Pediatric Short Bowel Syndrome Medication

Updated: May 23, 2019
  • Author: Carmen Cuffari, MD; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
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Medication

GLP-2 Analogs

Class Summary

Analogs of a naturally occurring glucagonlike peptide-2 (GLP-2) bind to the GLP-2 receptors located in intestinal subpopulations of enteroendocrine cells, subepithelial myofibroblasts, and enteric neurons of the submucosal and myenteric plexus.

Teduglutide (Gattex)

Binds to GLP-2 receptors and activates local release of intestinal mediators that increase intestinal absorptive capacity, resulting in increased fluid and nutrient absorption. It is indicated for children aged 1 y or older with short bowel syndrome who are dependent on parenteral support.

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Antibiotics

Class Summary

These agents are used sparingly to prevent small-bowel bacterial overgrowth. They are used on a biweekly basis to prevent bacterial resistance.

Metronidazole (Flagyl)

Used to prevent intestinal small-bowel bacterial overgrowth.

Gentamicin (Garamycin, Gentacidin)

Aminoglycoside antibiotic for gram-negative coverage. May be used to prevent bacterial overgrowth in children with SBS.

Consider if penicillins or other less toxic drugs are contraindicated.

Gentamicin works well when administered PO to prevent intestinal overgrowth.

Drug interactions and precautions are likely to be clinically insignificant because PO gentamicin has minimal systemic absorption.

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H2 blockers

Class Summary

This agent is one of two treatment modalities used for gastric acid hypersecretion.

Ranitidine (Zantac)

Inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which in turn reduces gastric acid secretion, gastric volume, and hydrogen concentrations.

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Proton pump inhibitors

Class Summary

This agent is one of two treatment modalities used for gastric acid hypersecretion.

Omeprazole (Prilosec)

Decreases gastric acid secretion by inhibiting parietal cell H+/K+ -ATP pump.

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Choleretic agents

Class Summary

These agents improve biliary flow and prevent total parenteral nutrition (TPN)-induced liver disease.

Ursodiol (Actigall, Urso)

Also called ursodeoxycholic acid. Improves bile acid–dependent bile flow.

Phenobarbital (Barbita, Luminal, Solfoton)

Improves bile acid–independent flow.

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Bile salt binders

Class Summary

These agents decrease choleretic diarrhea.

Cholestyramine (Prevalite, Questran)

Forms a nonabsorbable complex with bile acids in the intestine, which in turn inhibits enterohepatic reuptake of intestinal bile salts. Effective in reducing the choleretic diarrhea in patients with SBS.

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Antisecretin agents

Class Summary

These agents decrease intestinal secretions.

Octreotide (Sandostatin)

Acts primarily on somatostatin receptor subtypes II and V. Inhibits GH secretion and has multitude of other endocrine and nonendocrine effects, including inhibition of glucagon, VIP, and GI peptides.

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Hypomotility agents

Class Summary

These agents increase intestinal transit time.

Loperamide (Imodium, Kaopectate)

Acts on intestinal muscles to inhibit peristalsis and slow intestinal motility. Prolongs movement of electrolytes and fluid through bowel and increases viscosity and loss of fluids and electrolytes.

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