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Changes of Drug Pharmacokinetics in Patients with Short Bowel Syndrome: A Systematic Review

  • Systematic Review
  • Published:
European Journal of Drug Metabolism and Pharmacokinetics Aims and scope Submit manuscript

A Letter to Editor to this article was published on 05 October 2021

A Letter to the Editor to this article was published on 07 September 2021

Abstract

Background and Objectives

Short bowel syndrome is a clinical condition defined by malabsorption of nutrients and micronutrients, most commonly following extensive intestinal resection. Due to a loss of absorptive surfaces, the absorption of orally administered drugs is also often affected. The purpose of this study was to systematically review the published literature and examine the effects of short bowel syndrome on drug pharmacokinetics and clinical outcomes.

Methods

Studies were identified through searches of databases MEDLINE, EMBASE, Web of Science, and SCOPUS, in addition to hand searches of studies’ reference lists. Two reviewers independently assessed studies for inclusion, yielding 50 studies involving 37 different drugs in patients with short bowel syndrome.

Results

Evidence of decreased drug absorption was observed in 29 out of 37 drugs, 6 of which lost therapeutic effect, and 14 of which continued to demonstrate clinical benefit through drug monitoring.

Conclusions

The influence of short bowel syndrome on drug absorption appears to be drug-specific and dependent on the location and extent of resection. The presence of a colon in continuity may also influence drug bioavailability as it can contribute significantly to the absorption of drugs (e.g., metoprolol); likewise, drugs that have a wide absorption window or are known to be absorbed in the colon are least likely to be malabsorbed. Individualized dosing may be necessary to achieve therapeutic efficacy, and therapeutic drug monitoring, where available, should be considered in short bowel syndrome patients, especially for drugs with narrow therapeutic indices.

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Acknowledgements

Ms. Subashini Gunasegaran and Ms. Emily Poh for their input into the conceptualization of the study

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Authors and Affiliations

  1. Imperial College School of Medicine, South Kensington, London, SW7 2DD, UK

    Wallace Bok-Thoe Hong

  2. Department of Pharmacy, National University Hospital, Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

    Wee Kiat Tan &  Elaine Ah-Gi Lo

  3. Alexandra Hospital, National University Health System, 378 Alexandra Road, Singapore, 159964, Singapore

    Lawrence Siu-Chun Law

  4. Department of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, Singapore, 119077, Singapore

    David Eng-Hui Ong

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  1. Wallace Bok-Thoe Hong
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Hong, .BT., Tan, .K., Law, .SC. et al. Changes of Drug Pharmacokinetics in Patients with Short Bowel Syndrome: A Systematic Review. Eur J Drug Metab Pharmacokinet 46, 465–478 (2021). https://doi.org/10.1007/s13318-021-00696-y

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