From the Guidelines
Intestinal failure in short bowel syndrome is primarily influenced by factors such as loss of the ileocecal valve, extensive resection of the ileum, loss of the colon, and reduced intestinal adaptation capacity, which significantly increase the risk of complications and mortality. Four key factors that increase the risk of intestinal failure in short bowel syndrome include:
- Loss of the ileocecal valve, which normally prevents bacterial backflow from the colon 1
- Extensive resection of the ileum, which is crucial for nutrient and bile salt absorption 1
- Loss of the colon, which plays an important role in water absorption and energy salvage 1
- Reduced intestinal adaptation capacity due to factors like advanced age or radiation enteritis 1
Beyond weight loss, intestinal failure can lead to six significant complications, including:
- Fluid and electrolyte imbalances, resulting from impaired absorption of water and electrolytes 1
- Malnutrition, particularly deficiencies in fat-soluble vitamins (A, D, E, K) and micronutrients 1
- Bacterial overgrowth in the remaining bowel, causing further malabsorption and inflammation 1
- D-lactic acidosis from bacterial fermentation of unabsorbed carbohydrates 1
- Nephrolithiasis (kidney stones) due to increased oxalate absorption and dehydration 1
- Liver disease, ranging from steatosis to fibrosis and potentially cirrhosis, often associated with long-term parenteral nutrition 1
Management of intestinal failure in short bowel syndrome should prioritize a multidisciplinary approach, focusing on optimizing remaining bowel function, nutritional support, and preventing complications, as outlined in the ESPEN guidelines on parenteral nutrition 1. This approach is crucial in minimizing morbidity, mortality, and improving the quality of life for patients with intestinal failure.
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