The non-surgical treatment of adult patients with short bowel syndrome

Jeppesen, Palle Bekker

doi:10.1517/21678707.2013.814536

Cited by 11 publications

(4 citation statements)

References 68 publications

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“…Tanto la anatomía del circuito intestinal remanente del caso que presentamos así como su longitud y tiempo de evolución hacen actualmente improbable la rehabilitación intestinal completa con el tratamiento presente, dado que mientras la mitad de los adultos con síndrome de intestino corto y falla intestinal tipo III pueden independizarse completamente de la NPC dentro de los cinco años posteriores al diagnóstico, menos del 6% aban-donarán la NP utilizando métodos convencionales si no se logra la independencia en los primeros dos años posteriores a la resección (18)(19)(20) . La reconstrucción gastrointestinal autóloga incluye varias técnicas que manipulan el intestino quirúrgicamente para facilitar el proceso de adaptación intestinal y la restauración de la nutrición enteral.…”

Section: Discusión Y Comentariosunclassified

Dependiendo de la nutrición parenteral para sobrevivir. Falla intestinal crónica por síndrome de intestino corto. Comunicación de un caso y revisión de la literatura

Moreira

López

Silva

et al. 2019

REVISTA MEDICA DEL URUGUAY

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Cuando la falla intestinal ocurre luego de una resección intestinal masiva se denomina síndrome de intestino corto. Es una entidad rara, con un espectro clínico que va desde una disfunción leve y reversible hasta una condición grave e incapacitante. Presenta una elevada morbimortalidad, altos costos de atención médica e importante impacto en la calidad de vida. El 50% de los pacientes con síndrome de intestino corto no se adaptan espontáneamente ni mejoran la absorción por el intestino remanente, por lo que deben recurrir de por vida a la nutrición parenteral. La terapia nutricional especializada y el tratamiento hormonal focalizado en el intestino son pilares en la rehabilitación promoviendo la adaptación intestinal, logrando independencia de la nutrición parenteral y evitando el trasplante intestinal. Actualmente, teduglutide es el tratamiento de referencia en estos pacientes, pero hasta el momento inaccesible en Uruguay por su elevado costo. Presentamos el único caso en nuestro país de un paciente de 23 años portador de falla intestinal crónica por síndrome de intestino corto que depende de la nutrición parenteral desde hace 17 años y presenta complicaciones graves asociadas a esta técnica. Palabras clave: Síndrome del intestino corto Nutrición parenteral Teduglutida Fallo intestinal Enfermedad crónica

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Section: Discusión Y Comentariosunclassified

Dependiendo de la nutrición parenteral para sobrevivir. Falla intestinal crónica por síndrome de intestino corto. Comunicación de un caso y revisión de la literatura

Moreira

López

Silva

et al. 2019

REVISTA MEDICA DEL URUGUAY

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“…Teduglutide is recommended for clinically stable patients with nonobstructive, nonmalignant disease who require PN even following optimization of diet, hydration, and adjunctive medications 125 . Because of the potential for the acceleration of hyperplasia with teduglutide, a colonoscopy to evaluate the occurrence of polyps is recommended before treatment initiation, along with periodic follow‐up colonoscopies 37 , 126 . In addition, teduglutide is contraindicated in patients with current or a past malignancy, except for basal cell carcinoma.…”

Section: Augmenting Adaptation and Absorptionmentioning

confidence: 99%

Short Bowel Syndrome

Kelly

Tappenden

Winkler

2013

J Parenter Enteral Nutr

111

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Short bowel syndrome (SBS) occurs as a result of intestinal resection, and in many patients is associated with complications, such as diarrhea, dehydration, weight loss, and nutrition deficiencies. Many individuals with SBS develop intestinal failure and require parenteral nutrition (PN) and/or intravenous (IV) fluids (PN/IV). Although PN is essential for survival, some patients with SBS who require long-term PN experience significant complications that contribute to morbidity and mortality. Consequently, therapies that decrease reliance on PN are of considerable importance. Intestinal adaptation, which results in morphologic and functional changes that increase performance of the remnant bowel, occurs spontaneously after intestinal resection. These effects can be enhanced with nutrition and pharmaceutical approaches. For example, oral or tube-fed nutrients stimulate growth and adaptation of intestinal tissues. In addition, prebiotics support growth of beneficial intestinal microbiota that produce short-chain fatty acids, which have been shown in preclinical studies to enhance intestinal structure and function. Finally, glucagon-like peptide 2 (GLP-2) is an endogenous peptide that promotes intestinal rehabilitation and improves intestinal absorption. Teduglutide, a recombinant human GLP-2 analog, has recently been approved in the United States for the treatment of adults with SBS who are dependent on PN. In pharmacodynamic and clinical studies, teduglutide has been shown to promote changes in intestinal structure, such as increases in villus height and crypt depth, and to improve intestinal absorption, as indicated by reduced PN/IV dependence. This article presents a brief overview of SBS, including effects on survival and quality of life and current treatment options.

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“…Patients with short bowel syndrome (SBS) are heterogeneous in their disease phenotype, as a result of variable origins of their SBS state as well as differences in length, anatomy, and health of the remnant intestine 1 , 2 . Consequently, a myriad of management strategies involving diet and therapeutic interventions might be considered and, most important, must be individualized for each patient 3 , 4 . Digestion and absorption are optimized through multiple complementary strategies that target gastrointestinal motility, secretions, and adaptation.…”

mentioning

confidence: 99%

“…1,2 Consequently, a myriad of management strategies involving diet and therapeutic interventions might be considered and, most important, must be individualized for each patient. 3,4 Digestion and absorption are optimized through multiple complementary strategies that target gastrointestinal motility, secretions, and adaptation. Oral rather than parenteral delivery of nutrition enhances the endogenous process of intestinal adaptation following resection and should be implemented to the fullest extent possible.…”

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confidence: 99%

Pharmacologic Options for Intestinal Rehabilitation in Patients With Short Bowel Syndrome

Jeppesen

2014

J Parenter Enteral Nutr

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A primary goal of intestinal rehabilitation programs is to facilitate intestinal adaptation. Adult patients with short bowel syndrome (SBS) who are dependent on parenteral nutrition and/or intravenous fluid (PN/IV) support have 2 hormonal pharmacologic treatment options available that may promote intestinal growth: a glucagon-like peptide 2 analog (teduglutide) and recombinant human growth hormone (somatropin). In two phase III clinical trials (N=169), 24 weeks of teduglutide administered to outpatients with SBS resulted in significant decreases in PN/IV volume requirements of 2.5-4.4 L/wk. In an extension study of one of these trials, patients with SBS who completed 30 months of teduglutide experienced a mean PN/IV reduction of 7.6 L/wk from baseline. Furthermore, some patients achieved independence from PN/IV support. The most common adverse events associated with teduglutide treatment in clinical trials were gastrointestinal symptoms, including abdominal distension, abdominal pain, and nausea. This safety profile is consistent with the associated underlying diseases leading to SBS or the known mechanism of action of teduglutide. A single phase III study (N=41) evaluated the safety and efficacy of a 4-week inpatient course of somatropin in combination with a glutamine-supplemented diet for adults with SBS. Somatropin treatment significantly reduced parenteral support requirements by 1.1 L/d in these patients. The most common adverse events were peripheral edema and musculoskeletal events. Large-scale, long-term follow-up studies of somatropin for SBS have not been conducted. Although treatment for patients with SBS must be individualized, teduglutide and somatropin are positive extensions to existing fluid and nutrient management strategies.

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The non-surgical treatment of adult patients with short bowel syndrome

Cited by 11 publications

References 68 publications

Dependiendo de la nutrición parenteral para sobrevivir. Falla intestinal crónica por síndrome de intestino corto. Comunicación de un caso y revisión de la literatura

Dependiendo de la nutrición parenteral para sobrevivir. Falla intestinal crónica por síndrome de intestino corto. Comunicación de un caso y revisión de la literatura

Short Bowel Syndrome

Pharmacologic Options for Intestinal Rehabilitation in Patients With Short Bowel Syndrome

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