Clinical Management of Patients With Parenteral Nutrition-Dependent Short Bowel Syndrome During Teduglutide Therapy.

BACKGROUND: Patients with intestinal failure, who are dependent on parenteral nutrition (PN) to supplement their limited absorption of dietary nutrients, are subject to complications associated with long-term PN therapy. Medication therapy that results in improved dietary nutrient absorption may enable these patients to reduce or even become independent from PN therapy and its related complications. The glucagon-like peptide 2 (GLP-2) analogue teduglutide was approved for use in such patients by the U.S. Food and Drug Administration in 2012. PURPOSE: The purpose of this article is to describe the experience of 7 patients with PN-dependent intestinal failure who were treated with teduglutide by a single center that had been involved in the teduglutide clinical trials. RESULTS: Two patients who were treated during the clinical trials and 5 others who were treated since teduglutide came to market in the United States are described. Protocols used to prepare and monitor patients with this drug and PN weaning and adverse event outcomes are presented. CONCLUSIONS: While some patients had uncomplicated PN reduction, others experienced various complications. Careful monitoring of patients' clinical course is needed during drug therapy.

Application of the A.S.P.E.N. clinical guideline for nutrition support of hospitalized adult patients with obesity: a case study of home parenteral nutrition.

An A.S.P.E.N. clinical guideline addressing the nutrition support of hospitalized adult patients with obesity was recently published in the Journal of Parenteral and Enteral Nutrition. Among the patient presentations for which this guideline might be used is those who have a gastrointestinal complication after bariatric surgery. A case study is discussed of a 43-year-old woman with a long history of severe obesity who had a bowel obstruction approximately 2 weeks after her laparoscopic sleeve gastrectomy surgery. The patient's treatment plan for bowel rest and home parenteral nutrition was based on the A.S.P.E.N. clinical guideline for patients with obesity. She tolerated the course well and resumed the expected diet advancement and weight loss patterns expected of her weight-loss surgery.