scholarly journals Sitagliptin, a dipeptidyl peptidase-4 inhibitor, in patients with short bowel syndrome and colon in continuity: an open-label pilot study

2021 ◽  
Vol 8 (1) ◽  
pp. e000604
Author(s):  
Rahim Mohammad Naimi ◽  
Mark Krogh Hvistendahl ◽  
Lise Margrete Thomassen ◽  
Hanna Johnsen ◽  
Charlotte Bayer Christiansen ◽  
...  
Keyword(s):  
Pilot Study ◽  
Short Bowel Syndrome ◽  
Therapeutic Potential ◽  
Case Series ◽  
Dipeptidyl Peptidase ◽  
Open Label ◽  
Small Pilot Study ◽  
Short Bowel ◽  
Dipeptidyl Peptidase 4 ◽  
Wet Weight

ObjectivePatients with short bowel syndrome (SBS) and colon in continuity have better adaptation potential compared with patients with jejunostomy. Adaptation may involve enhanced postprandial secretion of the enteroendocrine hormones glucagon-like peptide (GLP)-1 and GLP-2 which are normally degraded by dipeptidyl peptidase (DPP)-4. Nevertheless, some patients with SBS with colon in continuity suffer from high-volume faecal excretions and have been shown to benefit from treatment with GLP-2. Therefore, we aimed to evaluate efficacy of sitagliptin, a DPP-4 inhibitor, on reducing faecal excretions in this patient group.DesignIn an open-label, case series, proof-of-concept pilot study, 100 mg oral sitagliptin was given two times per day for 8 weeks to patients with SBS with ≥50% colon in continuity with or without the need for parenteral support (PS). To assess intestinal function, metabolic balance studies were done at baseline and following 8 weeks of treatment.ResultsOf the 10 patients planned for enrolment, 8 patients were included; 7 patients completed the study. Although postprandial endogenous GLP-2 concentrations increased by 49 hours×pmol/L (39, 105; p=0.018) (median (min, max)), sitagliptin did not significantly reduce median faecal wet weight (−174 g/day (−1510, 675; p=0.176)) or increase intestinal wet weight absorption. However, heterogeneity in the treatment effect was observed: intestinal wet weight absorption increased in all four patients with intestinal failure. One patient achieved a reduction in PS by 500 mL per administration day.ConclusionFollowing this negative, small pilot study, larger, placebo-controlled, studies are needed to establish the therapeutic potential of DPP-4 inhibition in patients with SBS.

scholarly journals Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid

2021 ◽  
Vol 10 (9) ◽  
pp. 1916
Author(s):  
Ágnes Kinyó ◽  
Anita Hanyecz ◽  
Zsuzsanna Lengyel ◽  
Dalma Várszegi ◽  
Péter Oláh ◽  
...  
Keyword(s):  
Bullous Pemphigoid ◽  
Clinical Laboratory ◽  
Case Series ◽  
Dipeptidyl Peptidase ◽  
Area Index ◽  
Histological Features ◽  
Dipeptidyl Peptidase 4 ◽  
First Case ◽  
Dipeptidyl Peptidase 4 Inhibitor ◽  
The Mean

Bullous pemphigoid (BP) is an autoimmune blistering disease of elderly patients that has shown increasing incidence in the last decades. Higher prevalence of BP may be due to more frequent use of provoking agents, such as antidiabetic dipeptidyl peptidase-4 inhibitor (DPP4i) drugs. Our aim was to assess DPP4i-induced bullous pemphigoid among our BP patients and characterize the clinical, laboratory and histological features of this drug-induced disease form. In our patient cohort, out of 127 BP patients (79 females (62.2%), 48 males (37.7%)), 14 (9 females and 5 males) were treated with DPP4i at the time of BP diagnosis. The Bullous Pemphigoid Disease Area Index (BPDAI) urticaria/erythema score was significantly lower, and the BPDAI damage score was significantly higher in DPP4i-BP patients compared to the nonDPP4i group. Both the mean absolute eosinophil number and the mean periblister eosinophil number was significantly lower in DPP4i-BP patients than in nonDPP4i cases (317.7 ± 0.204 vs. 894.0 ± 1.171 cells/μL, p < 0.0001; 6.75 ± 1.72 vs. 19.09 ± 3.1, p = 0.0012, respectively). Our results provide further evidence that DPP4i-associated BP differs significantly from classical BP, and presents with less distributed skin symptoms, mild erythema, normal or slightly elevated peripheral eosinophil count, and lower titers of BP180 autoantibodies. To our knowledge, this is the first case series of DPP4i-related BP with a non-inflammatory phenotype in European patients.

scholarly journals Mesenteric Venous Thrombosis in a Referral Hospital in East Africa: A Retrospective Study of Four Cases

2021 ◽  
pp. 107-116
Author(s):  
Richard Wismayer
Keyword(s):  
Venous Thrombosis ◽  
East Africa ◽  
Short Bowel Syndrome ◽  
High Mortality ◽  
Case Series ◽  
Mesenteric Venous Thrombosis ◽  
African Region ◽  
Bowel Ischaemia ◽  
Short Bowel ◽  
Delay In Diagnosis

Introduction: Acute mesenteric venous thrombosis is a rare condition with the most common site of thrombosis development being the superior mesenteric vein. Patients predisposed to this condition tend to develop a disruption to Virchow’s triad of endothelial injury, stasis and hypercoagulability. In the acute form the presentation is with bowel ischaemia and so a diagnosis before bowel gangrene develops remains a challenge. The limited experience with this condition in the East African region shows that a delayed diagnosis due to limited investigative capacity results in patients’ experiencing acute renal failure and a high mortality. This review describes the aetiology, clinical features and management of acute mesenteric venous ischaemia. Methods: A descriptive retrospective review of four patients over an 18-month period. Demographic and clinical data was extracted from the patients’ clinical files and manual analysis using a spreadsheet was performed. Results: Over an 18-month period, four patients were reported. All patients had a delay in diagnosis with acute symptoms persisting for 5 days up to 21 days. Two patients died within 30-days post-operatively of complications which included short bowel syndrome and acute kidney failure. Two patients survived developing complications from short bowel syndrome and another the complications of acute kidney injury requiring haemodialysis. Conclusions: A delay in diagnosis of acute MVT characterises this short case series. This resulted in all cases presenting with gangrenous bowel and hence the high mortality. Venous clot propagation is prevented with anticoagulation which is associated with decreased mortality and recurrence. Thrombolysis and thrombectomy should be considered in certain circumstances to prevent bowel of questionable viability. In the last four decades the mortality from MVT has decreased and currently stands at 10-20% however there is no sufficient literature in East Africa to make this judgement.

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