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Pharmacologic options for intestinal rehabilitation in patients with short bowel syndrome

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  1. The effect of glucagon-like peptide-1 and glucagon-like peptide-2 on microcirculation: a systematic review

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  3. Randomised clinical trial: 2% taurolidine versus 0.9% saline locking in patients on home parenteral nutrition

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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.

Original languageEnglish
JournalJournal of Parenteral and Enteral Nutrition
Volume38
Issue number1 Suppl
Pages (from-to)45S-52S
ISSN0148-6071
DOIs
Publication statusPublished - May 2014

    Research areas

  • Adaptation, Physiological, Clinical Trials, Phase III as Topic, Glucagon-Like Peptide 2, Human Growth Hormone, Humans, Intestinal Absorption, Intestines, Parenteral Nutrition, Peptides, Short Bowel Syndrome

ID: 45056276