Intestinal rehabilitation using semisynthetic glucagon-like peptide-2 analogue
First experience with teduglutide in Uruguay
Keywords:
CHRONIC INTESTINAL FAILURE, SHORT BOWEL SYNDROME, PARENTERAL NUTRITION AT HOME, GLUCAGON-LIKE PEPTIDE 2, TEDUGLUTIDE
Abstract
Long-term home parenteral nutrition (HPN) is a life-saving treatment for patients with chronic intestinal failure, an invalidating condition. However, only 1 out of 3 countries can rely on this treatment and complications associated to chronic parenteral nutrition are rather frequent.
The latter constitute the main indication for intestinal transplantation, a procedure that in most middle-income countries has not yet developed and has not shown the expected outcome. In recent years, intestinal rehabilitation has significantly improved at the global level with the use of GLP2, based on the growing evidence that proves the possibility of intestinal rehabilitation and independence from parenteral nutrition with Teduglutide, even in the case of patients with unfavorable anatomy. These results have caused a positive impact on survival and the quality of life of patients with chronic renal failure, and they can often abstain from transplant.
The patient of the case study is the first one who received this therapy in our country and this article analyses his favorable early response to treatment and future perspectives.
References
1) Pironi L. Definitions of intestinal failure and the short bowel syndrome. Best Pract Res Clin Gastroenterol 2016; 30(2):173-85.
2) Pironi L. Revised ESPEN Clinical Classification Of Chronic Intestinal Failure: from 16 to 8 categories. JPEN J Parenter Enteral Nutr 2017; 41(6):911.
3) Pironi L, Goulet O, Buchman A, Messing B, Gabe S, Candusso M, et al. Outcome on home parenteral nutrition for benign intestinal failure: a review of the literature and benchmarking with the European prospective survey of ESPEN. Clin Nutr 2012; 31(6):831-45.
4) Lal S, Pironi L, Wanten G, Arends J, Bozzetti F, Cuerda C, et al. Clinical approach to the management of Intestinal Failure Associated Liver Disease (IFALD) in adults: a position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN. Clin Nutrit 2018; 37(6 Pt A):1794-7.
5) Joly F, Baxter J, Staun M, Kelly DG, Hwa YL, Corcos O, et al. Five-year survival and causes of death in patients on home parenteral nutrition for severe chronic and benign intestinal failure. Clinical Nutr 2018; 37(4):1415-22.
6) Pironi L, Arends J, Bozzetti F, Cuerda C, Gillanders L, Jeppesen PB, et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr 2016; 35(2):247-307.
7) Moreira E, López P, Silva L, Olano E. Dependiendo de la nutrición parenteral para sobrevivir. Falla intestinal crónica por síndrome de intestino corto. Comunicación de un caso y revisión de la literatura Rev Méd Urug 2019; 35(4):316-24. doi: 10.29193/RMU.35.4.8.
8) Sudan D, Rege A. Update on surgical therapies for intestinal failure. Curr Opin Organ Transplant 2014; 19(3):267-75.
9) Gondolesi GE, Pattín F, Nikkoupur H. Management of intestinal failure in middle-income countries, for children and adults. Curr Opin Organ Transplant 2018; 23(2):212-8.
10) Gondolesi GE, Doeyo M, Echevarria C, Lobos F, Rubio S, Rumbo C, et al. Results of surgical and medical rehabilitation for adult patients with type III intestinal failure in a comprehensive unit today: building a new model to predict parenteral nutrition independency. JPEN J Parenter Enteral Nutr 2020; 44(4):703-13.
11) Abu-Elmagd KM, Armanyous SR, Fujiki M, Parekh NR, Osman M, Scalish M, et al. Management of five hundred patients with gut failure at a single center: surgical innovation versus transplantation with a novel predictive model. Ann Surg 2019; 270(4):656-74.
12) Kelly DG, Tappenden KA, Winkler MF. Short bowel syndrome: highlights of patients management, quality of life, and survival. JPEN J Parenter Enteral Nutr 2014; 38(4):427-37.
13) Schwartz LK, O´Keefe SJD, Fujioka K, Gabe SM, Lamprecht G, Pape UF, et al. Long-term teduglutide for the treatment of patients with intestinal failure associated with short bowel syndrome. Clin Transl Gastroenterol 2016; 7(2):e142.
14) Seidner DL, Fujioka K, Boullata JI, Iyer K, Lee HM, Ziegler TR. Reduction of parenteral nutrition and hydration support and safety with long term teduglutide treatment in patients with short bowel syndrome-associated intestnal failure: STEPS-3 study. Nutr Clin Pract 2018; 33(4):520-7.
15) Orphanet. El portal sobre enfermedades raras y medicamentos huérfanos. Disponible en: http://www.orpha.net (Consulta: 2 noviembre 2020).
16) Amiot A, Messing B, Corcos O, Panis Y, Joly F. Determinants of home parenteral nutrition dependence and survival of 268 patients with non-malignant short bowel syndrome. Clin Nutr 2013; 32(3):368-74.
17) Noelting J, Gramlich L, Whittaker S, Armstrong D, Marliss E, Jurewitsch B, et al. Survival of patients with short-bowel syndrome on home parenteral nutrition: a prospective cohort study. JPEN J Parenter Enteral Nutr 2020. doi: 10.1002/jpen.1984.
18) Fishbein TM, Gondolesi GE, Kaufman SS. Intestinal transplantation for gut failure. Gastroenterology 2003; 124(6):1615-28.
19) Abu-Elmagd K. The concept of gut rehabilitation and the future of visceral transplantation. Nat Rev Gastroenterol Hepatol 2015; 12(2):108-20.
20) Kaufman SS, Avitzur Y, Beath SV, Ceulemans LJ, Gondolesi GE, Mazariegos GV, et al. New insights into the indications for intestinal transplantation: consensus in the year 2019. Transplantation 2019; 104(5):937-46.
21) Gondolesi GE, Doeyo M, Solar-Muñiz H. A detailed analysis of the current status of intestinal transplantation in Latin America. Curr Opin Organ Transplant 2020; 25(2):189-95.
22) Amiot A, Messing B, Corcos O, Panis Y, Joly F. Determinants of home parenteral nutrition dependence and survival of 268 patients with non-malignant short bowel syndrome. Clin Nutr 2013; 32(3):368-74.
23) Noelting J, Gramlich L, Whittaker S, Armstrong D, Marliss E, Jurewitsch B, et al. Survival of patients with short-bowel syndrome on home parenteral nutrition: a prospective cohort study. JPEN J Parenter Enteral Nutr 2020. doi: 10.1002/jpen.1984.
24) Lam K, Schwartz L, Batisti J, Iyer KR. Single-center experience with the use of teduglutide in adult patients with short bowel syndrome. JPEN J Parenter Enteral Nutr 2018; 42(1):225-30.
25) Schalamon J, Mayr JM, Höllwarth ME. Mortality and economics in short bowel syndrome. Best Pract Res Clin Gastroenterol 2003; 17(6):931-42. doi: 10.1016/s1521-6918(03)00079-9.
26) Jeppesen PB, Gilroy R, Pertkiewicz M, Allard JP, Messing B, O´Keefe SJ. Randomised placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome. Gut 2011; 60(7):902-14.
27) Solar H, Doeyo M, Ortega M, De Barrio S, Olano E, Moreira E, et al. Postsurgical intestinal rehabilitation using semisynthetic glucagon] like peptide] 2 analogue (sGLP] 2) at a referral center: ¿Can patients achieve parenteral nutrition and sGLP] 2 independency? JPEN J Parenter Enteral Nutr 2020. doi:10.1002/jpen.1983.
28) Drucker DJ, Yusta B. Physiology and pharmacology of the enteroendocrine hormone glucagon-like peptide-2. Annu Rev Physiol 2014; 76:561-83. doi: 10.1146/annurev-physiol-021113-170317.
29) Tappenden KA, Edelman J, Joelsson B. Teduglutide enhances structural adaptation of the small intestinal mucosa in patients with short bowel syndrome. J Clin Gastroenterol 2013; 47(7): 602-7. doi: 10.1097/MCG.0b013e3182828f57.
30) Bremholm L, Hornum M, Andersen UB, Hartmann B, Holst JJ, Jeppesen PB. The effect of glucagon-like peptide-2 on mesenteric blood flow and cardiac parameters in end-jejunostomy short bowel patients. Regul Pept 2011; 168(1-3): 32-8. doi: 10.1016/j.regpep.2011.03.003.
31) O´Keefe SJ, Jeppesen PB, Gilroy R, Pertkiewicz M, Allard JP, Messing B. Safety and efficacy on teduglutide after 52 weeks of treatment in patients with short bowel intestinal failure. Clin Gastroenterol Hepatol 2013; 11(7):815-23.e1-3.
32) Iyer KR, Kunecki M, Boullata JI, Fujioka K, Joly F, Gabe S, et al. Independence from parenteral nutrition and intravenous fluid support during treatment with teduglutide among patients with intestinal failure associated with short bowel syndrome. JPEN J Parenter Enteral Nutr 2017; 41(6):946-51.
33) Lam K, Schwartz L, Batisti J, Iyer KR. Single-center experience with the use of teduglutide in adult patients with short bowel syndrome. JPEN J Parenter Enteral Nutr 2018; 42(1):225-30.
34) Jeppesen PB, Gabe SM ,Seidner DL, Lee HM, Olivier C. Factors associated with response to teduglutide in patients with short bowel syndrome and intestinal failure. Gastroenterology 2018; 154(4):874-85.
35) Compher C, Gilroy R, Pertkiewicz M, Ziegler TR, Ratcliffe SJ, Joly F, et al. Maintenance of parenteral nutrition volume reduction, without weight loss, after stopping teduglutide in a subset of patients with short bowel syndrome. JPEN J Parent Enteral Nutr 2011; 35(5):603-9.
36) Pevny S, Maasberg S, Rieger A, Karber M, Blüthner E, Knappe-Drzikova B, et al. Experience with teduglutide treatment for short bowel syndrome in clinical practice. Clin Nutr 2019; 38(4):1745-55.
2) Pironi L. Revised ESPEN Clinical Classification Of Chronic Intestinal Failure: from 16 to 8 categories. JPEN J Parenter Enteral Nutr 2017; 41(6):911.
3) Pironi L, Goulet O, Buchman A, Messing B, Gabe S, Candusso M, et al. Outcome on home parenteral nutrition for benign intestinal failure: a review of the literature and benchmarking with the European prospective survey of ESPEN. Clin Nutr 2012; 31(6):831-45.
4) Lal S, Pironi L, Wanten G, Arends J, Bozzetti F, Cuerda C, et al. Clinical approach to the management of Intestinal Failure Associated Liver Disease (IFALD) in adults: a position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN. Clin Nutrit 2018; 37(6 Pt A):1794-7.
5) Joly F, Baxter J, Staun M, Kelly DG, Hwa YL, Corcos O, et al. Five-year survival and causes of death in patients on home parenteral nutrition for severe chronic and benign intestinal failure. Clinical Nutr 2018; 37(4):1415-22.
6) Pironi L, Arends J, Bozzetti F, Cuerda C, Gillanders L, Jeppesen PB, et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr 2016; 35(2):247-307.
7) Moreira E, López P, Silva L, Olano E. Dependiendo de la nutrición parenteral para sobrevivir. Falla intestinal crónica por síndrome de intestino corto. Comunicación de un caso y revisión de la literatura Rev Méd Urug 2019; 35(4):316-24. doi: 10.29193/RMU.35.4.8.
8) Sudan D, Rege A. Update on surgical therapies for intestinal failure. Curr Opin Organ Transplant 2014; 19(3):267-75.
9) Gondolesi GE, Pattín F, Nikkoupur H. Management of intestinal failure in middle-income countries, for children and adults. Curr Opin Organ Transplant 2018; 23(2):212-8.
10) Gondolesi GE, Doeyo M, Echevarria C, Lobos F, Rubio S, Rumbo C, et al. Results of surgical and medical rehabilitation for adult patients with type III intestinal failure in a comprehensive unit today: building a new model to predict parenteral nutrition independency. JPEN J Parenter Enteral Nutr 2020; 44(4):703-13.
11) Abu-Elmagd KM, Armanyous SR, Fujiki M, Parekh NR, Osman M, Scalish M, et al. Management of five hundred patients with gut failure at a single center: surgical innovation versus transplantation with a novel predictive model. Ann Surg 2019; 270(4):656-74.
12) Kelly DG, Tappenden KA, Winkler MF. Short bowel syndrome: highlights of patients management, quality of life, and survival. JPEN J Parenter Enteral Nutr 2014; 38(4):427-37.
13) Schwartz LK, O´Keefe SJD, Fujioka K, Gabe SM, Lamprecht G, Pape UF, et al. Long-term teduglutide for the treatment of patients with intestinal failure associated with short bowel syndrome. Clin Transl Gastroenterol 2016; 7(2):e142.
14) Seidner DL, Fujioka K, Boullata JI, Iyer K, Lee HM, Ziegler TR. Reduction of parenteral nutrition and hydration support and safety with long term teduglutide treatment in patients with short bowel syndrome-associated intestnal failure: STEPS-3 study. Nutr Clin Pract 2018; 33(4):520-7.
15) Orphanet. El portal sobre enfermedades raras y medicamentos huérfanos. Disponible en: http://www.orpha.net (Consulta: 2 noviembre 2020).
16) Amiot A, Messing B, Corcos O, Panis Y, Joly F. Determinants of home parenteral nutrition dependence and survival of 268 patients with non-malignant short bowel syndrome. Clin Nutr 2013; 32(3):368-74.
17) Noelting J, Gramlich L, Whittaker S, Armstrong D, Marliss E, Jurewitsch B, et al. Survival of patients with short-bowel syndrome on home parenteral nutrition: a prospective cohort study. JPEN J Parenter Enteral Nutr 2020. doi: 10.1002/jpen.1984.
18) Fishbein TM, Gondolesi GE, Kaufman SS. Intestinal transplantation for gut failure. Gastroenterology 2003; 124(6):1615-28.
19) Abu-Elmagd K. The concept of gut rehabilitation and the future of visceral transplantation. Nat Rev Gastroenterol Hepatol 2015; 12(2):108-20.
20) Kaufman SS, Avitzur Y, Beath SV, Ceulemans LJ, Gondolesi GE, Mazariegos GV, et al. New insights into the indications for intestinal transplantation: consensus in the year 2019. Transplantation 2019; 104(5):937-46.
21) Gondolesi GE, Doeyo M, Solar-Muñiz H. A detailed analysis of the current status of intestinal transplantation in Latin America. Curr Opin Organ Transplant 2020; 25(2):189-95.
22) Amiot A, Messing B, Corcos O, Panis Y, Joly F. Determinants of home parenteral nutrition dependence and survival of 268 patients with non-malignant short bowel syndrome. Clin Nutr 2013; 32(3):368-74.
23) Noelting J, Gramlich L, Whittaker S, Armstrong D, Marliss E, Jurewitsch B, et al. Survival of patients with short-bowel syndrome on home parenteral nutrition: a prospective cohort study. JPEN J Parenter Enteral Nutr 2020. doi: 10.1002/jpen.1984.
24) Lam K, Schwartz L, Batisti J, Iyer KR. Single-center experience with the use of teduglutide in adult patients with short bowel syndrome. JPEN J Parenter Enteral Nutr 2018; 42(1):225-30.
25) Schalamon J, Mayr JM, Höllwarth ME. Mortality and economics in short bowel syndrome. Best Pract Res Clin Gastroenterol 2003; 17(6):931-42. doi: 10.1016/s1521-6918(03)00079-9.
26) Jeppesen PB, Gilroy R, Pertkiewicz M, Allard JP, Messing B, O´Keefe SJ. Randomised placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome. Gut 2011; 60(7):902-14.
27) Solar H, Doeyo M, Ortega M, De Barrio S, Olano E, Moreira E, et al. Postsurgical intestinal rehabilitation using semisynthetic glucagon] like peptide] 2 analogue (sGLP] 2) at a referral center: ¿Can patients achieve parenteral nutrition and sGLP] 2 independency? JPEN J Parenter Enteral Nutr 2020. doi:10.1002/jpen.1983.
28) Drucker DJ, Yusta B. Physiology and pharmacology of the enteroendocrine hormone glucagon-like peptide-2. Annu Rev Physiol 2014; 76:561-83. doi: 10.1146/annurev-physiol-021113-170317.
29) Tappenden KA, Edelman J, Joelsson B. Teduglutide enhances structural adaptation of the small intestinal mucosa in patients with short bowel syndrome. J Clin Gastroenterol 2013; 47(7): 602-7. doi: 10.1097/MCG.0b013e3182828f57.
30) Bremholm L, Hornum M, Andersen UB, Hartmann B, Holst JJ, Jeppesen PB. The effect of glucagon-like peptide-2 on mesenteric blood flow and cardiac parameters in end-jejunostomy short bowel patients. Regul Pept 2011; 168(1-3): 32-8. doi: 10.1016/j.regpep.2011.03.003.
31) O´Keefe SJ, Jeppesen PB, Gilroy R, Pertkiewicz M, Allard JP, Messing B. Safety and efficacy on teduglutide after 52 weeks of treatment in patients with short bowel intestinal failure. Clin Gastroenterol Hepatol 2013; 11(7):815-23.e1-3.
32) Iyer KR, Kunecki M, Boullata JI, Fujioka K, Joly F, Gabe S, et al. Independence from parenteral nutrition and intravenous fluid support during treatment with teduglutide among patients with intestinal failure associated with short bowel syndrome. JPEN J Parenter Enteral Nutr 2017; 41(6):946-51.
33) Lam K, Schwartz L, Batisti J, Iyer KR. Single-center experience with the use of teduglutide in adult patients with short bowel syndrome. JPEN J Parenter Enteral Nutr 2018; 42(1):225-30.
34) Jeppesen PB, Gabe SM ,Seidner DL, Lee HM, Olivier C. Factors associated with response to teduglutide in patients with short bowel syndrome and intestinal failure. Gastroenterology 2018; 154(4):874-85.
35) Compher C, Gilroy R, Pertkiewicz M, Ziegler TR, Ratcliffe SJ, Joly F, et al. Maintenance of parenteral nutrition volume reduction, without weight loss, after stopping teduglutide in a subset of patients with short bowel syndrome. JPEN J Parent Enteral Nutr 2011; 35(5):603-9.
36) Pevny S, Maasberg S, Rieger A, Karber M, Blüthner E, Knappe-Drzikova B, et al. Experience with teduglutide treatment for short bowel syndrome in clinical practice. Clin Nutr 2019; 38(4):1745-55.
Published
2021-08-24
How to Cite
1.
Moreira E, Silva L, Olano E, Solar H. Intestinal rehabilitation using semisynthetic glucagon-like peptide-2 analogue. Rev. Méd. Urug. [Internet]. 2021Aug.24 [cited 2024Dec.18];37(3):e37315. Available from: https://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/746
Section
Clinical Cases
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
