Perioperative Growth Hormone Treatment Increases Nitrogen and Fluid Balance and Results in Short-term and Long-term Conservation of Lean Tissue.
The surgical procedure for forming an ileoanal anastomosis with a J pouch (IAA) usually involves a temporary ileostomy. Patients undergoing IAA surgery thus need to recover quickly because they return for ileostomy closure three months later. We evaluated the effects of perioperative biosynthetic growth hormone (GH) treatment on short- and long-term changes in body composition and on nutritional intake. Patients with ulcerative colitis undergoing IAA surgery were randomly assigned to double-blind treatment with placebo (n = 12) or 6 IU GH twice daily (n = 12) from two day before to seven days after the operation. Examinations were from two days before to nine days after the operation and on days 30 and 90. Body composition was assessed with a dual-energy X-ray absorptiometry scanner. The two groups had similar nutritional intakes. On postoperative day seven, placebo-treated patients had lost 4.2 kg (95% CI: 3.0, 5.4) total tissue mass, 3.6 kg (2.1, 5.1) lean tissue mass, and 0.5 kg (-0.1, 1.2) fat mass. These reductions persisted three months later. Compared with placebo, GH improved nitrogen balance, changes in lean tissue mass [gain of 4.0 kg (1.9, 6.0), P=0.001], and changes in total tissue mass [gain of 3.2 kg (1.6, 4.9), P=0.001], but increased the loss of fat mass [loss of 0.7 kg (0.0, 1.5), P=0.049] on postoperative day seven. Three months later, the placebo-treated patients had lost 2.4 kg (0.7, 4.2) more lean tissue mass than GH-treated patients (P=0.009), whereas changes in total tissue and fat mass were not significantly different. Hence, GH treatment enhanced the long-term regain of tissue mass.
