Which pharmacological treatments are effective in managing symptoms associated with short bowel syndrome?

Pharmacological management of symptoms associated with short bowel syndrome (SBS) primarily focuses on enhancing intestinal adaptation, reducing diarrhoea, and improving nutrient absorption. Key effective treatments include:

• Antimotility agents such as loperamide are commonly used to reduce diarrhoea by slowing intestinal transit, thereby increasing nutrient and fluid absorption.
• Proton pump inhibitors (PPIs) or H2 receptor antagonists may be considered to reduce gastric acid secretion, which can improve nutrient absorption and reduce diarrhoea, especially if symptoms persist despite other treatments.
• Somatostatin analogues (e.g., octreotide) can be used to decrease intestinal secretions and slow motility, which helps manage high-output stomas or diarrhoea in SBS patients.
• Glucagon-like peptide-2 (GLP-2) analogues (e.g., teduglutide) have emerged as effective agents that promote intestinal mucosal growth and enhance absorptive capacity, thereby reducing dependence on parenteral nutrition.
• Pancreatic enzyme replacement therapy may be necessary if exocrine pancreatic insufficiency contributes to malabsorption symptoms.

These pharmacological options are often used in combination with nutritional support and fluid management to optimise patient outcomes. The choice and titration of medications should be individualised based on symptom severity and response to treatment.

This approach aligns with UK clinical practice where acid suppression and enzyme replacement are considered for malabsorption symptoms, and antimotility agents are used to manage diarrhoea ¹. Additionally, recent literature highlights the role of somatostatin analogues and GLP-2 analogues as important pharmacologic options for intestinal rehabilitation in SBS (Jeppesen, 2014).