Treating short bowel syndrome with pharmacotherapy

ABSTRACT

Introduction

Short bowel syndrome (SBS) has traditionally been regarded as a rapidly fatal medical catastrophe. The advent of pharmacological options directly targeting disease pathophysiology justified this review.

Areas covered

Since the 1970s, home parenteral nutrition has reduced mortality, converting SBS into a chronic and disabling compensated and occasionally curable illness. Off-label antidiarrheal drugs and related products, though having minimal scientific evidence of efficacy, represent the standard-of-care and are here reviewed. Trophic intestinal hormones, including GLP-2 and its analogs, have great promise for alleviating malabsorption, the most important symptom within a nonsurgical, routine outpatient framework. Current indications involve adults with massive intestinal losses (fecal wet weight >1500 g/day). Surgical options such as intestinal lengthening or transplantation are also addressed although these options are considerably more aggressive and have stricter indications.

Expert opinion

GLP-2 analogs are the first candidates from a pioneering pharmacotherapic family within the SBS framework, namely disease-modifying, absorption-restoring agents. This family of drugs, potentially applicable in all contexts of severe intestinal loss, could become the therapeutic benchmark of the near future.

KEYWORDS:

• Short bowel syndrome
• Intestinal insufficiency
• Massive bowel resection
• Home parenteral nutrition
• GLP-2
• GLP-2 analogs
• Teduglutide
• Glepaglutide

Article highlights

• Home parenteral nutrition (HPN) allows survival in short bowel syndrome; however, it also leaves the patient at a risk of major as well as life-threatening complications.

• Some patients are weaned off HPN, if they are able to successfully undergo intestinal lengthening or gut transplantation.

• Until recently, pharmacotherapeutic options have been limited to symptomatic, nonspecific drugs, along with experimental trophic hormones.

• Two recent GLP-2 analogs are potentially paradigm-shifting additions to the pharmaceutical arsenal.

• If confirmed and expanded in larger trials, these agents promise to offer targeted and effective pharmacological therapy, for the majority of SBS patients.

This box summarizes the key points contained in the article.

Acknowledgments

The assistance of Djilda Faintuch, BA, M.A., CCC-SLP in the review and correction of the text is greatly appreciated.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.