Effects of Early Enteral Glutamine Supplementation on Intestinal Permeability in Critically Ill Patients

Background and aims: Enteral administration of glutamine has been proposed as an effective recovery of intestinal barrier function.This amino acid has a modulating effect on the reducing bacterial translocation, which can influence immune functions of the intestine.The objective was to evaluate the effects of early enteral glutamine supplementation on intestinal permeability in critically ill patients. Materials and methods: A total of 80 critically ill patients older than 18 years were randomly assigned to one of two groups according to the stratified blocked randomization by age and admission category. Consecutive participants took enteral formula plus 0.3 g/kg/day glutamine powder or enteral formula plus maltodextrin during the ICU stay for a maximum of 10 days. Plasma glutamine, endotoxin, zonulin, and antiendotoxin immunoglobulin (Ig)G/IgM concentrations were measured on days 5 and 10 of intervention. Results: Out of 80 participants, 36 patients in the glutamine group and 34 patients in the control group were included in the analysis of the outcomes. Enteral glutamine significantly reduced plasma zonulin concentration up to 40% during 10 days. This reduction was significantly greater compared with that of the placebo group (P<0.001). Endotoxin concentration decreased in both groups; this reduction was significantly greater in the glutamine group (p = 0.014). The antiendotoxin IgM and IgG antibody levels increased in the glutamine group but decreased in the control group (p <0.001). There were no significant differences in clinical outcomes between two groups. Conclusion: Early enteral glutamine supplementation led to a declined intestinal permeability in critically ill patients.