Unlocking the Complex Management of Short Bowel Syndrome

Release Date: December 15, 2023                                                                      

Expiration Date: December 15, 2024

Activity Specialties:

Family/general practice, gastroenterology, hospitalist, internal medicine, nutrition, pediatrics, primary care, surgery

Program Description:

Short bowel syndrome (SBS) can result from surgical removal of portions of the small intestine and often leads to permanent reliance upon parenteral support. Because patients with SBS are heterogenous, basic management is complex and multifaceted, involving nutrition support, fluid and electrolyte management, and pharmacologic therapies to control diarrhea. However, strategies for enhancing intestinal adaptation to improve the efficiency of absorption can reduce the need for parenteral support and help patients achieve enteral autonomy.  Stay informed on the complex management of SBS and ways to reach the goal of enteral autonomy through these small group discussions designed to facilitate sharing of clinical expertise and practical guidance across the multidisciplinary care team. 

Intended Audience:

This activity is intended for the multispecialty/multidisciplinary clinical team managing patients with SBS.

Provider:

Provided by the Academy for Continued Healthcare Learning (ACHL). 

Commercial Supporter:

Supported by an educational grant from Takeda Pharmaceuticals U.S.A., Inc.

Learning Objectives:

Upon completion of this activity, learners will be able to:

• Outline dietary and drug treatment strategies for achieving and maintaining enteral autonomy and promoting intestinal absorption in diverse patients with SBS
• Describe challenges and unmet needs with parenteral nutrition and identify strategies to reduce patient dependency on parenteral support
• Implement system-based tools and best practices for providing coordinated, multidisciplinary care for patients with SBS
• Develop individualized, state of the art SBS care plans for diverse groups of patients    

Activity Purpose (Statement of Need):

Short bowel syndrome (SBS) is a malabsorptive condition that can occur after resection of portions of the small intestine that results in the inability to maintain appropriate homeostasis in electrolyte balance, fluid absorption, and nutritional intake, leading to significant impacts on quality of life and overall morbidity and mortality. The nutritional needs of patients with SBS are especially complex and must be tailored to the individual patient because they are heavily dependent on the anatomy of the remaining bowel, including frequent lifelong reliance upon parenteral nutrition (PN). Similarly, oral fluid therapy and careful assessment of hydration status are also essential, and the needs of an individual patient often vary according to which portions of the bowel remain. The pharmacologic management of SBS often focuses on symptom control and includes anti-secretory agents, antimotility agents, bile acid binders, antibiotics, and probiotics. In addition, certain medications may aid in optimizing the functioning of the existing bowel, including recombinant growth hormone and a glucagon-like peptide 2 (GLP-2) analog (teduglutide). With the availability of drugs that can promote better functioning and improved absorption capabilities of the remaining intestines, clinicians today have a better armamentarium of tools for promoting the return of enteral autonomy than in the past, but reducing dependence on long-term PN is difficult and requires a coordinated approach from an array of healthcare professionals, including dietitians, gastroenterologists, pharmacists, surgeons, specialized nurses, social workers, and psychologists. Consequently, ensuring that the multidisciplinary team has the knowledge needed to assist patients with SBS is critical.

Accreditation Statement:

The Academy for Continued Healthcare Learning is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement:

The Academy for Continued Healthcare Learning designates this enduring material for a maximum of 3.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician assistants, nurse practitioners, and nurses may participate in this educational activity and earn a certificate of completion as AAPA, AANP, and ANCC accept AMA PRA Category 1 Credits™ through their reciprocity agreements.

Dietitians:

The Academy for Continued Healthcare Learning is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). CDR Credentialed Practitioners will receive 3.5 Continuing Professional Education units (CPEUs) for completion of this activities/materials. Level 2. CDR Accredited Provider #AC001.

RDs and DTRs may submit additional evaluations of the quality of this program/material at QualityCPE@eatright.org.

The activity number for this activity is 179712.

Faculty:

Donald F. Kirby, MD 
Director, Center for Human Nutrition
Medical Director, Intestinal Transplant Program
Department of Gastroenterology, Section of Nutrition
Cleveland Clinic
Cleveland, OH

Samuel A. Kocoshis, MD
Professor, Pediatrics
University of Cincinnati College of Medicine, Cincinnati Children’s Hospital
Medical Director, Intestinal Transplant and Intestinal Care Center
Cincinnati Children’s Hospital Medical Center
Cincinnati, OH

Disclosure of Financial Relationships Policy:

The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships within 24 months (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with all ineligible companies. All relevant financial relationships have been mitigated prior to this activity. 

The following financial relationships have been provided:

Donald F. Kirby, MD
Advisory Board: OWYN, Inc., Takeda Pharmaceuticals, VectivBio

Samuel A. Kocoshis, MD
Advisory Board: Abbott Nutrition, Alcresta Pharmaceuticals, Zealand Pharmaceuticals
Research Support: Protara Pharmaceuticals and VectivBio
Speakers Bureau: Abbott Nutrition

Disclosure of Unlabeled Use:

Discussion of Off-Label, Investigational, or Experimental Drug/Device Use: Proton pump inhibitors, histamine type-2 receptor antagonists, and clonidine are not indicated for the treatment of diarrhea; nitinol springs are an investigational device for the treatment of SBS. 

Disclaimer:

The content for this activity was developed independently of any ineligible company. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantor(s).

This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in a continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.

This CME/CE activity might describe the off-label, investigational, or experimental use of medications and/or devices that may exceed their FDA-approved labeling. Physicians should consult the current manufacturers’ prescribing information for these products. ACHL requires the speaker to disclose that a product is not labeled for the use under discussion.

Staff and Reviewer Disclosures:

ACHL staff members and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. 

Method of Participation/Instructions:

This activity will take approximately 3.5 hours to complete. To receive credit, learners are required to complete the pretest, view the online activity, and complete the posttest and evaluation. A certificate will be immediately available. There is no fee to participate in the activity or for the generation of the certificate.

In order to claim the maximum amount of credit available, you must complete all of the following:

Baseline Assessment- 0.25 credits
Self-study Modules- 0.75 credits 
Group Discussion 1- 0.75 credits
Group Challenge- 0.5 credits
Group Discussion 2- 0.75 credits
Action Plan Development- 0.25 credits
Final Assessment & Evaluation- 0.25 credits