From the Guidelines
Treatments for short gut syndrome primarily aim to improve nutrient absorption and manage complications through various mechanisms of action, including promoting intestinal growth, enhancing absorption, slowing intestinal transit time, reducing gastric acid secretion, and managing bile acid-induced diarrhea. The primary mechanism of action of teduglutide, a glucagon-like peptide-2 analog, is to promote intestinal growth and enhance absorption, thereby reducing the need for parenteral nutrition (PN) 1. Antimotility agents like loperamide and diphenoxylate work by slowing intestinal transit time, allowing more contact between nutrients and absorptive surfaces, while antisecretory medications such as proton pump inhibitors or H2 blockers reduce gastric acid secretion, preventing fluid losses and protecting the remaining bowel from acid damage 1. Bile acid sequestrants like cholestyramine manage bile acid-induced diarrhea in patients with preserved colon, although their use should be avoided in patients with diminished bile acid pool, as they may worsen steatorrhea and fat-soluble vitamin losses 1. Octreotide, a somatostatin analog, reduces intestinal secretions in severe cases, but its use should be reserved for patients with large volume stool losses and avoided during the period of intestinal adaptation 1. Vitamin and mineral supplements are essential to prevent deficiencies, particularly fat-soluble vitamins, vitamin B12, zinc, and magnesium, and should be used in conjunction with other treatments to maximize the absorptive capacity of the remaining intestine and support overall nutritional status until adaptation occurs 1. Some key points to consider when using these treatments include:
- Teduglutide should be used at a dose of 0.05 mg/kg subcutaneously once daily, and patients should be carefully informed of the potential benefits and risks associated with growth factor treatments 1.
- Antimotility agents like loperamide should be preferred to opiate drugs, as they are not addictive or sedative, and should be used in conjunction with objective measurements of effect on stool output 1.
- The use of growth factors, including teduglutide, should be guided by experts who are experienced in the diagnosis and management of short bowel syndrome patients, and patients should be carefully monitored for potential adverse effects and risks 1. Overall, the goal of treatment for short gut syndrome is to maximize the absorptive capacity of the remaining intestine, reduce intestinal losses, and minimize the need for intravenous supplementation, while also considering the potential benefits and risks of each treatment option 1.
From the FDA Drug Label
Teduglutide is a glucagon-like peptide-2 (GLP-2) analog The mechanism of action (MOA) of teduglutide for the treatment of short gut syndrome is related to its ability to increase intestinal absorption by:
- Enhancing intestinal mucosal growth
- Improving intestinal barrier function
- Increasing intestinal blood flow This allows for a reduction in parenteral nutrition/intravenous (PN/I.V.) support 2, 2, 2.
From the Research
Mechanisms of Action (MOAs) of Treatments for Short Gut Syndrome
The treatments for short gut syndrome have various mechanisms of action, including:
- Enhancing intestinal absorption through the use of trophic factors, such as glucagon-like peptide-2 (GLP-2) analogs 3, 4, 5
- Promoting growth of the mucosa and reducing gastric emptying and secretion 4
- Increasing fluid and nutrient absorption in patients with short bowel syndrome with intestinal failure (SBS-IF) 4
- Restoring digestive continuity through rehabilitative surgery 3
- Reducing parenteral support volume and improving quality of life 3, 4, 5
Medical Management
Medical management of short gut syndrome includes:
- Parenteral nutrition (PN) as the major treatment of intestinal failure 3
- Treatment with trophic factors, such as GLP-2 analogs, to reduce PN dependency and improve quality of life 3, 4, 5
- Use of specialized oral diets, soluble fiber, and oral rehydration solutions (ORS) to enhance absorption 6
Surgical Management
Surgical management of short gut syndrome includes: