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Teduglutide, a glucagon-like peptide 2 analogue, might restore intestinal structural and functional integrity by promoting growth of the mucosa and reducing gastric emptying and secretion. These factors could increase fluid and nutrient absorption in patients with short bowel syndrome with intestinal failure (SBS-IF). We performed a prospective study to determine whether teduglutide reduces parenteral support in patients with SBS-IF.We performed a 24-week study of patients with SBS-IF who were given subcutaneous teduglutide (0.05 mg/kg/d; n = 43) or placebo (n = 43) once daily. Parenteral support was reduced if 48-hour urine volumes exceeded baseline values by ≥ 10%. The primary efficacy end point was number of responders (patients with20% reduction in parenteral support volume from baseline at weeks 20 and 24).There were significantly more responders in the teduglutide group (27/43 [63%]) than the placebo group (13/43 [30%]; P = .002). At week 24, the mean reduction in parenteral support volume in the teduglutide group was 4.4 ± 3.8 L/wk (baseline 12.9 ± 7.8 L/wk) compared with 2.3 ± 2.7 L/wk (baseline 13.2 ± 7.4 L/wk) in the placebo group (P.001). The percentage of patients with a 1-day or more reduction in the weekly need for parenteral support was greater in the teduglutide group (21/39 [54%]) than in the placebo group (9/39 [23%]; P = .005). Teduglutide increased plasma concentrations of citrulline, a biomarker of mucosal mass. The distribution of treatment-emergent adverse events that led to study discontinuation was similar between patients given teduglutide (n = 2) and placebo (n = 3).Twenty-four weeks of teduglutide treatment was generally well tolerated in patients with SBS-IF. Treatment with teduglutide reduced volumes and numbers of days of parenteral support for patients with SBS-IF; ClinicalTrials.gov Number, NCT00798967.

controls. Results: The patients had an apparently SBS-specific increase in the prevalence of Lactobacilli. Bacteroides (Bac303), Roseburia (EREC) groups increased, and Bifidobacteriaceae (Bac 164) and Enterobacteriaceae (Ebac) groups decreased significantly with Sb therapy in SBS. These changes all represented an alteration towards the distribution seen in the normal controls. The changes in all other microbial groups were not consistent, and the median values did not change significantly. The SBS-specific increase in Lactobacilli demonstrated a tendency to decrease, which was however statistically non-significant. However, probiotic treatment decreased levels of lactic acid from 30, 72 mg/dL to 18, 64 mg/dL, so to the reference value. Conclusions: The composition of colonic microbiota in patients with SBS on long term parenteral nutrition differs significantly from that in healthy persons. Saccharomyces boulardii treatment made the microbiota more similar to healthy controls. Especially strong effects are observed with regard to Bacteroides, Roseburia, Bifidobacteriaceae and Enterobacteriaceae groups. None of these bacterial groups showed complete normalization when compared to healthy controls however. The concentration of plasma lactate fell to reference values after Sb treatment. It is possible that the two-week treatment was insufficient to unravel specific shifts in other bacterial groups or to normalize the main fermentative groups. Longer-term therapeutic studies are necessary for what appears a promising strategy.