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Purpose of review Intestinal failure is a life-threatening medical condition that remains as a rare or orphan disease in most countries. The prevalence of intestinal failure and the therapeutic options available in middle-income countries (MIC) remain unclear. We aim to provide an overview on the current differences in management of intestinal failure patients in MIC from Latin America and Asia. Recent findings In order to fulfil the challenge, and after facing the difficulties of going over a topic with scarce available data, from countries with an extreme variety of social and economic problems, which are closely related to the treatment of intestinal failure patients, we have used both the existing publications and personal surveys to draft this document. Our results have shown that there is still significant disparity among MIC over the last years, concepts such as the need for establishing multidisciplinary dedicated teams as well as the need to evolve first home parenteral nutrition (HPN), then rehabilitation, and finally transplantation, have become important signals of an adequate understanding of this evolving field. Summary The manuscript presents, for the first time, an overview of the different developments and needs to manage intestinal failure patients in MIC from Latin America and Asia. Future discussions will emerge from this manuscript, aiming to pursue the development of registries, guidelines and health policies to continue improving the long-term care of intestinal failure patients in all MIC. Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina Fil: Pattín, Francisco. Fundación Favaloro; Argentina Fil: Nikkoupur, Hamed. Shiraz Infertility Center; Irán