Intestinal Rehab

Teduglutide is given once daily by subcutaneous injection. It is a GLP-2 analog with a 2-hour half-life. Monitoring guidance is limited: the FDA recommends checking electrolytes and complete blood counts to screen for anemia, though no formal long-term monitoring protocol exists from major organizations. Clinical outcomes tracked include reduction in TPN requirements—approximately 1–2 liters per week in adults, or 40% reduction in fluid and calorie needs over 6 months.

Dr. Wales defined intestinal failure as a functional problem where gut function is insufficient to absorb enough nutrients, fluids, and calories to support survival and, in children, growth. He noted that until recently there was no standardized definition for the condition. Patients presenting to intestinal rehabilitation programs have intestinal failure, which can be divided into three categories of causes. Some patients present with elements of two or all three categories simultaneously.

Todd Ponsky hosted the intestinal rehabilitation series at Cincinnati Children's Hospital alongside Rod Gerardo and Ellen Encisco, beginning in 2021. He and Brian Modi noted that children with intestinal failure might be slightly short statured but are not severely undersized compared to the general population, while also observing a high incidence of short stature in chronic intestinal failure.

Experts disagree on management of atresia in gastroschisis: whether to repair at initial closure, create stomas, or delay repair. Evidence for mucous fistula refeeding is not strong. Additionally, there is disagreement on bowel resection philosophy: some experts advocate resecting all damaged bowel, while intestinal rehabilitation specialists at Cincinnati Children's challenge this, arguing that understanding physiology may allow bowel regeneration and recovery without complete resection.