Short Bowel Syndrome - Treatments

Treatments

Symptoms of short bowel syndrome are usually addressed by prescription medicine. These include:

• Anti-diarrheal medicine (e.g. loperamide, codeine)
• Vitamin, mineral supplements and L-Glutamine powder mixed with water
• H2 blocker and proton pump inhibitors to reduce stomach acid
• Lactase supplement (to improve the bloating and diarrhoea associated with lactose intolerance)
• Surgery, including intestinal lengthening, tapering, and small bowel transplant.
• Parenteral nutrition (PN or TPN for total parenteral nutrition - nutrition administered via intravenous line).
• Nutrition administered via gastrostomy tube

In 2004, the USFDA approved a therapy that reduces the frequency and volume of TPN, comprising: NutreStore (oral solution of glutamine) and Zorbtive (growth hormone, of recombinant DNA origin, for injection) together with a specialized oral diet. Eight years later, in 2012, an advisory panel to the USFDA voted unanimously to approve for treatment of SBS the agent teduglutide, a glucagon-like peptide-2 analog developed by NPS Pharmaceuticals, who intend to market the agent in the United States under the brandname Gattex. Teduglutide had been previously approved for use in Europe and is marketed under the brand Revestive by Nycomed.

Surgical procedures to lengthen dilated bowel include the Bianchi procedure (where the bowel is cut in half and one end is sewn to the other) and a newer procedure called serial transverse enteroplasty (STEP—where the bowel is cut and stapled in a zigzag pattern). Heung Bae Kim, MD, and Tom Jaksic, MD, both of Children's Hospital Boston, devised the STEP procedure in the early 2000s. The procedure lengthens the bowel of children with SBS and may allow children to avoid the need for intestinal transplantation. As of June 2009, Kim and Jaksic have performed 18 STEP procedures.

The Bianchi and STEP procedures are usually performed by pediatric surgeons at quaternary hospitals who specialize in small bowel surgery.