Identifying and Treating Patients With SBS-IF

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Presentation transcript:

Identifying and Treating Patients With SBS-IF

Nutritional Homeostasis and Imbalance

Normal

Imbalance

Homeostasis by PS

A Spectrum of Intestinal Function and Metabolic Consequences

ESPEN Guidelines on Chronic IF in Adults

Definitions: Intestinal Insufficiency and IF

Pathophysiological Causes of IF

What Is SBS-IF?

What Is SBS?

Alternative Methods of Classification and Characterization of SBS

Causes and Preexisting Disease Leading to SBS

SBS Classification According to Postsurgical Outcome

SBS Classification According to Anatomy Groups

SBS Classification According to Remnant Intestinal Absorptive Capacity

Absorption of Wet Weight and Energy in Patients Receiving HPN

Summary

Management of Patients With SBS-IF

Consequences of Untreated IF

Oversight of Management Strategy and Multidisciplinary Teams in Intestinal Rehabilitation

Management Focus: Individualized High Quality of Care to Ensure Best Quality of Life

Summary

Nonsurgical Treatment of SBS-IF

Pharmacologic Treatment of SBS-IF: Objectives

Pharmacologic Treatment of SBS-IF: Goal

SBS-IF: Most Common Medical Strategies -- Make the Most of What the Patient Still Has

ESPEN: Recommendations Regarding Diet

ESPEN: Recommendations Regarding Oral Fluid

SBS-IF: Most Common Medical Strategies -- Make the Most of What the Patient Still Has (cont)

ESPEN: Recommendations Regarding Antidiarrheal Agents

ESPEN: Recommendations Regarding Antisecretory Agents

SBS-IF: Most Common Medical Strategies -- Make the Most of What the Patient Still Has (cont)

SBS Pathophysiology

ESPEN: Recommendations Regarding Hormonal Agents

ESPEN: Recommendations Regarding Hormonal Agents (cont)

Evidence for the Use of Teduglutide

Release Sites of Humoral and Neural Mediators of Nutrient Processing

Teduglutide

Beneficial Effects of Teduglutide

STEPS, STEPS-2, and STEPS-3: Study Design

STEPS: Patient Demographics

STEPS: Primary Endpoint -- Greater Than 20% Reduction in PN/IV

STEPS: Mean Reduction in PN/IV Volume at Week 24

STEPS: Difference in Mean FCE and Components of FCE at Week 24

STEPS: Patients Achieving at Least 1 Day off PN per Week

STEPS and STEPS-2: PN/IV Volume Reductions Over 30 Months

Teduglutide: Safety/Tolerability

Benefits of Intestinal Rehabilitation

Program Summary

Program Summary (cont)

Abbreviations

Abbreviations (cont)