Management of Short Bowel Syndrome/Chronic Intestinal Failure – the Experience of a Single Portuguese Center
Teduglutide may help reduce the need for Home Parenteral Nutrition in some patients with Short Bowel Syndrome, but more research is needed to confirm its benefits.
Where it sits
this study against the rest of the teduglutide corpusSummary and findings
This study analyzed the experience of a single center with 13 adult patients diagnosed with Short Bowel Syndrome/Chronic Intestinal Failure (SBS/CIF) treated with Home Parenteral Nutrition (HPN). The median duration of HPN was 173 months for the eight surviving patients, while five patients died during the study period. Two patients recently started teduglutide, showing good tolerance and a need for reduced HPN support.
Abstract
<h4>Aim: </h4> To analyze a single center's experience with Short Bowel Syndrome/ Chronic Intestinal Failure (SBS/CIF) in adult patients treated with Home Parenteral Nutrition (HPN). Materials and methods: In the last thirty years, 13 patients with SBS/CIF were included in an HPN program. <h4>Results:</h4> Between 1992 and 2023, 13 patients were included in an HPN program. The primary underlying pathology was acute mesenteric ischemia. The median age of the starting HPN was 44 years old. Most are submitted to several surgeries of extensive intestinal resection with posterior intestinal reconstruction. Five of the 13 patients have died while on HPN for a median of 42 months. The causes of death HPN-related were catheter sepsis, endocarditis with cardiac failure, or hepatic failure. One patient died due to underlying pathology: pelvic abscesses and bleeding related to radiotherapy. Eight patients remain alive with a median time of HPN of 173 months. During the HPN support, the most frequent complications were venous catheter infection and venous territory thrombosis. None of the eight patients alive have hepatic failure. Two patients recently started teduglutide, with good tolerance, and need reduction of HPN support. All these eight patients have a satisfactory quality of life (parenteral support needs range between five to two nutrition bags per week). <h4>Conclusion:</h4> HPN remains the gold standard of SBS/CIF treatment, although Teduglutide may reduce HPN needs and HPN complications and provide a better quality of life. An HPN multidisciplinary healthcare group support is essential to ensure these patients' survival and quality of life. Keywords Short bowel Syndrome, Chronic Intestinal failure, Home Parenteral Nutrition, Teduglutide, Complications of Parenteral Support.
Background
This paper addresses the management of Short Bowel Syndrome/Chronic Intestinal Failure (SBS/CIF) and the role of Home Parenteral Nutrition (HPN) in treatment. Previous literature has established HPN as the gold standard for patients with SBS/CIF, but there is limited information on the long-term outcomes and complications associated with this treatment. The introduction of teduglutide as a potential adjunct therapy raises questions about its impact on HPN needs and patient quality of life.
Methods
The study is a retrospective analysis of 13 adult patients treated with HPN at a single center over a 30-year period. The primary outcome measures include survival rates, complications related to HPN, and the effects of teduglutide on HPN requirements. The median duration of HPN was reported for patients alive at the time of the study.
Results
The primary endpoint indicates that five of the 13 patients died while on HPN for a median of 42 months. The causes of death included catheter sepsis, endocarditis with cardiac failure, and hepatic failure. Eight patients remained alive with a median time of HPN of 173 months. Complications during HPN included venous catheter infection and venous territory thrombosis. Two patients who started teduglutide showed good tolerance and reduced HPN support needs.
Interpretation
The findings suggest that while HPN remains the standard treatment for SBS/CIF, the introduction of teduglutide may offer benefits in reducing HPN requirements. However, the small sample size and single-center design limit the strength of these conclusions. The effect sizes observed may not be clinically significant, and further research is needed to establish the long-term impact of teduglutide on patient outcomes.
Key findings
- 13 patients included in HPN program from 1992 to 2023.
- Median age at starting HPN was 44 years.
- Five of the 13 patients died while on HPN for a median of 42 months.
- Eight patients remain alive with a median time of HPN of 173 months.
- Most frequent complications during HPN were venous catheter infection and venous territory thrombosis.
- Two patients recently started teduglutide with good tolerance and reduced HPN support.
Limitations
- small sample size of 13 patients
- single-center study limits generalizability
- no control group for comparison
- observational design may introduce bias
- short follow-up for some patients