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.
- SHORT BOWEL SYNDROME
- SURGICAL RESECTION
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Contributors TEC and SL equally contributed to the conception, design and style of the manuscript. TEC and SH contributed to the acquisition and analysis of the clinical information. All authors (TEC, KLW, AB, SH, JM, SL) drafted the manuscript, critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work. All authors (TEC, KLW, AB, SH, JM, SL) have read and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests John McLaughlin: Member of National Institute for Health and Care Excellence (NICE) diagnostics advisory committee and project team for formulation of diagnostics guidance [DG44 - SeHCAT (tauroselcholic [75 selenium] acid) for diagnosing bile acid diarrhoea]. Published: 17 November 2021.
Provenance and peer review Not commissioned; externally peer reviewed.