TREATMENT WITH TEDUGLUTIDE IN A PATIENT WITH SHORT BOWEL SYNDROME SECONDARY TO CROHN'S DISEASE

Case Presentation A 35-year-old female with Crohn's disease since 2008, with an entero-colonic form. In 2009, she underwent left colectomy with rectal burial and creation of a terminal colostomy. She developed lesions in the small intestine and underwent two additional surgeries with enterectomies. During this period, she was treated with azathioprine and infliximab. She later developed enterocutaneous fistulas, with as many as 4 concurrent fistulas, requiring treatment with parenteral nutrition and somatostatin. She underwent multiple surgical procedures, with the last one in 2018, involving extensive small intestine resection, and the terminal colostomy of the transverse colon was maintained. A total of 15 laparotomies were performed. The patient developed short bowel syndrome, with multiple episodes of dehydration and acute renal failure, requiring repeated hospitalizations for hydration and nutritional support on average every 48 hours over the last 5 years. In May 2024, treatment with teduglutide 5 mg subcutaneously per day was initiated, and 30 days after the start of treatment, the patient no longer required hospitalization. As of now, 60 days into the treatment, she has gained 3 kg.

Discussion Short bowel syndrome (SBS) is defined when there is less than 200 centimeters of remaining small intestine, leading to an inability to absorb nutrients. The main causes of SBS in adults are extensive or multiple enterectomies, which can occur in cases of Crohn's disease, radiation enteritis, mesenteric infarction, trauma, or cancer. These patients develop diarrhea, dehydration, malnutrition, acute renal failure, and require recurrent hospitalizations for hydration and parenteral nutrition. Teduglutide is a drug indicated for the treatment of SBS patients, acting as a GLP-2 analogue, activating GLP-2 receptors in the intestine and releasing insulin-like growth factors (IGF), nitric oxide, and keratinocyte growth factor (KGF), promoting intestinal mucosal repair and growth by increasing villi and crypt depth.

ConclusionThis initial experience with teduglutide shows positive and encouraging results, as the patient no longer requires repeated hospitalizations and no longer needs parenteral nutrition. The only difficulty remains access to the drug due to its high cost.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025