AGA Clinical Practice Update on Management of Short Bowel Syndrome: Expert Review

DiBaise, John K.; Iyer, Kishore; Rubio–Tapia, Alberto

doi:10.1016/j.cgh.2022.05.032

Cited by 17 publications

(27 citation statements)

References 59 publications

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“…There are no randomized controlled trials comparing the effectiveness of these medications in patients with SBS; however, data may be extrapolated from their use in patients with high‐output ileostomies and fistulas 10 . Loperamide or diphenoxylate‐atropine, generally administered 30 min before meals and bedtime, are recommended first‐line agents because of their low incidence of systemic side effects 11 . In the case of loperamide, because of its normal uptake in the enterohepatic circulation, those patients with SBS without the distal ileum may require higher than conventionally recommended doses (eg, up to four tablets four times per day) to achieve a therapeutic response 2…”

Section: Diarrheamentioning

confidence: 99%

“…However, both hypotonic and hypertonic fluids can increase stool output and exacerbate diarrhea. 11 Oral rehydration solutions (ORSs) leverage the sodium-glucose cotransport system of the jejunum to promote passive absorption of water and electrolytes in the proximal intestine. 23 Patients with an endjejunostomy may benefit most from the use of ORSs, with a goal sodium concentration of 90-120 mEq/L.…”

Section: Fluid and Electrolyte Imbalancementioning

confidence: 99%

“…10 Loperamide or diphenoxylate-atropine, generally administered 30 min before meals and bedtime, are recommended first-line agents because of their low incidence of systemic side effects. 11 In the case of loperamide, because of its normal uptake in the enterohepatic circulation, those patients with SBS without the distal ileum may require higher than conventionally recommended doses (eg, up to four tablets four times per day) to achieve a therapeutic response. 2 More systemically available opioids such as codeine and tincture of opium are alternatives for patients with diarrhea; however, their use is generally limited to those with refractory diarrhea because of increased risk of centrally acting adverse effects such as sedation and potential for addiction.…”

Section: Diarrheamentioning

confidence: 99%

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Short bowel syndrome: Complications and management

Bering

DiBaise

2023

Nut in Clin Prac

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Short bowel syndrome (SBS) occurs when a patient loses bowel length or function significantly enough to cause malabsorption, oftentimes requiring lifelong parenteral support. In adults, this occurs most commonly in the setting of massive intestinal resection, whereas congenital anomalies and necrotizing enterocolitis predominate in children. Many patients with SBS develop long-term clinical complications over time related to their altered intestinal anatomy and physiology or to various treatment interventions such as parenteral nutrition and the central venous catheter through which it is administered. Identifying, preventing, and treating these complications can be challenging. This review will focus on the diagnosis, treatment, and prevention of several complications that can occur in this patient population, including diarrhea, fluid and electrolyte imbalance, vitamin and trace element derangements, metabolic bone disease, biliary disorders, small intestinal bacterial overgrowth, D-lactic acidosis, and complications of central venous catheters.

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Section: Diarrheamentioning

confidence: 99%

Section: Fluid and Electrolyte Imbalancementioning

confidence: 99%

Section: Diarrheamentioning

confidence: 99%

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Short bowel syndrome: Complications and management

Bering

DiBaise

2023

Nut in Clin Prac

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“…Although high‐dose rhGH was approved for 4‐week use in adult patients with SBS nearly a decade before the GLP‐2 analogue teduglutide, its use has not gained popularity in clinical practice, possibly owing to concerns of short‐lived benefits and a variety of potential adverse effects. By contrast, since it was first approved a decade ago, teduglutide continues to be used in both adults and children and is recommended as the first choice in SBS‐specific treatments 6,7 . Importantly, when effective at reducing or eliminating parenteral support, its lifelong use has been recommended 8 .…”

Section: Unmet Need: Demonstrate the Long‐term Safety And Effectivene...mentioning

confidence: 99%

Short bowel syndrome: Recognizing unmet needs

DiBaise

2023

Nut in Clin Prac

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“…In patients with SBS and a remnant colon, the potential stimulatory colonic effects of malabsorbed bile acids have prompted the use of bile acid binders, such as cholestyramine. However, the use of these sequestrants may worsen steatorrhea in SBS because of the presence of a diminished bile acid pool, with additional losses of fat‐soluble vitamins 2 . In contrast, conjugated bile acid replacement therapy (eg, ox bile supplements) showed beneficial effects on fat absorption and nutrition status in patients with SBS with or without a colon, although their availability is limited 26,27 .…”

Section: Nonconventional Therapymentioning

confidence: 99%

Treatment of short bowel syndrome: Breaking the therapeutic ceiling?

Wauters

Joly

2023

Nut in Clin Prac

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Short bowel syndrome (SBS) is the most common cause of chronic intestinal failure, requiring home parenteral support (intravenous fluid, parenteral nutrition, or parenteral nutrition with intravenous fluid) to compensate for severe malabsorption. The loss of mucosal absorptive area after extensive intestinal resection is accompanied by an accelerated transit and hypersecretion. Changes in physiology and clinical outcomes differ between patients with SBS with or without the distal ileum and/or colon-in-continuity. This narrative review summarizes the treatments used in SBS, with a focus on novel approaches with intestinotrophic agents. During the early postoperative years, spontaneous adaptation occurs and can be induced or accelerated with conventional therapies, which include dietary and fluid modifications and antidiarrheal and antisecretory drugs. Based on the proadaptive role of enterohormones (eg, glucagon-like peptide [GLP]-2), analogues have been developed to allow enhanced or hyperadaptation after a period of stabilization.Teduglutide is the first GLP-2 analogue developed and commercialized with proadaptive effects resulting in reduced parenteral support needs; however, the potential for weaning of parenteral support is variable. Whether early treatment with enterohormones or accelerated hyperadaptation would further improve absorption and outcomes remains to be shown. Longer-acting GLP-2 analogues are currently being investigated. Encouraging reports with GLP-1 agonists require confirmation in randomized trials, and dual GLP-1 and GLP-2analogues have yet to be clinically investigated. Future studies will prove whether the timing and/or combinations of different enterohormones will be able to break the ceiling of intestinal rehabilitation in SBS.

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AGA Clinical Practice Update on Management of Short Bowel Syndrome: Expert Review

Cited by 17 publications

References 59 publications

Short bowel syndrome: Complications and management

Short bowel syndrome: Complications and management

Short bowel syndrome: Recognizing unmet needs

Treatment of short bowel syndrome: Breaking the therapeutic ceiling?

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