Long-term outcomes and adverse effects of teduglutide in patients with short bowel syndrome: Highlighting hyperamylasemia and hyperlipasemia.

PURPOSE: Short bowel syndrome is a malabsorptive condition that occurs due to surgical removal or a congenital absence of a significant portion of the small intestine. Patients with short bowel syndrome often rely on parenteral support for extended periods or even their entire lives. Teduglutide, a glucagon-like peptide-2 analog, has shown promising results in reducing dependency on parenteral support in these patients by promoting intestinal adaptation and enhancing nutrient absorption. However, the long-term safety of teduglutide remains a concern, particularly with respect to its potential for the development of hyperamylasemia and hyperlipasemia. METHODS: This study involved patients who received teduglutide from December 2012 to December 2022 at Boston Medical Center. We evaluated outcomes and adverse events, focusing on hyperamylasemia and hyperlipasemia, through chart review. RESULTS: Thirteen eligible patients were identified who had used teduglutide. Of these, the majority (84.6%) experienced a reduction in parenteral support. A high incidence (72.7%) of nonpathological pancreatic enzyme elevation was observed in patients treated with teduglutide. These elevations were often dose dependent and were not associated with any clinical signs of acute pancreatitis or abnormal imaging findings. CONCLUSION: This study highlights the need for further investigations into the long-term safety of teduglutide and the importance of closely monitoring amylase and lipase levels in patients undergoing treatment with teduglutide.

Evaluating the Compliance, Efficacy, and Cost of Formulated Vitamins Versus Separate Supplements in Post-bariatric Surgery Patients.

OBJECTIVE: Micronutrient deficiencies are common complications after bariatric surgery as alterations to the gastrointestinal tract change absorption. Patients are recommended to take supplements including multivitamins, B complex, calcium, vitamin D, and iron after bariatric surgery, and can take these as specifically formulated vitamins for post-bariatric patients or separate vitamin supplements. We investigated the compliance, efficacy, and cost of specifically formulated vitamins for post-bariatric patients in comparison to separate vitamin supplements. METHODS: We surveyed 126 post-bariatric adult patients between February 1, 2022, and August 31, 2022, who had undergone bariatric surgery between 2014 and 2021 to assess the type of supplements taken, compliance, and cost. Demographics, type of bariatric surgery, and serum micronutrient levels were evaluated for all patients. RESULTS: There were 51 patients taking formulated vitamins and 75 patients taking separate vitamins. The formulated vitamin group demonstrated greater adherence to optimal vitamin dosage (formulated vitamin group, 76.5% vs. separate supplement group, 30.7%; p < 0.001) and higher compliance (formulated vitamin group, 90.2% vs. separate supplement group, 66.7%; p = 0.002). The costs associated with both groups were comparable. No significant difference was observed in the incidence of micronutrient deficiency between the groups. CONCLUSIONS: Our study shows that formulated vitamins do not offer significant difference in micronutrient levels or cost compared to separate standard vitamin supplements. However, formulated bariatric vitamins have improved compliance compared to separate vitamin supplements.

Case report: Exploring teduglutide as a therapeutic option for refractory microscopic colitis: insights and implications.

Microscopic colitis is a chronic inflammatory condition of the colon characterized by chronic watery diarrhea, generally with endoscopically normal or nonspecific findings, and can be diagnosed by histopathological examination of colon mucosal biopsies. Some patients experience severe symptoms that do not respond to conventional medical treatment. A glucagon-like peptide-2 (GLP-2) analog, teduglutide, is used in patients with short bowel syndrome (SBS) dependent on parenteral support. In this case report, we describe a patient with microscopic colitis who demonstrated significant symptom improvement following teduglutide treatment.

Prior bariatric surgery and risk of poor in-hospital outcomes in COVID-19: findings from a National Inpatient Sample.

BACKGROUND: Obesity and obesity-related co-morbidities are risk factors for severe coronavirus disease 2019 (COVID-19). OBJECTIVES: As bariatric surgery effectively addresses obesity-related conditions, we hypothesized that prior bariatric surgery may be associated with a reduced risk of severe COVID-19. Small-scale studies have suggested favorable outcomes; however, large-scale nationwide database studies are scarce. SETTING: A retrospective analysis of the 2020 Healthcare Cost and Utilization Project National Inpatient Sample. METHODS: All patients diagnosed with COVID-19 were examined and stratified by history of bariatric surgery. We performed 1:1 propensity score matching and compared patients with COVID-19 with and without prior bariatric surgery. The primary outcome was in-hospital mortality rate. Secondary outcomes included total hospital costs, length of hospital stay, and intensive treatment needs. Multivariate logistic regression analysis was performed to identify independent factors associated with in-hospital mortality. RESULTS: In-hospital mortality rate was significantly lower in patients with prior bariatric surgery (6.2% versus 8.7%, P = .001). Furthermore, sepsis, acute kidney injury, and mechanical ventilation rates were significantly lower in patients with COVID-19 and prior bariatric surgery, resulting in a reduced need for intensive treatment (12.1% versus 14.9%, P = .005). The total hospitalization costs were lower, and the length of hospital stay was shorter in patients with prior bariatric surgery, demonstrating statistical significance. Old age, male sex, body mass index >50, and co-morbidities were significantly associated with in-hospital mortality in patients with COVID-19 and prior bariatric surgery. CONCLUSIONS: Prior bariatric surgery was independently associated with decreased mortality and better in-hospital outcomes in patients hospitalized for COVID-19.

A Case of Abnormal Liver Function Tests in a Patient Receiving Total Parenteral Nutrition.

Hepatic dysfunction is prevalent in patients receiving total parenteral nutrition (TPN), resulting from steatosis, cholestasis, and cholecystitis. Regular assessments and monitoring of TPN patients are essential, even for clinically stable patients on long-term TPN. Furthermore, it is crucial to establish a differential diagnosis for hepatic dysfunction and investigate for other possible causes of elevated liver enzymes and underlying liver conditions. We present the case of a 56-year-old female patient with severe protein-calorie malnutrition on TPN, who exhibited significantly elevated liver enzymes during the routine periodic assessment. Subsequent investigation revealed that the patient had been taking traditional Chinese herbal medications concurrently with TPN. After discontinuing the herbal medications, the patient's liver enzymes returned to normal levels within 3 weeks.

Changes in Patellar Height After Opening Wedge and Closing Wedge High Tibial Osteotomy: A Meta-analysis.

PURPOSE: To test that patellar height decreases (patellar baja) after opening wedge high tibial osteotomy (HTO) and increases (patellar alta) after closing wedge HTO. In addition, this meta-analysis evaluated whether the method of measuring patellar height affected the change in patellar height after opening and closing HTO. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, all studies comparing pre- and postoperative patellar height using various indices, including the Insall-Salvati index (ISI), Blackburne-Peel index, and Caton Deschamps index, in patients who underwent opening or closing wedge HTO were included. The main outcome of this meta-analysis, mean change in patellar height from before to after surgery, was analyzed with a random effects model. Publication bias was evaluated using funnel plots and Egger's test. RESULTS: Twenty-three studies were included in the meta-analysis. Pooled data, including subgroups of the 3 measurement methods, showed that patellar height decreased 7% after opening wedge HTO (95% confidence interval [CI]: 0.05 to 0.10; P < .001), except when patellar height was assessed by ISI (95% CI: -0.02 to 0.06; P = .34), but that there was no change in patellar height after closing HTO (95% CI: -0.01 to 0.04; P = .29). CONCLUSIONS: The patellar height decreased after opening wedge HTO, except when assessed by ISI. In contrast, patellar height was unchanged after closing wedge HTO, regardless of the measurement method. LEVEL OF EVIDENCE: Level II, meta-analysis of Level I and II studies.