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Short Bowel Syndrome
with Intestinal Failure

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Short Bowel Syndrome with Intestinal Failure

Napo EU logo in white

What is Intestinal Failure?

Intestinal failure (IF) occurs when the digestive tract is unable to absorb enough fluids and nutrients essential to maintain health and/or growth, such that the patient requires intravenous nutrition and fluids for survival.1 It can be caused by short bowel syndrome (SBS), a condition caused by surgical removal of large lengths of bowel due to cancer, Crohn’s disease, trauma, or other GI events.2 An estimated 10,000-20,000 individuals in the US have SBS-IF, and it is estimated that the population of SBS patients in Europe is approximately the same size.3,4

What is Intestinal Failure?

Intestinal failure (IF) occurs when the digestive tract is unable to absorb enough fluids and nutrients essential to maintain health and/or growth, such that the patient requires intravenous nutrition and fluids for survival.1 It can be caused by short bowel syndrome (SBS), a condition caused by surgical removal of large lengths of bowel due to cancer, Crohn’s disease, trauma, or other GI events.2 An estimated 10,000-20,000 individuals in the US have SBS-IF, and it is estimated that the population of SBS patients in Europe is approximately the same size.3,4

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3/4 of patients with SBS are still dependent on PN 1 year after starting(2)

Complications associated with SBS-IF

Patients with SBS often suffer from malnutrition, dehydration, ulcers, imbalances of fluids and salts, and excessive intestinal fluid output.2 To maintain adequate health and/or growth, people living with SBS-IF may require parenteral nutrition (PN). This means that essential nutrients are delivered via a catheter or tube in the veins.5

Patients with SBS have a 75%, 64%, and 48% chance of remaining dependent on PN at 1, 2, and 5 years, respectively, after starting PN after their surgery.2

While PN is essential for the patient to survive, IV delivery of nutrients can result in infections or other systemic complications, such as IF-associated liver and renal disease.2 The mortality rate of SBS patients on home PN is about 30% after 5 years.6

Complications associated with SBS-IF

Patients with SBS often suffer from malnutrition, dehydration, ulcers, imbalances of fluids and salts, and excessive intestinal fluid output.2 To maintain adequate health and/or growth, people living with SBS-IF may require parenteral nutrition (PN). This means that essential nutrients are delivered via a catheter or tube in the veins.5

Patients with SBS have a 75%, 64%, and 48% chance of remaining dependent on PN at 1, 2, and 5 years, respectively, after starting PN after their surgery.2

3/4 of patients with SBS are still dependent on PN 1 year after starting(2)

While PN is essential for the patient to survive, IV delivery of nutrients can result in infections or other systemic complications, such as IF-associated liver and renal disease.2 The mortality rate of SBS patients on home PN is about 30% after 5 years.6

The impact of PN and SBS-IF

PN can significantly impact quality of life by posing challenges to activities of daily living, such as school and work.7

PN is also very costly. Inpatient parenteral support is approximately $34,000 to $91,000 per patient per year in the US, and €28,000 to €75,000 per patient per year in Europe.8-10 The estimated annual cost for nonhospitalized PN in the US is approximately $150,000 USD.11

Graphic depicting Inpatient parenteral support of $34K-$91K in United States and €28K-€75K in Europe per year.

The impact of PN and SBS-IF

PN can significantly impact quality of life by posing challenges to activities of daily living, such as school and work.7

PN is also very costly. Inpatient parenteral support is approximately $34,000 to $91,000 per patient per year in the US, and €28,000 to €75,000 per patient per year in Europe.8-10 The estimated annual cost for nonhospitalized PN in the US is approximately $150,000 USD.11

Graphic depicting Inpatient parenteral support of $34K-$91K in United States and €28K-€75K in Europe per year.
Graphic showing Crofelemer’s ability to regulate ion channels in the gut normalizes the salt and water balance in the small bowel, which may lead to better absorption of fluids and nutrients in those living with SBS-IF. Better absorption of major nutrients, such as proteins, fats, carbohydrates, and vitamins, not only supports health and survival, but can reduce dependence on PN. Clinical trials with crofelemer are planned for addressing disease management goals of SBS-IF, such as reducing dependence on PN and improving the quality of life for patients, Improved quality of life, and Better absorption of major nutrients, such as proteins, fats, carbohydrates, and vitamins.

Why crofelemer is being studied in SBS

Crofelemer’s ability to regulate ion channels in the gut normalizes the salt and water balance in the small bowel, which may lead to better absorption of fluids and nutrients in those living with SBS-IF.

Better absorption of major nutrients, such as proteins, fats, carbohydrates, and vitamins, not only supports health and survival, but can reduce dependence on PN.

Clinical trials with crofelemer are planned for addressing disease management goals of SBS-IF, such as reducing dependence on PN and improving the quality of life for patients.

Why crofelemer is being studied in SBS

Crofelemer’s ability to regulate ion channels in the gut normalizes the salt and water balance in the small bowel, which may lead to better absorption of fluids and nutrients in those living with SBS-IF.

Better absorption of major nutrients, such as proteins, fats, carbohydrates, and vitamins, not only supports health and survival, but can reduce dependence on PN.

Clinical trials with crofelemer are planned for addressing disease management goals of SBS-IF, such as reducing dependence on PN and improving the quality of life for patients.

Graphic showing Crofelemer’s ability to regulate ion channels in the gut normalizes the salt and water balance in the small bowel, which may lead to better absorption of fluids and nutrients in those living with SBS-IF. Better absorption of major nutrients, such as proteins, fats, carbohydrates, and vitamins, not only supports health and survival, but can reduce dependence on PN. Clinical trials with crofelemer are planned for addressing disease management goals of SBS-IF, such as reducing dependence on PN and improving the quality of life for patients, Improved quality of life, and Better absorption of major nutrients, such as proteins, fats, carbohydrates, and vitamins.

References

References

  1. Pironi L. Definitions of intestinal failure and the short bowel syndrome. Best Pract Res Clin Gastroenterol. 2016;30(2):173-185.
  2. Parrish CR, DiBaise JK. Managing the adult patient with short bowel syndrome. Gastroenterol Hepatol (NY). 2017;13(10):600-608.
  3. Chen KS, Xie J, Tang W, Zhao J, Jeppesen PB, Signorovitch JE. Identifying a subpopulation with higher likelihoods of early response to treatment in a heterogeneous rare disease: a post hoc study of response to teduglutide for short bowel syndrome. Ther Clin Risk
    Manag
    . 2018;14:1267-1277. doi:10.2147/TCRM.S166081
  4. OxThera AB. (2014, September 24). OxThera’s Oxabact gets European orphan drug status to treat short bowel syndrome [Press release]. http://www.pharmabiz.com/NewsDetails.aspx?aid=84221&sid=2
  5. Abunnaja S, Cuviello A, Sanchez JA. Enteral and parenteral nutrition in the perioperative period: state of the art. Nutrients.
    2013;5(2):608-623. doi:10.3390/nu5020608
  6. Schalamon J, Mayr JM, Höllwarth ME. Mortality and economics in short bowel syndrome. Best Pract Res Clin Gastroenterol.
    2003;17(6):931-942. doi:10.1016/s1521-6918(03)00079-9
  7. Winkler MF. Quality of life in adult home parenteral nutrition patients. JPEN J Parenter Enteral Nutr. 2005;29(3):162-170.
    doi:10.1177/0148607105029003162
  8. Tu Duy Khiem-El Aatmani A, Senesse P, Reimund JM, Beretz L, Baumann R, Pinguet F. Home Parenteral Nutrition: a direct costs study in the approved centres of Montpellier and Strasbourg. Gastroenterol Clin Biol. 2006;30(4):574-579. doi:10.1016/s0399-8320(06)73230-4
  9. Arhip L, García-Peris P, Romero RM, et al. Direct costs of a home parenteral nutrition programme. Clin Nutr. 2019;38(4):1945-1951. doi:10.1016/j.clnu.2018.06.972
  10. Howard L. Home parenteral nutrition: survival, cost, and quality of life. Gastroenterology. 2006;130(2 Suppl 1):S52-59. doi:10.1053/j.gastro.2005.09.065
  11. How Coverage of Medical Foods Can Save Costs and Lives. Patients and Providers for Medical Nutrition Equity. May 2018. Accessed July 20, 2021. https://nutritionequity.org/wp-content/uploads/2018/05/mnea-factsheet-sbs.pdf