Home parenteral nutrition (HPN) has saved the\u00a0lives of thousands of short bowel syndrome (SBS)\u00a0patients with intestinal failure (IF) since the introduction in the late 1960s. SBS-IF patients have inadequate absorption of fluid, electrolytes, macronutrients, trace elements, or vitamins to meet their\u00a0metabolic requirements and fail to maintain their\u00a0hydration, body composition, function, and health\u00a0without parenteral support (PS). In adults, SBS is\u00a0most frequently seen following intestinal resections due to inflammatory bowel disease (IBD),\u00a0mesenteric vascular disease, complications to\u00a0non-IBD surgery (ileus, volvulus, leakage of\u00a0anastomoses, etc.), and complications to treatment of cancers, whereas in children, resections\u00a0are also seen as a consequence of congenital\u00a0defects or necrotizing enterocolitis. However,\u00a0extensive parenchymal and mucosal disease of\u00a0the bowel may also diminish the absorptive capacity of the bowel \u2013 in the absence of resection \u2013 and\u00a0lead to \u201cfunctional short bowel syndrome\u201d and IF.<\/p>\n
The short bowel syndrome could be considered as a spectrum, where\u00a0SBS patients with intestinal insufficiency are able\u00a0to compensate for their malabsorption by increasing oral intake (hyperphagia) and adapt metabolically or pharmacologically, whereas SBS\u00a0patients with intestinal failure (SBS-IF)\u00a0require\u00a0supplemental or total PS. It is clear that, although\u00a0all patients with intestinal resections and malabsorption are included in the same syndrome, they\u00a0are truly heterogeneous and present with many\u00a0phenotypes as described in a recent review.<\/p>\n
Although providing a lifesaving option in the\u00a0home environment of the SBS-IF patient, these\u00a0patients are not only challenged by the inconveniences and symptoms of their gastrointestinal\u00a0disorder but also by the fear of \u2013 or the factual\u00a0burden of \u2013 the potentially life-threatening complications of HPN. Therefore, treatments should\u00a0seek to maximize remnant intestinal absorption,\u00a0decrease malabsorption and accompanying symptoms, and reduce the fear, burdens, or complications related to HPN, thereby ultimately\u00a0improving the health-related quality of life in\u00a0SBS-IF patients.<\/p>\n
In general, treatments aiming to increase intestinal absorption have consisted of dietary advice\u00a0in conjunction with a limited pharmacological\u00a0treatment armamentarium, mainly including\u00a0antisecretory and antidiarrheal agents. Only few centers\u00a0taking care of SBS patients have the facilities,\u00a0methods, and resources to objectively assess\u00a0effects of interventions on intestinal absorption\u00a0in the individual patients. With the large interpatient treatment-effect variability in relation to\u00a0interventions, mainly due to the large patient heterogeneity, the evaluations of the true effects of\u00a0each of the components of the multidimensional\u00a0treatment approach frequently rely on subjective\u00a0global assessments by the physician and on the\u00a0patients feedback rather than on objective measurements of intestinal function. In general, the\u00a0maximal intestinal digestion and absorption is\u00a0sought by maximizing the exposure of the mucosal\u00a0surface area to nutrients, fluids, electrolytes, trace\u00a0elements, and vitamins in the right form, concentration, and composition, at the right place, in the\u00a0right environment, and in a timely fashion as\u00a0described in a recent review.<\/p>\n
Over the past decades, it has become increasingly clear that mucosal nerve ends and endocrine\u00a0cells within the gastrointestinal tract mediate\u00a0information via the enteric nervous system in\u00a0response to the passing of luminal contents,\u00a0thereby contributing to the highly coordinated\u00a0processes of nutrient assimilation. These \u201cneuroendocrine feedback mechanisms\u201d often referred\u00a0to as the \u201cgastric, jejunal, ileal, or colonic brakes\u201d\u00a0may be disrupted by intestinal resections or mucosal disease.\u00a0The attenuation of the meal-stimulated secretion\u00a0of hormones, such as the glucagon-like peptides\u00a0(GLPs) 1 and 2 <\/a>and peptide YY<\/a> by L cells in the\u00a0terminal ileum and the colon, may be associated\u00a0with some of the pathophysiological features of\u00a0SBS patients with distal bowel resections: accelerated gastrointestinal motility, gastric and intestinal hypersecretion,\u00a0diminished intestinal blood flow, disturbed immunological and barrier functions, and impaired\u00a0mucosal replacement, repair, and adaptation.\u00a0In SBS patients with a terminal ileum or colon in\u00a0continuity, an increase in the endogenous hormonal\u00a0secretion may be responsible for the progressive intestinal adaptation believed to occur in\u00a0these patients.<\/p>\n Consequently, these observations have instigated the pharmacological use of hormonal factors in the intestinal rehabilitation of SBS patients.\u00a0The first peptide hormone to gain marketing\u00a0approval for the treatment of SBS patients is the\u00a0GLP-2 agonist teduglutide. Teduglutide has\u00a0recently gained approval by the US Food and\u00a0Drug Administration and European Medicines\u00a0Agency. NPS Pharmaceuticals has marketed\u00a0teduglutide as Gattex\u00ae\u00a0in the United States and\u00a0seek to market teduglutide as Revestive\u00ae\u00a0\u00a0in Europe in the near future.\u00a0When introducing new therapies, it is prudent\u00a0to evaluate and balance the benefit or clinical\u00a0meaningfulness of interventions versus the inconveniences, adverse effects, risks, and costs. This\u00a0chapter describes the results of the clinical trials of\u00a0native GLP-2 and of teduglutide, leading to marketing approval of the latter for the treatment of\u00a0SBS patients, in this respect.<\/p>\n <\/p>\n Reference:<\/p>\n Palle Bekker Jeppesen<\/p>\n","protected":false},"excerpt":{"rendered":" Home parenteral nutrition (HPN) has saved the\u00a0lives of thousands of short bowel syndrome (SBS)\u00a0patients with intestinal failure (IF) since the introduction in the late 1960s. SBS-IF patients have inadequate absorption …<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[75],"tags":[83,84,82],"_links":{"self":[{"href":"https:\/\/www.creative-peptides.com\/blog\/wp-json\/wp\/v2\/posts\/443"}],"collection":[{"href":"https:\/\/www.creative-peptides.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.creative-peptides.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.creative-peptides.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.creative-peptides.com\/blog\/wp-json\/wp\/v2\/comments?post=443"}],"version-history":[{"count":1,"href":"https:\/\/www.creative-peptides.com\/blog\/wp-json\/wp\/v2\/posts\/443\/revisions"}],"predecessor-version":[{"id":444,"href":"https:\/\/www.creative-peptides.com\/blog\/wp-json\/wp\/v2\/posts\/443\/revisions\/444"}],"wp:attachment":[{"href":"https:\/\/www.creative-peptides.com\/blog\/wp-json\/wp\/v2\/media?parent=443"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.creative-peptides.com\/blog\/wp-json\/wp\/v2\/categories?post=443"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.creative-peptides.com\/blog\/wp-json\/wp\/v2\/tags?post=443"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}