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Presenter: Sophie, Pevny, Berlin, Germany
Authors: Sophie Pevny, Sebastian Maasberg, Mirjam Karber, Barbora Knappe-Drzikova, Dana Thurmann, Andreas Pascher, Ulrich-Frank Pape
Sophie Pevny1, Sebastian Maasberg1, Mirjam Karber1, Barbora Knappe-Drzikova1, Dana Thurmann1, Andreas Pascher2, Ulrich-Frank Pape1.
1Department of Gastroenterology, Hepatology and Endocrinology, Charité University Medicine Berlin, Berlin, Germany; 2Department of General, Visceral and Transplantation Surgery, Charité University Medicine Berlin, Berlin, Germany
Introduction: Teduglutide (TED), an analogue of glucagon like peptide-2 (GLP-2), a protrophic gastrointestinal hormone that promotes regeneration of the intestinal mucosa, is effective for enhancing intestinal adaption in patients with short bowel syndrome (SBS) and chronic intestinal failure. Thus it is expected to improve nutritional status, oral autonomy and clinical outcome.
Methods: Center based clinical and paraclinical data of patients with benign SBS were analyzed retrospectively from a single university hospital. Within a subcohort, nutritional status was assessed in clinical routine by bioelectrical impedance analysis (BIA).
Results: In total, 23 patients were treated since October 2014. For this interim analysis of nutritional parameters, records of 17 patients (mean age: 51 years; SD: 16y) with anatomical SBS type 1 (enterostomy; n=3), type 2 (jejunocolonic anastomosis; n=9), type 3 (ileocolonic anastomosis; n=1) or very short SBS (n=4) were analyzed.
Three month after initiation of TED treatment (0.025-0.05 mg/kg) patients showed a 2679 ml reduction in intravenous volume requirements per week (n=17; p=0.007) and a 1522 kcal reduction in intravenous energy requirement per week (n=17; p=0.007). After one year, the difference of each approximately doubled to 5666 ml and 2776 kcal reduction (n=9; p=0,001 and p= 0,005 resp.). Analysis of BIA parameters revealed stability in body mass index (BMI), phase angle α, body cell mass (BCM), and intra- or extracellular water albeit reduction in parenteral support after 24 (n=9) and 48 (n=7) weeks on TED.
Conclusions: Throughout the gradual reduction of intravenous fluid and nutritional support in TED-treated SBS patients, meaningful parameters of body composition remained constant. This demonstrates a beneficial effect of TED allowing reduction of parenteral support at no cost of body composition suggesting stability of nutritional status with improved intestinal function. Applying BIA for monitoring body composition as a surrogate of nutritional status in clinical routine can guide decision making in parenteral support management.
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