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Insuficiência Intestinal Crónica- Melhor Abordagem Terapêutica na atualidade
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Abstract(s)
Introdução: A insuficiência intestinal crónica é uma condição que pode resultar de
diversas outras doenças, como a síndrome do intestino curto, doenças intestinais
inflamatórias e complicações cirúrgicas, e causa má-absorção de nutrientes, diarreia e
complicações metabólicas. O tratamento da insuficiência intestinal crónica baseia-se na
nutrição parentérica domiciliária, podendo ser também realizados procedimentos de
alongamento intestinal, utilização de fármacos que ajudam na adaptação intestinal e até
mesmo transplante intestinal em casos selecionados.
Hipótese: A nutrição parentérica domiciliária é a melhor abordagem terapêutica na
insuficiência intestinal crónica.
Objetivos: Estudar os tratamentos disponíveis para a insuficiência intestinal crónica,
incluindo uma análise comparativa quanto à eficácia e complicações, bem como os novos
métodos e compostos terapêuticos que promovam a adaptação intestinal.
Métodos: Pesquisa baseada no modelo PICO com termos específicos no PubMed para
avaliar os diferentes tratamentos e os seus resultados em pacientes com insuficiência
intestinal crónica.
Resultados e discussão: A nutrição parentérica domiciliária permite a manutenção
nutricional dos pacientes com insuficiência intestinal crónica, oferecendo-lhes uma
maior independência. Porém, este método está associado a complicações, como infeções
associadas ao cateter, trombose venosa e doença óssea metabólica, que requerem uma
monitorização contínua. O transplante intestinal surge como uma alternativa em casos
nos quais a nutrição parentérica domiciliária se tornou impossível de ser realizada, mas
apresenta desafios significativos, como a rejeição, complicações imunológicas e uma taxa
de mortalidade mais elevada. Os procedimentos de alongamento intestinal são uma
opção cirúrgica, no entanto, ainda não têm tantos benefícios como as outras opções de
tratamento. O teduglutide, como análogo do GPL-2, estimula a adaptação intestinal,
melhora a absorção de nutrientes e reduz a necessidade de nutrição parentérica
domiciliária, contudo, é um fármaco bastante dispendioso e os seus efeitos desaparecem
após a sua descontinuação.
Conclusão: Apesar das limitações e desafios, a nutrição parentérica domiciliária
continua a ser a melhor opção terapêutica disponível para a insuficiência intestinal
crónica, enquanto novas terapêuticas, como o teduglutide, representam avanços
promissores neste campo. Assim, a nutrição parentérica domiciliária deve ser
complementada com tratamentos moleculares, como o teduglutide, e, conforme a
evolução dos doentes, pode ser necessário realizar os procedimentos de alongamento intestinal de modo a aumentar a superfície absortiva. Quando estas abordagens falham
ou não são viáveis, o transplante intestinal torna-se a melhor opção.
Introduction: Chronic intestinal failure is a condition that can result from various other diseases, such as short bowel syndrome, inflammatory bowel diseases and surgical complications, and causes malabsorption of nutrients, diarrhea and metabolic complications. The treatment of chronic intestinal insufficiency is based on home parenteral nutrition, but intestinal lengthening procedures, the use of drugs that help intestinal adaptation and even intestinal transplantation can also be carried out in selected cases. Hypothesis: Home parenteral nutrition is the best therapeutic approach in chronic intestinal failure. Objectives: To study the available treatments for chronic intestinal failure, including a comparative analysis of their effectiveness and complications, as well as new methods and therapeutic compounds that promote intestinal adaptation. Methods: Search based on the PICO model with specific terms in PubMed to evaluate different treatments and their results in patients with chronic intestinal failure. Results and discussion: Home parenteral nutrition enables nutritional maintenance in patients with chronic intestinal failure, offering them greater independence. However, this method is associated with complications such as catheter-associated infections, venous thrombosis and metabolic bone disease, which require continuous monitoring. Intestinal transplantation has emerged as an alternative in cases in which parenteral nutrition becomes impossible, but presents significant challenges, such as rejection, immunological complications and a higher mortality rate. Intestinal lengthening procedures are a surgical option, however, they still don't have as many benefits as the other treatment options. Teduglutide, as an analog of GPL-2, stimulates intestinal adaptation, improves nutrient absorption and reduces the need for home parenteral nutrition, however, it is a very expensive drug and its effects disappear after its discontinuation. Conclusion: Despite the limitations and challenges, home parenteral nutrition remains the best therapeutic option available for chronic intestinal failure, while new therapies such as teduglutide represent promising advances in this field. Therefore, home parenteral nutrition should be complemented with molecular treatments, such as teduglutide, and, depending on the patient’s evolution, it may be necessary to perform intestinal lengthening procedures in order to increase the absorptive surface. When these approaches fail or are not feasible, intestinal transplantation becomes the best option.
Introduction: Chronic intestinal failure is a condition that can result from various other diseases, such as short bowel syndrome, inflammatory bowel diseases and surgical complications, and causes malabsorption of nutrients, diarrhea and metabolic complications. The treatment of chronic intestinal insufficiency is based on home parenteral nutrition, but intestinal lengthening procedures, the use of drugs that help intestinal adaptation and even intestinal transplantation can also be carried out in selected cases. Hypothesis: Home parenteral nutrition is the best therapeutic approach in chronic intestinal failure. Objectives: To study the available treatments for chronic intestinal failure, including a comparative analysis of their effectiveness and complications, as well as new methods and therapeutic compounds that promote intestinal adaptation. Methods: Search based on the PICO model with specific terms in PubMed to evaluate different treatments and their results in patients with chronic intestinal failure. Results and discussion: Home parenteral nutrition enables nutritional maintenance in patients with chronic intestinal failure, offering them greater independence. However, this method is associated with complications such as catheter-associated infections, venous thrombosis and metabolic bone disease, which require continuous monitoring. Intestinal transplantation has emerged as an alternative in cases in which parenteral nutrition becomes impossible, but presents significant challenges, such as rejection, immunological complications and a higher mortality rate. Intestinal lengthening procedures are a surgical option, however, they still don't have as many benefits as the other treatment options. Teduglutide, as an analog of GPL-2, stimulates intestinal adaptation, improves nutrient absorption and reduces the need for home parenteral nutrition, however, it is a very expensive drug and its effects disappear after its discontinuation. Conclusion: Despite the limitations and challenges, home parenteral nutrition remains the best therapeutic option available for chronic intestinal failure, while new therapies such as teduglutide represent promising advances in this field. Therefore, home parenteral nutrition should be complemented with molecular treatments, such as teduglutide, and, depending on the patient’s evolution, it may be necessary to perform intestinal lengthening procedures in order to increase the absorptive surface. When these approaches fail or are not feasible, intestinal transplantation becomes the best option.
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Complicações
Nutrição Parentérica Insuficiência Intestinal Crónica Nutrição Parentérica Domiciliária Procedimentos Alongamento Intestinal Teduglutide Transplante Intestinal