Title: Teduglutide for treating short bowel syndrome (ID3937)
Funder: Department of Health and Social Care

Abstract: Short bowel syndrome is a chronic and potentially life-threatening condition characterised by reduced absorption of nutrients, water and electrolytes in the intestine. The main symptom is diarrhoea, which can lead to dehydration, malnutrition and weight loss. The most common cause of short bowel syndrome in adults is surgical removal of at least half of the small intestine in people with Crohn’s disease. People may also have sections of their bowel removed after developing complications from previous surgery, a major injury, or during surgery to remove a malignant tumour. The remaining part of the bowel adapts and grows over time to increase its ability to absorb nutrients, but the level of natural adaptation is different from person to person and can take up to 2–3 years._x000D_ _x000D_ Paediatric short bowl syndrome is also a chronic and potentially life-threatening condition. Symptoms include malnutrition, dehydration, and metabolic and electrolyte disturbances. Paediatric short bowl syndrome can occur at birth or shortly after. The most common causes are necrotizing enterocolitis, abdominal wall defects, intestinal atresia, and mid-gut volvulus._x000D_ _x000D_ The main treatment for short bowel syndrome is nutritional support (delivery of nutrients, electrolytes and fluids), which is given directly into the vein (parenteral support). Enteral tube feeding into the stomach or small bowel is infrequently used. The majority of people self-administer parenteral support at home, using a long term intravenous tube inserted by a healthcare professional. These tubes are associated with life threatening complications such as blood infections, blood clots, and liver failure. Parenteral support places a huge burden on patients, because it requires them to be attached to an infusion pump for many hours each night, for several nights a week. Some people need treatment every night, and are unable to work. People with short bowel syndrome will also receive drugs to promote nutrient absorption, including antimotility agents (such as loperamide and codeine) to increase the time it takes food to travel through the intestines, and antisecretory agents (such as proton pump inhibitors) to reduce the production of gastric acid. Patients will be advised to restrict their oral fluid intake and change their diet to promote absorption. In addition, where possible, surgery is considered to reconstruct or lengthen the remaining parts of the bowel, to increase the surface area for absorption. People whose condition does not respond to treatment, or who develop serious complications from long-term parenteral support, may require an intestinal transplant, but this is considered only as a last resort._x000D_ _x000D_ Based on the British Artificial Nutrition Survey (BANS) from the British Association for Parenteral and Enteral Nutrition (BAPEN)[1], it is estimated that around 500 adults in England have short bowel syndrome and are dependent on long-term parenteral support (data from 2015)._x000D_ _x000D_ References_x000D_ 1 BANS Report 2016 (2017); Artificial Nutrition Support in the UK 2005-2015. http://www.bapen.org.uk/resources-and-education/publications-and-reports/bans/bans-reports [accessed March 2021]

Lay abstract: To appraise the clinical and cost effectiveness of teduglutide within its marketing authorisation for treating short bowel syndrome.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: ORAL AND GASTROINTESTINAL