Short Bowel Syndrome and the Potential for Treatment with Potassium Competitive Acid Blockers
Keywords:
short bowel syndrome, potassium competitiveacid blocker, anti-secretoryagent, gastric hypersecretionAbstract
Short Bowel Syndrome (SBS) is defined by a functional small bowel length of less than 200 centimeters and is frequently associated with significant fluid loss, particularly during the hypersecretory phase. Anti-secretory agents such histamine-2 receptor, antagonists, proton pump inhibitors (PPIs), somatostatin analogues, and clonidine are commonly employed to manage gastric hypersecretion. Potassium Competitive Acid Blockers (PCABs), a newer class of acid suppressants, offer several advantages over PPIs, including food-independent activity, rapid onset, consistent metabolism, and prolonged half-life. These properties make PCABs promising candidates for managing the acute phase of SBS. This review outlines the anatomy and physiology of bowel, defines SBS, explores its pathophysiology and complications, summarizes current treatment strategies, and discusses the potential role of PCABs as anti-secretory agent.
References
Guillen B, Atherton NS. Short bowel syndrome. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
O’Keefe SJ, Buchman AL, Fishbein TM, Jeejeebhoy KN, Jeppesen PB, Shaffer J. Short bowel syndrome and intestinal failure: consensus definitions and overview. Clin Gastroenterol Hepatol. 2006;4(1):6–10.
Cuerda C, Pironi L, Arends J, Bozzetti F, Gillanders L, Jeppesen PB, et al. ESPEN practical guideline: Clinical nutrition in chronic intestinal failure. Clin Nutr. 2021;40(9):5196–220.
Goetze O, Steingoetter A, Menne D, van der Voort IR, Kwiatek MA, Boesiger P, et al. The effect of macronutrients on gastric volume responses and gastric emptying in humans: a magnetic resonance imaging study. Am J Physiol Gastrointest Liver Physiol. 2007;292(1):G11–7.
Ross AC, Caballero B, Cousins RJ, Tucker KL. Modern nutrition in health and disease. China: Jones & Bartlett Learning; 2020.
Sensoy I. A review on the food digestion in the digestive tract and the used in vitro models. J Curr Res Food Sci. 2021;4:308–19.
Martinsen TC, Fossmark R, Waldum HL. The phylogeny and biological function of gastric juice—microbiological consequences of removing gastric acid. Int J Mol Sci. 2019;20(23):6031.
Kopic S, Geibel JP. Gastric acid, calcium absorption, and their impact on bone health. Physiol Rev. 2013;93(1):189–268.
Fine LG, Riera CE. Sense of smell as the central driver of Pavlovian appetite behavior in mammals. Front Physiol. 2019;10:456375.
Konturek SJ, Kaess H, Kwiecien N, Radecki T, Dorner M, Teckentrupp U. Characteristics of intestinal phase of gastric secretion. Am J Physiol. 1976;230(2):335-40.
Engevik AC, Kaji I, Goldenring JR. The physiology of the gastric parietal cell. Physiol Rev. 2020;100(2):573–602.
Broide E, Bloch O, Ben-Yehudah G, Cantrell D, Shirin H, Rapoport MJ. GLP-1 receptor is expressed in human stomach mucosa: analysis of its cellular association and distribution within gastric glands. J Histochem Cytochem. 2013;61(9):649–58.
Parikh A, Thevenin C. Physiology, gastrointestinal hormonal control. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
Summers RW, Kent TH, Osborne JW. Effects of drugs, ileal obstruction, and irradiation on rat gastrointestinal propulsion. Gastroenterology. 1970;59(5):731–9.
Ricotta J, Zuidema G, Gadacz T, Sadri D. Construction of an ileocecal valve and its role in massive resection of the small intestine. Surg Gynecol Obstet. 1981;152(3):310–4.
Banks MR, Farthing MJ. Fluid and electrolyte transport in the small intestine. Curr Opin Gastroenterol. 2002;18(2):176–81.
Farrugia A, Arasaradnam R. Bile acid diarrhoea: pathophysiology, diagnosis and management. Frontline Gastroenterol. 2021;12(6):500–7.
Thompson W, Wrathell E. The relation between ileal resection and vitamin B12 absorption. Can J Surg. 1977;20(5):461–4.
Hofmann AF, Poley JR. Role of bile acid malabsorption in pathogenesis of diarrhea and steatorrhea in patients with ileal resection: I. Response to cholestyramine or replacement of dietary long chain triglyceride by medium chain triglyceride. Gastroenterology. 1972;62(5):918–34.
McRorie JW Jr, McKeown NM. Understanding the physics of functional fibers in the gastrointestinal tract: an evidence-based approach to resolving enduring misconceptions about insoluble and soluble fiber. J Acad Nutr Diet. 2017;117(2):251–64.
Bergman E. Energy contributions of volatile fatty acids from the gastrointestinal tract in various species. Physiol Rev. 1990;70(2):567–90.
Kowlgi NG, Chhabra L. D-lactic acidosis: an underrecognized complication of short bowel syndrome. Gastroenterol Res Pract. 2015;2015:1–8.
Lakkasani S, Seth D, Khokhar I, Touza M. Concise review on short bowel syndrome: etiology, pathophysiology, and management. World J Clin Cases. 2022;10(31):11273–86.
Kaufman SS, Loseke CA, Lupo JV, Young RJ, Murray ND, Pinch LW, et al. Influence of bacterial overgrowth and intestinal inflammation on duration of parenteral nutrition in children with short bowel syndrome. J Pediatr. 1997;131(3):356–61.
Venkatasubramanian J, Rao MC, Sellin JH. Intestinal electrolyte absorption and secretion. In: Sleisenger and Fordtran's gastrointestinal and liver disease. 10th ed. Philadelphia: Elsevier; 2010. p. 1675–94.e3.
Martin G, Beck P, Sigalet D. Gut hormones and short bowel syndrome: the enigmatic role of glucagon-like peptide-2 in the regulation of intestinal adaptation. World J Gastroenterol. 2006;12(26):4117–25.
Walton KL. Teaching the role of secretin in the regulation of gastric acid secretion using a classic paper by Johnson and Grossman. Adv Physiol Educ. 2009;33(3):165–8.
Sharkey L. BAPEN/BIFA guidelines on the diagnosis and management of intestinal failure associated liver disease (IFALD), 2022 [Internet]. Available from: https://www.bapen.org.uk/pdfs/bifa/bifa-ifald-guidelines.pdf
Fell GL, Cho BS, Dao DT, Anez-Bustillos L, Baker MA, Nandivada P, et al. Fish oil protects the liver from parenteral nutrition-induced injury via GPR120-mediated PPARγ signaling. Prostaglandins Leukot Essent Fatty Acids. 2019;143:8–14.
Norsa L, Nicastro E, Di Giorgio A, Lacaille F, D’Antiga L. Prevention and treatment of intestinal failure-associated liver disease in children. Nutrients. 2018;10(6):664.
Kjølbæk L, Lorenzen JK, Larsen LH, Astrup A. Calcium intake and the associations with faecal fat and energy excretion, and lipid profile in a free-living population. J Nutr Sci. 2017;6:e50.
Phan J, Benhammou JN, Pisegna JR. Gastric hypersecretory states: investigation and management. Curr Treat Options Gastroenterol. 2015;13:386–97.
Parrish CR, DiBaise JK. Managing the adult patient with short bowel syndrome. Gastroenterol Hepatol (N Y). 2017;13(10):600–8.
O’Keefe SJ, Emerling M, Koritsky D, Martin D, Stamos J, Kandil H, et al. Nutrition and quality of life following small intestinal transplantation. Am J Gastroenterol. 2007;102(5):1093–100.
Kiela PR, Ghishan FK. Physiology of intestinal absorption and secretion. Best Pract Res Clin Gastroenterol. 2016;30(2):145–59.
Beaugerie L, Cosnes J, Verwaerde F, Dupas H, Lamy P, Gendre J, et al. Isotonic high-sodium oral rehydration solution for increasing sodium absorption in patients with short-bowel syndrome. Am J Clin Nutr. 1991;53(3):769–72.
Stoll R, Ruppin H, Domschke W. Calmodulin-mediated effects of loperamide on chloride transport by brush border membrane vesicles from human ileum. Gastroenterology. 1988;95(1):69–76.
Hicks J, Swen J, Thorn C, Sangkuhl K, Kharasch E, Ellingrod V, et al. Clinical Pharmacogenetics Implementation Consortium guideline for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants. Clin Pharmacol Ther. 2013;93(5):402–8.
Sobocki J, Lachowicz K, Kaczanowska J, Omidi M, Majewska K, Osowska S, et al. Rac-ecadotryl reduces stoma output in end jejunostomy syndrome patients. Clin Nutr. 2018;37(Suppl 1):S99.
Patel KS, Carroll R. Hormonal management of small bowel failure. Clin Transl Gastroenterol. 2017;8(6):e105.
Drucker DJ. The discovery of GLP-2 and development of teduglutide for short bowel syndrome. ACS Pharmacol Transl Sci. 2019:134–42.
Reiner J, Berlin P, Held J, Thiery J, Skarbaliene J, Griffin J, et al. Dapiglutide, a novel dual GLP-1 and GLP-2 receptor agonist, attenuates intestinal insufficiency in a murine model of short bowel. JPEN J Parenter Enteral Nutr. 2022;46(5):1107–18.
Joly F, Dray X, Corcos O, Barbot L, Kapel N, Messing B. Tube feeding improves intestinal absorption in short bowel syndrome patients. Gastroenterology. 2009;136(3):824–31.
Woolf GM, Miller C, Kurian R, Jeejeebhoy KN. Nutritional absorption in short bowel syndrome: evaluation of fluid, calorie, and divalent cation requirements. Dig Dis Sci. 1987;32:8–15.
Bielawska B, Allard JP. Parenteral nutrition and intestinal failure. Nutrients. 2017;9(5):466.
Yee J. xPharm: the comprehensive pharmacology reference. Amsterdam: Elsevier; 2008.
Aghakhani L, Massoumi SJ. Effects of glutamine, growth hormone and modified diet in short bowel syndrome: a systematic review. Int J Nutr Sci. 2019;4(1):2–8.
Woodward JM, Massey D, Sharkey L. The long and short of IT: intestinal failure-associated liver disease (IFALD) in adults—recommendations for early diagnosis and intestinal transplantation. Frontline Gastroenterol. 2020;11(1):34–9.
Fryer JP. Intestinal transplantation: an update. Curr Opin Gastroenterol. 2005;21(2):162–8.
Helgadottir H, Bjornsson ES. Problems associated with deprescribing of proton pump inhibitors. Int J Mol Sci. 2019;20(21):5469.
Wong N, Reddy A, Patel A. Potassium-competitive acid blockers: present and potential utility in the armamentarium for acid peptic disorders. Gastroenterol Hepatol (N Y). 2022;18(12):693–700.
Simadibrata DM, Syam AF, Lee YY. A comparison of efficacy and safety of potassium-competitive acid blocker and proton pump inhibitor in gastric acid-related diseases: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2022;37(12):2217–28.
Sugano K. Vonoprazan fumarate, a novel potassium-competitive acid blocker, in the management of gastroesophageal reflux disease: safety and clinical evidence to date. Ther Adv Gastroenterol. 2018;11:1756283X17745776.
Festen H, Thijs J, Lamers C, Jansen J, Pals G, Frants R, et al. Effect of oral omeprazole on serum gastrin and serum pepsinogen I levels. Gastroenterology. 1984;87(5):1030–4.
Abuduwaili M, Boda T, Ito M, Takigawa H, Kotachi T, Matsuo T, et al. Serum gastrin and pepsinogen levels after administration of acid secretion inhibitors for ulcers due to endoscopic submucosal dissection in patients with early gastric cancer. Gastroenterol Res Pract. 2022;2022:1–8.
Parikh A, Thevenin C. Physiology, gastrointestinal hormonal control. 2023 May 1. In: StarPearls [Internet]. Treasure Island (FL): StarPears Publishing; 2025 Jan.
Lindström E, Chen D, Norlén P, Andersson K, Håkanson R. Control of gastric acid secretion: the gastrin–ECL cell–parietal cell axis. Comp Biochem Physiol A Mol Integr Physiol. 2001;128(3):503–11.
Konturek S, Kwiecien N, Obtulowicz W, Kopp B, Oleksy J, Rovati L. Cholecystokinin in the inhibition of gastric secretion and gastric emptying in humans. Digestion. 1990;45(1):1–8.
Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams textbook of endocrinology. 13th ed. Philadelphia: Elsevier; 2015.
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