Cuando la falla intestinal ocurre luego de una resección intestinal masiva se denomina síndrome de intestino corto. Es una entidad rara, con un espectro clínico que va desde una disfunción leve y reversible hasta una condición grave e incapacitante. Presenta una elevada morbimortalidad, altos costos de atención médica e importante impacto en la calidad de vida. El 50% de los pacientes con síndrome de intestino corto no se adaptan espontáneamente ni mejoran la absorción por el intestino remanente, por lo que deben recurrir de por vida a la nutrición parenteral. La terapia nutricional especializada y el tratamiento hormonal focalizado en el intestino son pilares en la rehabilitación promoviendo la adaptación intestinal, logrando independencia de la nutrición parenteral y evitando el trasplante intestinal. Actualmente, teduglutide es el tratamiento de referencia en estos pacientes, pero hasta el momento inaccesible en Uruguay por su elevado costo. Presentamos el único caso en nuestro país de un paciente de 23 años portador de falla intestinal crónica por síndrome de intestino corto que depende de la nutrición parenteral desde hace 17 años y presenta complicaciones graves asociadas a esta técnica. Palabras clave: Síndrome del intestino corto Nutrición parenteral Teduglutida Fallo intestinal Enfermedad crónica
Background
Teduglutide, a semisynthetic analogue of glucagon‐like peptide‐2 (sGLP‐2), increases intestinal absorption of fluids and nutrients, reducing the need for parenteral nutrition (PN). This report aims to describe our experience with sGLP‐2 in a cohort of adult patients with short‐bowel syndrome.
Methods
This is a prospective observational study on adult patients initially evaluated in our specialized intestinal rehabilitation program that received sGLP‐2 from June 2014 to March 2020.
Results
Autologous gastrointestinal reconstruction surgery (AGIRS) was performed in 108 patients; 68.5% (74 of 108) achieved intestinal sufficiency with standard medical therapy. Seventeen patients were treated with sGLP‐2; 66.5% (8 of 12) received treatment for a mean time of 25.8 weeks (3.4–54.0) and could suspend PN. One patient reinitiated treatment due to renal lithiasis and acute renal failure. Currently, 7 of 12 patients (53.8%) continue without PN for a mean time of 165.6 weeks. Volume, energy, and days of PN were reduced in all patients. No serious adverse events were registered. Four of 7 patients (57.1%) who discontinued PN could also discontinue sGLP‐2. Therefore, the use of sGLP‐2 increased the overall success rate of PN independency after AGIRS to 76% (82 of 108).
Conclusion
This study confirmed that sGLP‐2 should be considered as part of the standard therapy for postsurgical medical rehabilitation treatment in patients with chronic intestinal failure. We add to the current knowledge that some patients can discontinue both PN and sGLP‐2 in the long term, achieving complete recovery of their quality of life.
In critically ill surgical patients, whose CL6 on admission was over 2 mEq/l, lactate clearance in the first six hours could be useful to predict the ICU outcome.
Terapia nutricional y pre-habilitación multimodal en el paciente quirúrgico no crítico. Una revisión. Nutritional therapy and multimodal pre-habilitation in the non-critical surgical patient. A review.
La pancreatitis aguda metabólica por hipertrigliceridemia es una entidad excepcional. El riesgo de desarrollarla se vincula con niveles de triglicéridos mayores de 500 mg/dl; sin correlación directa entre el nivel con la gravedad ni las complicaciones.
Se analiza el caso clínico de un paciente con pancreatitis aguda hipertrigliceridémica recurrente; la complejidad terapéutica de su manejo y el alto riesgo de mortalidad de este tipo de pancreatitis.
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