Treating short bowel syndrome with pharmacotherapy. (12th April 2020)

• Record Type: Journal Article
• Authors: Hollanda Martins Da Rocha, Mariana; Lee, André Dong Won; Marin, Marcia Lucia De Mario; Faintuch, Salomao; Mishaly, Asher; Faintuch, Joel
• Is Part Of: Expert opinion on pharmacotherapy. Volume 21:Number 6(2020)
• Page Start: 709
• Page End: 720
• Publication Date: 2020-04-12
• Subjects: Short bowel syndrome -- Intestinal insufficiency -- Massive bowel resection -- Home parenteral nutrition -- GLP-2 -- GLP-2 analogs -- Teduglutide -- Glepaglutide; Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1080/14656566.2020.1724959
• Languages: English
• ISSNs: 1465-6566

Abstract

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.