LB049 - EARLY USE OF TEDUGLITIDE IN A PATIENTE WITH TYPE 1 SHORT BOWEL SYNDROME: A CASE REPORT

LB049

EARLY USE OF TEDUGLITIDE IN A PATIENTE WITH TYPE 1 SHORT BOWEL SYNDROME: A CASE REPORT

K. M. Camargo^1,*, C. A. B. Salomão¹, S. R. P. Santos¹

¹EMTN, Hospital Santa Paula, São Paulo, Brazil

Rationale: Type 1 short bowel syndrome (SBS), represents one of the most challenging scenarios of intestinal failure due to severe impairment of fluid and nutrient absorption, often requiring prolonged parenteral nutrition (PN). Teduglutide, a GLP-2 analog, has demonstrated efficacy in promoting intestinal adaptation and reducing PN dependence in chronic SBS, as shown in the STEPS and STEPS-2 trials. However, there is limited data on its early use during the initial rehabilitation phase, particularly in type 1 SBS. This case report describes early teduglutide administration in a hospitalized patient, highlighting safety, tolerability, and observed clinical benefits.

Methods: A 46-year-old male patient with hypertension and dyslipidemia provided written informed consent for the publication of this case. He was admitted in June 2024 with acute abdominal pain and underwent multiple surgeries, evolving with type 1 short bowel syndrome, with 160 cm of remaining small intestine, loop ileostomy, and absence of the ileocecal valve. Data were collected from the electronic medical record and supplemented by clinical follow-up through to the current outcome under home care.Three months after the diagnosis, teduglutide was initiated at a dose of 0.05 mg/kg/day. At that time, the patient was tolerating an oral diet with nutritional supplements and was receiving three-chamber parenteral nutrition (1477 mL over 12 hours, 7 times per week). High-output ileostomy was initially managed with loperamide, racecadotril, and calcium carbonate at maximum recommended doses. After two months of treatment, the patient showed clinical improvement and was transferred to a transitional care facility, where he remained for four months in rehabilitation. During this period, progressive reduction in intestinal output allowed for gradual discontinuation of antisecretory medications (currently using only loperamide 2 mg twice daily) and reduction of PN volume to 1080 mL over 12 hours, 7 times per week. Hydration and electrolyte balance were maintained, with weight gain, increased muscle mass and strength, and continuous functional improvement.

Results: Following the initiation of teduglutide, progressive clinical improvement was observed, including reduced ileostomy output and adjustment of antisecretory therapy. The patient transitioned from three medications to loperamide alone (2 mg twice daily). Parenteral nutrition volume was reduced from 1477 mL to 1080 mL over 12 hours, seven times per week.Clinically, the patient showed stable hydration, weight gain, increased muscle mass and strength, and improved functionality, enabling discharge with home care support. After six months of treatment, no adverse effects were reported, and tolerability was excellent. These findings reinforce the intestinotrophic role of teduglutide in intestinal adaptation. Notably, therapy was initiated early, during the rehabilitation phase, differing from major clinical trials such as STEPS and STEPS-2, which evaluated its use in chronic, stabilized patients.

Conclusion: This case describes the early use of teduglutide in a patient with type 1 short bowel syndrome during the initial phase of hospital rehabilitation. The introduction of the medication three months after diagnosis contributed to progressive clinical improvement and reduced parenteral nutrition dependence, despite low citrulline levels and the absence of colon or ileocecal valve. These findings suggest that the response to teduglutide may be multifactorial and not solely determined by anatomy. This report highlights the need for studies evaluating the safety and efficacy of teduglutide in the early stages of intestinal rehabilitation, particularly in clinically complex type 1 SBS cases.

References: Jeppesen PB, et al. Teduglutide reduces need for parenteral support among patients with short bowel syndrome with intestinal failure.
Gastroenterology. 2012;143(6):1473–1481.e3. 

Jeppesen PB, et al. Long-term effects of teduglutide in patients with short bowel syndrome: STEPS-2 study.
Therap Adv Gastroenterol. 2020;13:1756284820959242. 

Pironi L, et al. ESPEN practical guideline: Clinical nutrition in chronic intestinal failure in adults.
Clin Nutr. 2020;39(3):685–700. 

Schulz CS, et al. The timing of teduglutide initiation in short bowel syndrome: Considerations for early therapy.JPEN J Parenter Enteral Nutr. 2023;47(2):273–282. 

Disclosure of Interest: None declared