Bridging intestinal failure with Teduglutide - A case report

Abstract

Introduction and importance: Intestinal failure (IF) describes the state of a person's gastrointestinal absorption capabilities becoming unable to absorb fluids and nutrients needed to sustain normal physiology, leading to severe comorbidities and if left untreated, to death. IF is most commonly seen as a result of short bowel syndrome (SBS). Teduglutide is a glucagon-like peptide 2 (GLP-2) analogue used in the treatment of patients with SBS and intestinal failure (IF) as a way to reduce the need for parenteral support. Teduglutide leads to the growth of intestinal mucosa by stimulating intestinal crypt cell growth and inhibiting enterocyte apoptosis. It is usually prescribed as a final treatment step after the diagnosis of SBS-IF is made.

Case presentation: In this case report we present a novel strategy for using teduglutide as a bridging therapy to intestinal reconstruction. The patient achieved enteral autonomy preoperatively, underwent surgery, and remained in enteral autonomy after intestinal reconstruction.

Clinical discussion: Teduglutide has been previously exclusively used as continuous therapy in SBS-IF, this is the first reported case of using teduglutide as bridging to intestinal reconstruction. The hypothesis of this approach was to achieve an adequate nutritional status for reconstruction without the disadvantages of parenteral support.

Conclusion: The controlled application of teduglutide can provide the benefits of preoperative nutritional optimization without the disadvantages of parenteral support and at the same time facilitate an earlier and easier intestinal reconstruction.

Keywords: Bridging intestinal failure; GLP-2; Intestinal failure; Short bowel syndrome; Teduglutide.

Fig. 1

Abdominal wall (A) Preoperative. Red arrow indicating the double barrel jejunostomy, purple arrow indicating the ileostomy and green arrow indicating the two enteral fistulas showing hypertrophic mucosa. (B) Postoperative (3 months after surgery). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Overview of the amount of parenteral support, oral fluid intake, urinary output and body weight over the course of teduglutide therapy. Left y-axis indicating fluid amount in milliliters [ml]. Right y-axis indicating patient's body weight in kilogram [kg].