percent of total amino acid composition – or a glutamine-enriched polymeric diet holding 42 percent glutamine. The diet was administered over four weeks, and if the patients could not consume the diet orally, it was administered using a nasogastric tube. After four weeks, clinical remission was analyzed.

The trial reported no difference in remission rates between the groups, with 44 percent achieving remission in the glutamine group and 56 percent in the control group. The overall quality of the data was deemed low by the reviewers, who said the data was associated with “serious imprecision.”

The second trial, also a double-blind, single-center study, was performed in Germany, and included 24 adults with acute exacerbations of inflammatory bowel disease, of whom 19 had Crohn’s disease. All patients were considered for total intravenous feeding. They received 0.3 g/kg per day of alanyl­-glutamine in a standard amino acid solution, or the standard solution without glutamine. After one week of treatment, the researchers measured glutamine plasma concentrations and intestinal permeability of the patients, but could not report differences in permeability between the groups.

The trial involving children could also not detect any differences in intestinal permeability. Moreover, researchers noted that the study did not report data on endoscopic remission, clinical response, quality of life or growth in the children. While there were no serious adverse events during the study, the review noted that adverse events were generally not well documented.

In the adult study, however, three infections in the central catheter, confirmed with positive blood cultures, occurred in the glutamine-treated patients. No such infections were observed in the control group.

While both clinical trials reported negative efficacy results, the review concludes that the available evidence is not of good enough quality to draw any conclusions about the efficacy and safety of glutamine in Crohn’s disease. More large clinical trials are needed to clear the role of glutamine in Crohn’s management.

One comment

  1. magdeleine Frieberg says:

    Glutamine is the most abundant free amino acid in the body and commonly classified as a nonessential or a conditionally essential amino acid in catabolic conditions. The main glutamine functions within the cell include; its role in nitrogen balance, maintaining the cellular redox state, regulation of glucose metabolism and acid base homeostasis. In addition, it has an important role in cell-mediated immunity and the integrity of the intestinal mucosa. Glutamine stores are depleted during severe metabolic stress (i.e., trauma, sepsis, major surgery, inflammatory bowel diseases, etc). Glutamine supplementation during illness increases gut barrier, lymphocyte function and preserves lean body mass. Furthermore it causes a profound improvement in intestinal barrier function in highly stressed patients. This review will discuss effects of glutamine in patients with inflammatory bowel diseases.
    In vitro, animal and many recent human studies evaluated the role of several ways of glutamine supplementation including oral, enteral and parenteral rout in patients with inflammatory bowel disease. There is contradictory evidence regarding whether glutamine can improve IBD. It was reported that glutamine enriched oral diet offer no advantage in the treatment of active Crohn’s disease. In addition, enteral and parenteral glutamine administration has no biochemical or clinical benefit in patients with active IBD. In contrast, limited studies concluded that orally glutamine supplementation have favorable effect on treating IBD. Briefly we can conclude that it is inappropriate to recommend glutamine for therapeutic use in active phase of inflammatory bowel diseases. Further understanding and application of glutamine-based therapeutics effects can be enhanced by future studies.

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