From the Guidelines
Intestinal failure in short bowel syndrome is primarily influenced by factors such as extensive resection of the small intestine, loss of the ileocecal valve, resection of the terminal ileum, and loss of the colon, which significantly increase the risk of intestinal failure. Four key factors that increase the risk of intestinal failure in short bowel syndrome include:
- Extensive resection of the small intestine, as seen in conditions like Crohn's disease, superior mesenteric artery thrombosis, and irradiation damage 1
- Loss of the ileocecal valve, which can lead to bacterial overgrowth and other complications
- Resection of the terminal ileum, crucial for bile salt and vitamin B12 absorption
- Loss of the colon, important for fluid absorption and energy salvage
Regarding complications of intestinal failure beyond weight loss, six major issues are:
- Fluid and electrolyte imbalances leading to dehydration and metabolic disturbances, particularly in patients with a jejunostomy due to large stomal water and sodium losses 1
- Malnutrition with deficiencies in proteins, vitamins, and minerals
- Bacterial overgrowth in the remaining bowel segments
- D-lactic acidosis from bacterial fermentation
- Cholelithiasis (gallstones) due to altered bile metabolism
- Metabolic bone disease from calcium and vitamin D malabsorption
These complications can be managed with a multidisciplinary approach, including specialized nutritional support, antimicrobial therapy for bacterial overgrowth, and careful monitoring of fluid status and nutritional parameters to prevent these complications 1.
From the FDA Drug Label
- 1 Clinical Trials Experience Adults Because clinical trials are conducted under widely varying conditions, the adverse reaction rates observed cannot be directly compared to rates in other clinical trials and may not reflect the rates observed in clinical practice The rates of adverse reactions in 136 adult patients with SBS participating in two randomized, placebo-controlled, 24-week, double-blind clinical studies (Study 1 and Study 3) are summarized in Table 1. Only those reactions with a rate of at least 5% in the GATTEX group, and greater than placebo group, are summarized in Table 1 Table 1: Common Adverse Reactions* in Adult Patients with SBS in Placebo-Controlled Studies: Studies 1 and 3 Adverse ReactionPlacebo(N=59)(%)GATTEX0. 05 mg/kg Once Daily(N=77)(%)
- Reported at a rate of at least 5% in the GATTEX group, and greater than the placebo group h macular, drug eruption, eyelid edema, flushing Þ Includes: Influenza, influenza-like illness ß Includes: Hematoma, abdominal wall hematoma, post procedural hematoma, umbilical hematoma, blood blister à Includes: Insomnia (3 patients) and hypersomnia (1 patient) Abdominal pain†2230 Nausea2023 Upper respiratory tract infection‡1221 Abdominal distension220 Injection site reaction§1213 Vomiting1012 Fluid Overload¶712 Hypersensitivity#710 Flatulence79 Decreased appetite37 InfluenzaÞ27 Skin hemorrhageß25 Cough05 Sleep disturbancesà05
The FDA drug label does not answer the question.
From the Research
Factors that Increase the Risk of Intestinal Failure in Short Bowel Syndrome
- Extensive intestinal resection 2
- Very short remnant small bowel 2
- End-jejunal remnant anatomy 2
- Arterial mesenteric infarction as primary cause 2