title: Gut hormones in the treatment of short-bowel syndrome and intestinal failure.
abstract: OBJECTIVE
  The approval of teduglutide, a recombinant analog of human glucagon-like peptide (GLP) 2, by the US Food and Drug Administration (Gattex) and the European Medicines Agency (Revestive) has illustrated the potential of selected gut hormones as treatments in patients with short-bowel syndrome and intestinal failure. Gut hormones may improve the structural and functional intestinal adaptation following intestinal resection by decreasing a rapid gastric emptying and hypersecretion, by increasing the intestinal blood flow, and by promoting intestinal growth. This review summarizes the findings from phase 2 and 3 teduglutide studies, and pilot studies employing GLP-1 and agonists for this orphan condition.
  
  
  RESULTS
  In a 3-week, phase 2, metabolic balance study, teduglutide increased the intestinal wet weight absorption by approximately 700 g/day and reduced fecal energy losses by approximately 0.8 MJ/day (∼200 Kcal/day). In two subsequent 24-week, phase 3 studies, teduglutide reduced the need for parenteral support in the same magnitude. Adverse events were mainly of gastrointestinal origin and consistent with the known mechanism of action of teduglutide. Pilot studies suggest that GLP-1 may be less potent. Synergistic effects may be seen by co-treatment with GLP-2.
  
  
  CONCLUSIONS
  Gut hormones promote intestinal adaptation and absorption, decreasing fecal losses, thereby decreasing or even eliminating the need for parenteral support. This will aid the intestinal rehabilitation in these severely disabled short-bowel syndrome patients.
authors.affiliation: Department of Medical Gastroenterology CA-2121, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Palle B
authors.initials: PB
authors.lastname: Jeppesen
mesh_terms: D017322:Clinical Trials, Phase II as Topic; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D052216:Glucagon-Like Peptide 1 / Q000819:agonists*; D006801:Humans; D007408:Intestinal Absorption; D007421:Intestine, Small / Q000098:blood supply / Q000503:physiopathology* / Q000601:surgery; D010288:Parenteral Nutrition; D010455:Peptides / Q000627:therapeutic use*; D010865:Pilot Projects; D011788:Quality of Life; D012778:Short Bowel Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D014481:United States
chemical_list: D005765:Gastrointestinal Agents; D010455:Peptides; C494910:teduglutide; D052216:Glucagon-Like Peptide 1