Hepatobiliary Manifestations of Short Bowel Syndrome and Intestinal Failure–Associated Liver Disease

Wang, Jennifer; Micic, Dejan

doi:10.1002/cld.1053

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…Since liver function was not directly examined in the articles included it is difficult to know its contribution, particularly since SBS is associated with liver disease [37]. Whilst a handful of animal models have reported increased relative abundance of Enterobacteriaceae following ileocolic resection [38, 39], its significance for BAs is conflicting since it is also associated with low‐BA environments [40]. Nonetheless, it is clear there is a lack of experimental data to explain BAs and microbial interactions following ileal surgery.…”

Section: Discussionmentioning

confidence: 99%

Influence of the bile acid/microbiota axis in ileal surgery: a systematic review

Senanayake,

Makanyengo,

Hoedt

et al. 2024

Colorectal Disease

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AimThe gastrointestinal bile acid (BA)/microbiota axis has emerged as a potential mediator of health and disease, particularly in relation to pathologies such as inflammatory bowel disease (IBD) and colorectal cancer. Whilst it presents an exciting new avenue for therapies, it has not yet been characterized in surgical resection of the ileum, where BA reabsorption occurs. The identification of BA/microbiota signatures may provide future therapies with perioperative personalized medicine. In this work we conduct a systematic review with the aim of investigating the microbiome and BA changes that are associated with resection of the ileum.MethodThe databases included were MEDLINE, EMBASE, Web of Science and Cochrane libraries. The outcomes of interest were faecal microbiome and BA signatures after ileal resection.ResultsOf the initial 3106 articles, three studies met the inclusion/exclusion criteria for data extraction. A total of 257 patients (46% surgery, 54% nonsurgery controls) were included in the three studies. Two studies included patients with short bowel syndrome and the other included patients with IBD. Large‐scale microbiota changes were reported. In general, alpha diversity had decreased amongst patients with ileal surgery. Phylum‐level changes included decreased Bacteroidetes and increased Proteobacteria and Fusobacteria in patients with an intestinal resection. Surgery was associated with increased total faecal BAs, cholic acid and chenodeoxycholic acid. There were decreases in deoxycholic acid and glycine and taurine conjugated bile salts. Integrated BA and microbiota data identified correlations with several bacterial families and BA.ConclusionThe BA/microbiota axis is still a novel area with minimal observational data in surgery. Further mechanistic research is necessary to further explore this and identify its role in improving perioperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Influence of the bile acid/microbiota axis in ileal surgery: a systematic review

Senanayake,

Makanyengo,

Hoedt

et al. 2024

Colorectal Disease

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“…Proposed factors related to the development of IFALD include a host of factors (length of bowel remaining, presence or absence of colon), micronutrient de ciencies (choline, carnitine), small intestinal bacterial overgrowth (SIBO), and recurrent line infections [3,5]. Factors related to the PN therapy include the amount of the calories provided and the amount and type of lipid emulsion [6].…”

Section: Introductionmentioning

confidence: 99%

Parenteral fish oil lipid emulsion use in adults: A case series and review from an intestinal failure referral center

hakimian,

Wall,

Herlitz

et al. 2024

Preprint

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Background: Intestinal failure–associated liver disease (IFALD) is a complication of long-term PN use, attributed to use of ω-6 injectable lipid emulsions (ILE). Fish oil (FO) ILE have been successful in reversing liver injury in neonates. Evidence for pure FO ILE use in adult patients is limited. Methods: Case series of the use of FO lipid emulsions in adults with IFALD from the University of Chicago PN registry. Analysis of medical charts and PN formulations was performed. Results: Three cases of IFALD treated with FO ILE were identified. The first case was a 30 year old man with short bowel syndrome (SBS), hyperbilirubinemia, and biopsy proven IFALD. Following a change from a soy lipid emulsion to FO lipid emulsion, his liver tests rapidly improved and remained stable over 202 weeks of use. The second case was a 76 year old woman with intestinal failure (IF) due to frozen bowel. A change from a soy ILE to a composite lipid and later to a pure FO ILE did not result in improvement in her liver tests. The third case was a 28 year old man with SBS and biopsy proven IFALD. Change to a composite ILE and subsequently FO lipid emulsion resulted in a gradual improvement in liver tests. No clinical essential fatty acid deficiencies (EFA) were identified during treatment. Conclusion: FO ILE may be effective in the treatment of adult patients with cholestatic IFALD. Use is safe with no EFA deficiencies detected in up to four years of use.

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“…3 Patients with SBS-IF have an increased risk of complications including liver disease, gall bladder dis-ease, and nutrient deficiencies. [4][5][6] Renal impairment is also a common complication in these patients. 7 Renal impairment is associated with adverse outcomes that can severely affect quality of life or even survival.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with SBS‐IF have an increased risk of complications including liver disease, gall bladder disease, and nutrient deficiencies 4–6 . Renal impairment is also a common complication in these patients 7 .…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics and Tolerability of a Single Dose of Apraglutide, a Novel, Long‐Acting, Synthetic glucagon‐like peptide‐2 Analog With a Unique Pharmacologic Profile, in Individuals With Impaired Renal Function

Greig,

Youssef,

Bolognani

2024

The Journal of Clinical Pharma

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Renal impairment is a common complication in patients with short bowel syndrome with intestinal failure (SBS‐IF). Glucagon‐like peptide‐2 analogs, such as apraglutide, have been developed as a treatment option for SBS‐IF. This study assessed the potential for apraglutide overexposure in individuals with severely impaired renal function versus healthy volunteers with normal renal function. In this phase 1, open‐label, multicenter, nonrandomized, parallel‐group study, a single dose of apraglutide 5 mg was administered subcutaneously to individuals with severely impaired renal function (<30 mL/min/1.73 m2) and healthy volunteers with normal renal function (≥90 mL/min/1.73 m2). Primary pharmacokinetic endpoints were maximum observed concentration (Cmax) and exposure to apraglutide (area under the curve [AUC] from time 0 to infinity [AUCinf], and AUC from time 0 to the last quantifiable concentration [AUClast]). Each group comprised 8 individuals. Results show that patients with severe renal impairment do not have increased apraglutide exposure. Apraglutide achieved a lower Cmax and AUCinf in individuals with severe renal impairment versus those with normal renal function (Cmax = 36.9 vs 59.5 ng/L; AUCinf = 3100 vs 4470 h · ng/mL, respectively). The respective geometric mean ratios were 0.620 and 0.693 for Cmax and AUCinf, and the upper bound of their 90% confidence intervals were <2, indicating patients with severe renal impairment were not overexposed to apraglutide versus those with normal renal function. Adverse events were mild or moderate in severity. Apraglutide does not require dose reduction for any degree of renal impairment and could be used in a broader patient population of renally impaired patients without dose adjustment.

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Hepatobiliary Manifestations of Short Bowel Syndrome and Intestinal Failure–Associated Liver Disease

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/17-4-reading-wang a video presentation of this article

Cited by 4 publications

References 16 publications

Influence of the bile acid/microbiota axis in ileal surgery: a systematic review

Influence of the bile acid/microbiota axis in ileal surgery: a systematic review

Parenteral fish oil lipid emulsion use in adults: A case series and review from an intestinal failure referral center

Pharmacokinetics and Tolerability of a Single Dose of Apraglutide, a Novel, Long‐Acting, Synthetic glucagon‐like peptide‐2 Analog With a Unique Pharmacologic Profile, in Individuals With Impaired Renal Function

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