The use of glutamine in the treatment of gastrointestinal disorders in man

The human gastrointestinal tract (GIT) is a major site of glutamine utilisation accounting for more than half of the net splanchnic utilisation (∼15 g/day) of glutamine obtained from the systemic circulation. Dietary glutamine (∼5 g/day) is less important than circulating glutamine, especially in disease conditions associated with substantial reduction in food intake. Glutamine has multiple effects on the structure and function of the GIT, and effects in improving morbidity and mortality in animal models of GIT damage has led to a series of studies in man, which have produced variable results. Glutamine administration to treat mucositis of the upper GIT (mouth, oesophagus) due to cytotoxic drug therapy, has produced no evidence of benefit. Early studies suggested improved healing, as do recent studies of small intestinal mucositis resulting from chemotherapy. Investigations in colitis are lacking although in experimental rat models of colitis, no benefit has been reported. Multiple explanations can be put forward to explain the overall results, including the GIT distribution of enzymes involved in glutamine metabolism. Apart from the lower stomach in man (upper stomach in the rat) there is very little weak activity of glutamine synthetase, suggesting that the gut derives glutamine formed in other tissues and from the diet. The activity of glutaminase, which is key flux generating enzyme involved in glutaminolysis is very weak in mucosa with stratified squamous epithelium (oesophagus), where intermediate in the same intestine, and highest in the small intestinal mucosa which accounts for about 80% of the total glutaminase in the entire human GIT mucosa.