Short bowel syndrome (SBS) is a malabsorptive disorder of the GI tract characterized by diarrhea or high-output stoma, malnutrition, and dehydration.1, 2 It represents a major cause of chronic intestinal failure, defined by reduced absorptive capacity that requires IV support to maintain hydroelectrolytic and nutritional balance.3 Of note, parenteral nutrition (PN) is not without risks, including catheter-related sepsis or thrombosis, as well as negative impacts on quality of life and significant health care costs.4 The most common etiologies of SBS include Crohn’s disease, mesenteric ischemia, radiation enteritis, and postoperative complications.2, 3

The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends teduglutide as a first-line option for patients older than 18 years of age with SBS who have been carefully selected as eligible for treatment with growth factors.2, 5 Teduglutide is an analog of human glucagon-like peptide-2 (GLP-2).6, 7, 8 GLP-2 is a peptide secreted by intestinal L cells located in the ileum, which increases intestinal and portal blood flow, inhibits gastric acid secretion, and reduces intestinal motility.6, 7 Current clinical trials (STEPS 2 and 3) have demonstrated that it restores intestinal absorptive function and significantly reduces PN dependence in 63–67% of patients with SBS.2, 7, 9, 10 This drug may also serve as a bridge therapy prior to intestinal reconstruction, allowing for optimization of nutritional status without the need for prolonged parenteral support, and improving the patients’ quality of life.11, 12 However, available evidence supporting this use is extremely limited, with only 1 case report published in the scientific literature.1 Moreover, its high cost poses a major barrier to accessibility, underscoring the importance of careful patient selection2, 13 and the need for further studies to better define its potential role in this context.

We present a case of SBS due to surgery, in which PN withdrawal was achieved after teduglutide treatment, followed by a new metabolic challenge.