Use of Teduglutide in a Patient With Ulcerative Colitis and Short Bowel Syndrome: Case Report

Background: Patients with inflammatory bowel disease (IBD) undergoing extensive intestinal resections may develop short bowel disease (SBS). Patients with SBS are unable to absorb sufficient nutrients or fluids to maintain metabolic homeostasis via the oral or enteral route alone and require long-term intravenous supplementation consisting of partial or total parenteral nutrition, fluids, electrolytes, or a combination of these. The goal of medical and surgical treatment for patients with SBS is to maximize the absorptive capacity of the remaining intestine so that the need for intravenous support can be reduced or eliminated. Teduglutide (TED) is a glucagon-related peptide (aGLP2) agonist used as a complement or substitute to conventional home parenteral nutrition treatment for patients with SBS. The effects of TED for SBS in IBD patients remain unknown. Methods: Review of the medical record of a patient with IBD and SBS using TED with excellent short-term evolution. Results: A 42-year-old man with ulcerative colitis underwent total colectomy with terminal ileostomy in the emergency room due to severe acute ulcerative colitis. After one year, a proctectomy was performed with an ileal pouch with a J-shaped reservoir and a derivative loop ileostomy. He developed intestinal obstruction in the postoperative period, non-mechanical, refractory to all available clinical measures. He required new surgery requiring extensive ileal and jejunum resection including removal of the ileal pouch, retroperitoneal release of the left ureter with bladder reimplantation, terminal jejunostomy (1 meter of remaining jejunum) due to idiopathic capsulating peritonitis. Postoperatively, he presented with a ureteral fistula culminating in left nephrectomy, in addition to severe malnutrition, cachexia, sarcopenia, anemia, hypoalbuminemia and dehydration with repeated and long periods of hospitalization interspersed with home parenteral nutrition. Recommended use of TED. Currently, after 1 year of using TED, he is weaning from home parenteral nutrition with almost exclusive oral nutrition, weight gain, pasty stools in the jejunostomy, without hospitalizations during the period, still with daily intravenous hydration with saline solution. Conclusions: Daily subcutaneous administration of TED in this patient has been effective in reducing dependence on DPN and potentially improving quality of life.