PDF(Pubmed)
Abstract：
Following ileal resection, the combination of severe bile acid (BA) malabsorption, rapid small bowel transit and unrestricted upper gastrointestinal (GI) secretion results in severe diarrhoea that can prove refractory to pharmacological therapies. While established therapies, including BA sequestrants and antidiarrhoeal drugs seek to ameliorate symptoms, they do not target the underlying pathophysiological mechanisms in this patient group. Their use can also be limited by both intolerance and adverse effects. The novel use of glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) in these patients may allow restoration of the physiological negative feedback mechanisms lost in ileal resection and reduce diarrhoea by prolonging small bowel transit time, limiting upper GI secretions and perhaps by inhibiting hepatic BA synthesis. While recent evidence supports the use of GLP-1 RAs as a safe and effective therapy for bile acid diarrhoea (BAD), it remains uncertain whether those with severe BAD and subsequent short bowel syndrome secondary to extensive ileal resection will benefit. Here, we present three cases of severe diarrhoea secondary to extensive ileal resection in which the use of the GLP-1 RA, liraglutide, was well tolerated and resulted in an objective improvement in diarrhoeal symptoms. We further provide a narrative review of the emerging evidence base supporting the use of GLP therapies in this challenging condition.
摘要：
回肠切除后,严重胆汁酸（BA）吸收不良的组合，快速的小肠运输和不受限制的上消化道（GI）分泌导致严重的腹泻，可证明药物治疗难以治疗。虽然既定的疗法，包括BA螯合剂和止泻药寻求改善症状，它们不针对该患者组的潜在病理生理机制.它们的使用也可能受到不容忍和不利影响的限制。在这些患者中使用胰高血糖素样肽-1（GLP-1）受体激动剂（RAs）可以恢复回肠切除术中丢失的生理负反馈机制，并通过延长小肠运输时间来减少腹泻。限制上消化道分泌，并可能通过抑制肝BA合成。虽然最近的证据支持使用GLP-1RAs作为胆汁酸腹泻（BAD）的安全和有效的治疗，严重BAD和随后继发于广泛回肠切除的短肠综合征患者是否会受益仍不确定.这里,我们介绍了三例严重腹泻继发于广泛回肠切除，其中使用GLP-1RA，利拉鲁肽,耐受性良好，并导致腹泻症状的客观改善。我们进一步提供了支持在这种具有挑战性的情况下使用GLP疗法的新兴证据基础的叙述性综述。
