Treatment of Malabsorption in Short Bowel Syndrome Requiring Parenteral Support

This protocol addresses malabsorption caused by intestinal failure due to short bowel syndrome in patients who remain dependent on parenteral fluids or nutrients after the period of intestinal adaptation has concluded.

Clinical Scenario

Short bowel syndrome leads to intestinal failure when the residual bowel cannot sustain adequate nutrient and fluid absorption. Patients who continue to require parenteral support after intestinal adaptation — typically following one or more intestinal resections — represent a distinct population for whom a structured evidence-based approach exists.

Treatment Approach

For stable patients who remain on parenteral nutrition or parenteral fluids after adaptation, a specific class of intestinal growth factor therapy is recommended with the goal of reducing or withdrawing parenteral support. The complete protocol — including patient selection, timing considerations, and monitoring requirements — is available below.

Treatment Goals

Success is defined as a sustained 20% reduction in intravenous volume from baseline, with body weight and composition, electrolyte balance, and renal function remaining stable throughout.

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References

The use of glucagon-like peptide 2 (GLP-2) analogues (e.g., teduglutide) is recommended for patients with intestinal failure due to short bowel syndrome who require parenteral fluids or nutrients after the period of intestinal adaptation, in order to reduce or withdraw parenteral support and improve quality of life.
In patients with IF due to SBS, intestinal growth factors should be considered for patients requiring parenteral nutrition/parenteral fluids who are stable after postoperative intestinal adaptation of usually 12-24 months after the last intestinal resection.
Efficacy of the intestinal growth factor treatment is defined as a 20% stable reduction in intravenous volume from baseline.
Body weight and composition, electrolyte balance and renal function should remain stable despite the reduction in IV supplementation.

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