Short bowel syndrome (SBS) is a serious and chronic malabsorption disorder1,2

In short bowel syndrome (SBS), a large portion of the intestine is removed surgically, resulting in malabsorption which puts patients at risk of malnutrition, diarrhea, dehydration, and electrolyte disturbances.1,3-5 As a result, patients may require long-term parenteral support for their nutrition and fluids.6

SBS in adults can have a functional or anatomical origin leading to surgical resection of the bowel.7

Possible causes of bowel resection7-9:

  • Crohn’s disease
  • Vascular events (eg, embolism/thrombosis)
  • Complications of bariatric surgery
  • Trauma
  • Volvulus
  • Malignancy
  • Strangulated hernia
  • Small bowel fistulas

Images are provided for illustrative purposes only and are not an exact model of the human body.

Image of bowel anatomy illustration

Images are provided for illustrative purposes only and are not an exact model of the human body.

How does bowel anatomy affect PS requirements?

Bowel Anatomy

Long term PS is associated with serious complications8,10

Image of PS icon

Parenteral Support (PS)

PS refers to parenteral nutrition and/or essential fluids. PS cannot increase intestinal absorptive capacity7,11-13

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Complications

Many complications of SBS are PS related. They can be serious and sometimes life threatening8

When appropriate, attempts should be made to wean patients off of PS while encouraging increased oral consumption.7,8

Days off PS may allow patients more freedom for8,11,14:

Image of work icon

Work

Image of sleep and rest icon

Sleep and rest

Image of hobbies icons

Hobbies

(eg, travel, engaging in leisure sports)

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Social interaction

(eg, community events or connecting with friends and family)

Examples of how some patients may spend their time if they are able to achieve more days off parenteral support are for illustrative purposes only. Patients should always discuss their individual medical circumstances and activities with their doctor.

How does GATTEX work
in adult patients with SBS who are dependent on PS?

About Gattex

Image of actor portrayal of GATTEX patient

Not actual patient

Indication:
GATTEX® (teduglutide) for injection is indicated for the treatment of adult patients with Short Bowel Syndrome (SBS) who are dependent on parenteral support.

Important Safety Information:

Warnings and Precautions:
GATTEX has been associated with possible acceleration of neoplastic growth, intestinal obstruction, biliary and pancreatic disease, fluid imbalance and fluid overload, and increased absorption of concomitant oral medication. Click here for additional Important Safety Information.

Click here for additional Important Safety Information.

Indication

GATTEX® (teduglutide) for injection is indicated for the treatment of adult patients with Short Bowel Syndrome (SBS) who are dependent on parenteral support.

Important Safety Information

Warnings and Precautions

Acceleration of neoplastic growth

Colorectal polyps were identified during clinical trials. There is a risk for acceleration of neoplastic growth. Within 6 months prior to starting treatment with GATTEX, colonoscopy (or alternate imaging) of the entire colon with removal of polyps should be performed and follow-up colonoscopy (or alternate imaging) is recommended at the end of 1 year of GATTEX. Subsequent colonoscopies should be performed every 5 years or more often as needed. In case of intestinal malignancy (GI tract, hepatobiliary, pancreatic), discontinue GATTEX. The clinical decision to continue GATTEX in patients with non-gastrointestinal malignancy should be made based on benefit-risk considerations.

Intestinal obstruction

Intestinal obstruction has been reported in clinical trials and postmarketing. In patients who develop intestinal or stomal obstruction, GATTEX should be temporarily discontinued pending further clinical evaluation and management.

Biliary and pancreatic disease

Cholecystitis, cholangitis, cholelithiasis, and pancreatitis have been reported in clinical trials and postmarketing. Laboratory assessment (bilirubin, alkaline phosphatase, lipase, amylase) should be obtained within 6 months prior to starting GATTEX. Subsequent laboratory tests should be done every 6 months or more often as needed. If clinically meaningful changes are seen, further evaluation is recommended including imaging, and continued treatment with GATTEX should be reassessed.

Fluid imbalance and fluid overload

Fluid overload and congestive heart failure have been observed in clinical trials. If fluid overload occurs, especially in patients with underlying cardiovascular disease, parenteral support should be adjusted and GATTEX treatment reassessed. If significant cardiac deterioration develops while on GATTEX, continued GATTEX treatment should be reassessed.

Discontinuation of treatment with GATTEX may also result in fluid and electrolyte imbalance. Fluid and electrolyte status should be monitored in patients who discontinue treatment with GATTEX.

Increased absorption of concomitant oral medication

In clinical trials, one patient receiving prazepam concomitantly with GATTEX experienced dramatic deterioration in mental status progressing to coma during first week of GATTEX therapy. Patients receiving concomitant oral drugs requiring titration or with a narrow therapeutic index should be monitored for adverse reactions due to potential increased absorption of the concomitant drug. The concomitant drug may require a reduction in dosage.

Adverse Reactions

The most common adverse reactions (≥10%) with GATTEX are abdominal pain, nausea, upper respiratory tract infection, abdominal distension, injection site reaction, vomiting, fluid overload, and hypersensitivity.

Use in Specific Populations

Breastfeeding is not recommended during treatment with GATTEX.

Please click here for full Prescribing Information.

References:
  1. Jeppesen PB. JPEN J Parenter Enteral Nutr. 2014;38(suppl 1):8S-13S.
  2. Seidner DL, Schwartz LK, Winkler MF, et al. JPEN J Parenter Enteral Nutr. 2013;37(2):201-211.
  3. Pironi L, Arends J, Baxter J, et al. Clin Nutr. 2015;34:171-180.
  4. Thompson JS, Weseman R, Rochling FA, Mercer DF. Surg Clin North Am. 2011;91:493-510.
  5. O’Keefe SJ, Buchman AL, Fishbein TM, Jeejeebhoy KN, Jeppesen PB, Shaffer J. Clin Gastroenterol Hepatol. 2006;4(1):6-10.
  6. Pironi L, Arends J, Bozzetti F, et al. Clin Nutr. 2016; 35:247-307.
  7. Buchman AL, Scolapio J, Fryer J. Gastroenterology. 2003;124(4):1111-1134.
  8. Hofstetter S, Stern L, Willet J. Curr Med Res Opin. 2013;29(5):495-504.
  9. Parrish CR. Pract Gastroenterol. 2005;XXIX(9):67-106.
  10. Mullady DK, O’Keefe SJD. Nat Clin Pract Gastroenterol Hepatol. 2006;3(9):492-504.
  11. Jeppesen PB, Pertkiewicz M, Messing B, et al. Gastroenterology. 2012;143(6):1473-1481.
  12. Vipperla K, O’Keefe SJ. Expert Rev Gastroenterol Hepatol. 2011;5(6):665-678.
  13. Jeppesen PB, Gilroy R, Pertkiewicz M, Allard JP, Messing B, O’Keefe SJ. Gut. 2011;60(7):902-914.
  14. Schwartz LK, O’Keefe SJD, Fujioka K, Gabe SM, et al. Clin Transl Gastroenterol. 2016;7:e142. doi:10.1038/ctg.2015.69.