Introduction Prior to the availability of teduglutide (TED), functional bowel length was recognised as an important prognostic factor in patients (pts) with short bowel syndrome (SBS).¹ Pts with shorter residual small bowel following intestinal resection generally are more likely to remain chronically dependent on parenteral support (PS) to meet fluid and nutrient needs.¹TED enhanced absorption and reduced the PS volume needed to maintain clinical status in a wide range of pts with varying etiologies and durations of SBS.^2-4 In the STEPS (NCT00798967) study, 27/43 (63%) TED-treated vs 13/43 (30%) placebo-treated pts achieved responder criteria (≥20% reduction in weekly PS volume from baseline at Wks 20 and 24).⁴ Mean PS volume reduced by 4.4 L/wk at Wk 24 from the baseline mean volume of 12.9 L/wk. This subanalysis was undertaken to determine the impact of TED in pts with ultra-short (≤40 cm) remnant bowel and/or no colon-in-continuity.

Methods Data from pts randomised to TED 0.05 mg/kg/day in STEPS whose bowel length was known (n = 40) were assessed by descriptive statistics. Also, data from all pts randomised to TED 0.05  mg/kg/day in STEPS, regardless of bowel length (n = 43), were analysed according to presence or absence of colon-in-continuity. No between-group comparisons were done owing to the small sample size.

Results Responder criteria were met by similar percentages of pts regardless of bowel length, including pts with remnant bowel length ≤25 or ≤40 cm (Table). At Wk 24, pts in each of these 2 groups with ultra-short bowel had mean decreases in weekly PS volume of 3.9 and 3.6 L, respectively. Data analysis from all pts randomised to TED, regardless of bowel length, found that 13/17 (77%) pts without colon-in-continuity and 14/26 (54%) pts with colon-in-continuity met the responder criteria. Furthermore, the mean change in weekly PS volume at Wk 24 was greater for pts with no colon-in-continuity (–6.4 L/wk) than pts with colon-in-continuity (–3.2 L/wk).

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Abstract PTU-111 Table 1

Baseline characteristics and changes in PS requirements from baseline to week 24 in SBS patients with ≤40 cm or ≤25 cm remnant bowel

Conclusion Pts without colon-in-continuity show a numerically greater response to TED, perhaps reflecting natural adaptation by GLP-2 secreting cells in pts with colon-in-continuity. The overall findings reinforce the benefits of treatment with TED 0.05 mg/kg/day to enhance absorptive capacity in SBS regardless of remnant anatomy.

References 1 O’Keefe, et al. Clin Gastroenterol Hepatol 2006;4:6–10.

2 Jeppesen, et al. Gut 2005;54:1224–31.

3 Jeppesen, et al. Gut 2011;60:902–14.

4 Jeppesen, et al. Gastroenterology 2012;143:1473–81.

Disclosure of Interest None Declared