Teduglutide to Treat Short Bowel Syndrome

By Alex Dean

For those people who have had at least half of their small intestine removed and sometimes all or part of their large intestine removed, they may get a disease called short bowel syndrome. This means that they have a series of difficulties in absorbing nutrients that are essential for survival, including enough water, vitamins, minerals, protein, fat, calories, and other nutrients from food.

Although this disease quite rarely occurs, 3 out of every million people do suffer from this disease each year. And the outcome brought by it may varies from mild to moderate to severe, depending on which section of small intestine has been damaged or removed and thus having trouble with absorption.

In surgeries to treat diseases like cancer, Crohn's disease, gastroschisis and intestinal atresia, patients have to have part of their small intestine removed so as to save lives. However, this is exactly the major cause of short bowel syndrome. Besides, some children are born with an abnormally short small intestine or with part of their bowel missing, which can also cause this disease. In infants, short bowel syndrome most commonly occurs following surgery to treat necrotizing enterocolitis, a condition in which part of the tissue in the intestines is destroyed.

Are there any signs of short bowel syndrome? Definitely YES. Diarrhea might be the most obvious symptom and insufficient absorption of nutrients may gradually lead to malnutrition in the end. Other signs and symptoms may include: bloating, cramping, fatigue, foul-smelling stool, heartburn or vomiting.

For the treatment of this syndrome, there are roughly three approaches with increasing severity of the conditions: medications, surgery and intestinal transplant. All aims to one goal, that is, to improve intestinal absorption. Among different medications prescribed by doctors to treat short bowel syndrome,    teduglutide specifically targets at this goal.

Teduglutide is a 33-membered polypeptide and glucagon-like peptide-2 (GLP-2) analog. It works by promoting mucosal growth and possibly restoring gastric emptying and secretion. Different from natural GLP-2 by a single amino acid: an alanine is replaced with a glycine, teduglutide blocks breaking down of the molecule by dipeptidyl peptidase and increases its half-life from seven minutes (GLP-2) to about two hours, while retaining its biological actions. These include maintenance of the intestinal mucosa, increasing intestinal blood flow, reducing gastrointestinal motility and secretion of gastric acid.

While fine surgical techniques and devotional care could minimize the negative consequences caused by unavoidable surgeries, there is no way to prevent short bowel syndrome present at birth.