McGovern Medical School Houston, TX, United States
Rachel Obimah, BS1, Tejal Mistry, MD2, Gabriela Gardner, RDN-AP, LD, CNSC3, Andrew DuPont, MD2 1McGovern Medical School, Houston, TX; 2University of Texas Health Science Center at Houston, Houston, TX; 3Digestive Disease Center, Memorial Hermann - Texas Medical Center, Houston, TX
Introduction: Patients with short bowel syndrome (SBS) are often dependent on parenteral support (PS) for maintaining adequate nutrition and hydration. However, well studied complications of PS include liver disease, sepsis, and thrombosis, which can occur within months after starting parenteral nutrition (PN). Studies show that patients with SBS who are completely weaned off PS have a higher 10-year survival than patients remaining dependent on PS. Therefore, it is vital to investigate measures which will rapidly wean patients with SBS off PS. Teduglutide, a glucagon-like peptide-2 analogue, has been revolutionary in helping patients with SBS wean off PN and transition to solely enteral nutrition by improving intestinal absorption. Previous studies have shown patients with SBS on at least 12 months of PS required a mean of 89 weeks of teduglutide in order to completely wean from PS.
Case Description/Methods: Our case is of a 73-year-old female who developed SBS after short bowel resection who was able to be weaned off PN after just 4 weeks of teduglutide therapy. The patient had colon adenocarcinoma and developed SBS due to complications during sigmoidectomy resulting in removal of 213 cm of small bowel with jejunoileal anastomosis. Teduglutide therapy began 5 months after initiating PN with the inclusion of oral rehydration therapy and a diet tailored to the remaining anatomy. The weaning process began after 7 days of starting teduglutide. Stool output, urine output, and physical exam findings of fluid overload (edema, shortness of breath, and weight gain) suggested intestinal adaptation and absorption. By 4 weeks of teduglutide therapy, the patient was completely weaned off PN, eating an oral diet, and at her baseline weight. She continues to be followed by a multi-disciplinary team and her weight remains stable with normal nutritional values at 12 months follow up.
Discussion: Our case report highlights teduglutide use in a patient with acquired SBS with a rapid response to teduglutide. It explores how teduglutide therapy can transition patients off PN faster than previous studies have reported. This warrants more research regarding early initiation of teduglutide after resection and if it is associated with early weaning of PN. Our case also highlights the importance of a multi-disciplinary approach to promote aggressive weaning measures and close monitoring, along with education on nutrition recommendations tailored to the patient’s remaining anatomy.
Rachel Obimah indicated no relevant financial relationships.
Tejal Mistry indicated no relevant financial relationships.
Andrew DuPont indicated no relevant financial relationships.
Rachel Obimah, BS1, Tejal Mistry, MD2, Gabriela Gardner, RDN-AP, LD, CNSC3, Andrew DuPont, MD2. P2020 - Teduglutide Completely Weans Patient With Short Bowel Syndrome From Parental Support in Four Weeks, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.