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Solar H, Ortega ML, Gondolesi G. Current Status of Chronic Intestinal Failure Management in Adults. Nutrients 2024; 16:2648. [PMID: 39203785 PMCID: PMC11356806 DOI: 10.3390/nu16162648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Chronic intestinal failure (CIF) is a heterogeneous disease that affects pediatric and adult populations worldwide and requires complex multidisciplinary management. In recent years, many advances in intravenous supplementation support, surgical techniques, pharmacological management, and intestinal transplants have been published. Based on these advances, international societies have published multiple recommendations and guidelines for the management of these patients. The purpose of this paper is to show the differences that currently exist between the recommendations (ideal life) and the experiences published by different programs around the world. METHODS A review of the literature in PubMed from 1980 to 2024 was carried out using the following terms: intestinal failure, CIF, home parenteral nutrition, short bowel syndrome, chronic intestinal pseudo-obstruction, intestinal transplant, enterohormones, and glucagon-like peptide-2. CONCLUSIONS There is a difference between what is recommended in the guidelines and consensus and what is applied in real life. Most of the world's countries are not able to offer all of the steps needed to treat this pathology. The development of cooperative networks between countries is necessary to ensure access to comprehensive treatment for most patients on all continents, but especially in low-income countries.
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Affiliation(s)
- Héctor Solar
- Nutritional Support, Intestinal Rehabilitation and Intestinal Transplant Unit, Hospital Universitario Fundación Favaloro, Buenos Aires C1093AAS, Argentina; (M.L.O.); (G.G.)
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Gondolesi GE, Pape UF, Mason JB, Allard JP, Pironi L, Casas MNV, Schwartz LK, Joly F, Gabriel A, Sabrdaran S, Zhang P, Kohl-Sobania M, Huang YW, Jeppesen PB. Baseline Characteristics of Adult Patients Treated and Never Treated with Teduglutide in a Multinational Short Bowel Syndrome and Intestinal Failure Registry. Nutrients 2024; 16:2513. [PMID: 39125394 PMCID: PMC11314329 DOI: 10.3390/nu16152513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
The Short Bowel Syndrome (SBS) Registry (NCT01990040) is a multinational real-world study evaluating the long-term safety of teduglutide in patients with SBS and intestinal failure (SBS-IF) in routine clinical practice. This paper describes the study methodology and baseline characteristics of adult patients who have (ever-treated) or have never (never-treated) received teduglutide. A total of 1411 adult patients (679 ever-treated; 732 never-treated) were enrolled at 124 sites across 17 countries. The mean (standard deviation [SD]) age at enrollment was 55.4 (15.46) years, and 60.2% of patients were women. Crohn's disease was the most common cause of major intestinal resection in both ever-treated (34.1%) and never-treated patients (20.4%). A similar proportion of ever-treated and never-treated patients had a prior history of colorectal polyps (2.7% vs. 3.6%), whereas proportionally fewer ever-treated patients reported a history of colorectal cancer (1.8% vs. 6.2%) or any malignancy (17.7% vs. 30.0%) than never-treated patients. Never-treated patients received a numerically greater mean (SD) volume of parenteral nutrition and/or intravenous fluids than ever-treated patients (12.4 [8.02] vs. 10.1 [6.64] L/week). Ever-treated patients received a mean teduglutide dosage of 0.05 mg/kg/day. This is the first report of patient baseline characteristics from the SBS Registry, and the largest cohort of patients with SBS-IF to date. Overall, ever-treated and never-treated patients had similar baseline characteristics. Differences between treatment groups may reflect variations in patient selection and degree of monitoring.
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Affiliation(s)
- Gabriel E. Gondolesi
- Intestinal Failure, Rehabilitation and Transplant Unit, Hospital Universitario Fundación Favaloro, Buenos Aires C1044AAA, Argentina
| | - Ulrich-Frank Pape
- Asklepios Klinik St. Georg, Asklepios Medical School, 20099 Hamburg, Germany
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, 13353 Berlin, Germany
| | - Joel B. Mason
- Tufts Medical Center, Tufts University, Boston, MA 02111, USA
| | - Johane P. Allard
- Toronto General Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
- Centre for Chronic Intestinal Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | | | - Francisca Joly
- Hôpital Beaujon, University of Paris Cité, 92110 Clichy, France
| | - André Gabriel
- Takeda Development Center Americas, Inc., Cambridge, MA 02142, USA
| | - Sasan Sabrdaran
- Takeda Development Center Americas, Inc., Cambridge, MA 02142, USA
| | - Pinggao Zhang
- Takeda Development Center Americas, Inc., Cambridge, MA 02142, USA
| | - Martina Kohl-Sobania
- Outpatient Clinic, Pediatric Emergency Department, University Hospital Schleswig-Holstein, 23538 Lübeck, Germany
| | - Yi-Wen Huang
- Takeda Development Center Americas, Inc., Cambridge, MA 02142, USA
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Frau T, El Khatib M, De Dreuille B, Billiauws L, Nuzzo A, Joly F. Emerging drugs for the treatment of short bowel syndrome. Expert Opin Emerg Drugs 2024:1-12. [PMID: 38761162 DOI: 10.1080/14728214.2024.2357567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/16/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION SBS is a rare and disabling condition. The standard management is based on diet optimization with parenteral supplementation. In addition, glucagon-like peptide-2 (GLP-2)analogs, have shown promising results as disease-modifying therapies for SBS. AREAS COVERED Short bowel syndrome (SBS) is defined as a reduction in functional intestinal length to less than 200 cm, leading to intestinal failure (IF) leading to malnutrition and parenteral support dependency. This review discusses the current management of SBS-CIFpatients, the place of GLP-2 analog treatment in terms of efficacy, safety and availability, and the new perspectives opened by the use of enterohormones. EXPERT OPINION Clinical trials and real-world experience demonstrated that Teduglutide reduces dependence on parenteral support and has a place in the management of patients with SBS-CIF. The use of Teduglutide should be discussed in patients stabilized after resection and its introduction requires the advice of an expert center capable of assessing the benefit-risk ratio. The complex, individualized management of SBS-C IF requires theexpertise of a specialized IF center which a multidisciplinary approach. The arrival of new treatments will call for new therapeutic strategies, and the question of how to introduce and monitor them will represent a new therapeutic challenge.
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Affiliation(s)
- Tristan Frau
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
| | - Myriam El Khatib
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
| | - Brune De Dreuille
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, UFR de Médecine Paris Diderot Paris, France
| | - Lore Billiauws
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, UFR de Médecine Paris Diderot Paris, France
| | - Alexandre Nuzzo
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Hôpital Bichat, Laboratory for Vascular Translational Science, Paris, France
| | - Francisca Joly
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, UFR de Médecine Paris Diderot Paris, France
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Pironi L, Allard JP, Joly F, Geransar P, Genestin E, Pape UF. Use of teduglutide in adults with short bowel syndrome-associated intestinal failure. Nutr Clin Pract 2024; 39:141-153. [PMID: 37294295 DOI: 10.1002/ncp.11015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 06/10/2023] Open
Abstract
Short bowel syndrome (SBS) is a rare gastrointestinal disorder associated with intestinal failure (SBS-IF) and poor health-related outcomes. Patients with SBS-IF are unable to absorb sufficient nutrients or fluids to maintain significantly metabolic homeostasis via oral or enteral intake alone and require long-term intravenous supplementation (IVS), consisting of partial or total parenteral nutrition, fluids, electrolytes, or a combination of these. The goal of medical and surgical treatment for patients with SBS-IF is to maximize intestinal remnant absorptive capacity so that the need for IVS support may eventually be reduced or eliminated. Daily subcutaneous administration of the glucagon-like peptide 2 analog, teduglutide, has been shown to be clinically effective in reducing IVS dependence and potentially improving the health-related quality of life of patients with SBS-IF. The management of patients with SBS-IF is complex and requires close monitoring. This narrative review discusses the use of teduglutide for patients with SBS-IF in clinical practice. The screening of patient eligibility for teduglutide treatment, initiation, monitoring of efficacy and safety of treatment, adapting or weaning off IVS, and the healthcare setting needed for SBS-IF management are described, taking into consideration data from clinical trials, observational studies, and clinical experience.
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Affiliation(s)
- Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Centre for Chronic Intestinal Failure-Clinical Nutrition and Metabolism Unit, IRCCS AOUBO, Bologna, Italy
| | - Johane P Allard
- Division of Gastroenterology, Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - Francisca Joly
- Service de Gastro-entérologie, MICI et Assistance Nutritive, Université de Paris, Hôpital Beaujon, Centre de Référence des Maladies Digestives Rares, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Parnia Geransar
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | | - Ulrich-Frank Pape
- Department of Internal Medicine and Gastroenterology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum and Charité Mitte, Berlin, Germany
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Disease-modifying therapies in short bowel syndrome. Curr Opin Pharmacol 2022; 65:102240. [PMID: 35617915 DOI: 10.1016/j.coph.2022.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022]
Abstract
Short bowel syndrome (SBS) is the main cause of chronic intestinal failure (IF), defined as 'the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth'. SBS is a rare disease requiring a multidisciplinary approach in specialized IF units. The aim of this review was to discuss the current pharmacological management of SBS-associated IF, since emerging treatments are currently modifying the natural evolution of these patients. Enterohormone therapy has become the first-choice treatment and may decrease the need for parenteral support and improve patients' quality of life.
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Hernia enlargement and pancreatitis in a patient with short bowel syndrome treated with teduglutide: a case report. NUTR HOSP 2021; 39:230-232. [PMID: 34903028 DOI: 10.20960/nh.03879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION teduglutide (TED) is indicated for the treatment of patients with short-bowel syndrome (SBS) who are dependent on parenteral support. CLINICAL CASE we report the case of a 60-year-old woman with SBS treated with TED. She had previously undergone multiple surgical resections due to Crohn's disease. Her remnant bowel included only the duodenum and 50-60 centimeters of jejunum. The patient was dependent on intravenous fluids (2,320 mL/48 h) and had a high stoma output (3,000 mL/day). After four months of TED the jejunostomy output had decreased to 2,200 mL/day with a thicker consistency, and intravenous fluid therapy was reduced to 2,010 mL/48 h. TED was withdrawn due to acute pancreatitis and enlargement of two supraumbilical hernias with high strangulation risk. DISCUSSION pancreatitis has been reported in clinical studies, and determination of amylase and lipase is recommended in all patients receiving TED. In contrast, there are no recommendations for the surveillance of hernia enlargement in patients on TED therapy, but we suggest the need for surveillance based on this case report.
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Pevny S, Pape UF, Elezkurtaj S, Rieger A, Jürgensen C, Blüthner E, Jochum C, Tacke F, Maasberg S. De Novo Development of Distal Jejunal and Duodenal Adenomas After 41 Months of Teduglutide Treatment in a Patient With Short-Bowel Syndrome: A Case Report. JPEN J Parenter Enteral Nutr 2020; 45:652-656. [PMID: 32740933 DOI: 10.1002/jpen.1982] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 12/30/2022]
Abstract
The glucagon-like peptide-2 (GLP-2) analogue teduglutide is a medical treatment option for patients with short-bowel syndrome-associated chronic intestinal failure. Because studies in mice have shown that GLP-2 analogues may promote the growth of colonic neoplasms, surveillance colonoscopies before and during teduglutide therapy were recommended. The occurrence of small-intestinal neoplasms has not been reported so far, except for a recent report about de novo development of hamartomatous duodenal polyps. We report a case of de novo development of small-intestinal premalignant adenomatous polyps in both bulbar duodenum and distal jejunum in a patient treated with teduglutide for 41 months. Therefore, additional endoscopic surveillance of the upper gastrointestinal tract may be advised during teduglutide therapy for early detection and removal of potential small-bowel adenomas.
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Affiliation(s)
- Sophie Pevny
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany
| | - Ulrich-Frank Pape
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany.,Asklepios Klinik St. Georg, Department of Internal Medicine and Gastroenterology, Hamburg, Germany
| | - Sefer Elezkurtaj
- Charité - Universitätsmedizin Berlin, Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin, Institute of Health, Institute of Pathology, Berlin, Germany
| | - Anja Rieger
- Charité - Universitätsmedizin Berlin, Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin, Institute of Health, Institute of Pathology, Berlin, Germany
| | - Christian Jürgensen
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany
| | - Elisabeth Blüthner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany
| | - Christoph Jochum
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany
| | - Frank Tacke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Hepatology and Gastroenterology, Berlin, Germany
| | - Sebastian Maasberg
- Asklepios Klinik St. Georg, Department of Internal Medicine and Gastroenterology, Hamburg, Germany
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George AT, Leong M, Shokouh-Amiri M, Benedetti E, Carroll RE. Accelerated Colorectal Polyposis in an Immunosuppressed Patient With a Small Bowel Transplant Treated With Teduglutide: Case Report and Review of Literature. Clin Colorectal Cancer 2019; 18:e275-e279. [PMID: 31176580 DOI: 10.1016/j.clcc.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Alvin T George
- Intestinal Rehabilitation and Transplant Center, Departments of Medicine and Surgery, University of Illinois at Chicago, Chicago, IL
| | - Michelle Leong
- Intestinal Rehabilitation and Transplant Center, Departments of Medicine and Surgery, University of Illinois at Chicago, Chicago, IL
| | | | - Enrico Benedetti
- Intestinal Rehabilitation and Transplant Center, Departments of Medicine and Surgery, University of Illinois at Chicago, Chicago, IL
| | - Robert E Carroll
- Intestinal Rehabilitation and Transplant Center, Departments of Medicine and Surgery, University of Illinois at Chicago, Chicago, IL.
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Kochar B, Herfarth HH. Teduglutide for the treatment of short bowel syndrome – a safety evaluation. Expert Opin Drug Saf 2018; 17:733-739. [DOI: 10.1080/14740338.2018.1483332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Bharati Kochar
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
- University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, NC, USA
| | - Hans H. Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
- University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, NC, USA
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