Short Bowel Syndrome Market Insight, Epidemiology And Market Forecast - 2034

Key Highlights:

• The prevalence of home parenteral nutrition (HPN) for SBS is generally higher in the US than in Europe. The US data often report annual prevalence rates, whereas European studies present point prevalence. This discrepancy partly reflects differences in reporting methods and the broader availability of HPN in the US, which encourages earlier transitions to home care for cost-saving reasons.
• Total Parenteral Nutrition (TPN) and dietary changes are the current standard of care treatment. SBS treatment is often tailored to the individual and depends on severity and symptoms.
• Over the past two decades, GLP-2 analogues have emerged as transformative therapies for SBS-IF, enhancing intestinal absorption, reducing reliance on parenteral support, and improving patient quality of life..
• Intestinal transplantation is the only cure for severe cases, but has limited survival rates (5-year ~58%, 10-year ~47%). This underscores the need for better alternative therapies.
• Takeda's GATTEX is the only GLP-2 analog approved for both adults and pediatric SBS patients. It leads the SBS treatment market due to proven clinical efficacy. Sales growth is driven by rising US demand, pediatric label expansion, and market expansion in the EU and Japan.
• With GATTEX's patent expiry in the US and Europe, and the anticipated launch of generics in Europe, revenue is expected to decline; however, the impact may be partially offset by the administration advantages of next-generation GLP-2 analogs like apraglutide and glepaglutide, including less frequent dosing.
• In the competitive landscape, glepaglutide emerges as a potential advancement, addressing some of the limitations of GATTEX. With an extended half-life of 88 h, glepaglutide offers the unique opportunity for once or twice-weekly dosing, potentially alleviating the treatment burden experienced by patients on GATTEX.
• Ironwood Pharmaceuticals' apraglutide is set to redefine the standard of care in short bowel syndrome by introducing the first once-weekly GLP-2 therapy for patients dependent on parenteral support.
• Companies like Ironwood Pharmaceuticals (apraglutide), Zealand Pharma (glepaglutide), Hanmi Pharmaceutical (sonefpeglutide), and Napo Therapeutics (MYTESI) are investigating their key products for SBS.

DelveInsight's "Short Bowel Syndrome (SBS) - Market Insights, Epidemiology, and Market Forecast - 2034" report delivers an in-depth understanding of Short Bowel Syndrome, historical and forecasted epidemiology as well as Short Bowel Syndrome market trends in the United States, EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan.

The Short Bowel Syndrome market report provides current treatment practices, emerging drugs, market share of individual therapies, and current and forecasted Short Bowel Syndrome market size from 2020 to 2034 in the 7MM. The report also covers current Short Bowel Syndrome treatment practices/algorithms and unmet medical needs to curate the best opportunities and assess the market's potential.

Geography Covered:

• The United States
• EU4 (Germany, France, Italy, and Spain) and the United Kingdom
• Japan

Study Period: 2020-2034

Short Bowel Syndrome Disease Understanding and Treatment Algorithm

Short Bowel Syndrome Overview

Short bowel syndrome is a complex disease that occurs due to the physical loss or the loss of function of a portion of the small and/or large intestine. Consequently, individuals with short bowel syndrome often have a reduced ability to absorb nutrients such as fats, carbohydrates (sugars), vitamins, minerals, trace elements, and fluids (malabsorption). The specific symptoms and severity of short bowel syndrome vary from one person to another. Diarrhea is common, often severe, and can cause dehydration, which can even be life-threatening. Short bowel syndrome can lead to malnutrition, unintended weight loss, and additional symptoms may be due to the loss of essential vitamins and minerals. There is no cure, but the disorder can usually be treated effectively. However, in some cases, short bowel syndrome can lead to severe, disabling, and life-threatening complications.

Short Bowel Syndrome Diagnosis

A diagnosis of short bowel syndrome is made based upon a detailed patient history, a thorough clinical evaluation, and a variety of specialized tests, including laboratory tests and X-ray studies.

A health care provider diagnoses short bowel syndrome based on a medical and family history, a physical exam, blood tests such as CBC, albumin, creatinine tests, and others. Fecal fat tests are also performed, which can show how well the small intestine is working. Imaging techniques may be used to assess individuals with short bowel syndrome. Such tests include plain abdominal X-rays to detect signs of obstruction or ileus (paralysis of intestinal muscles), computerized tomography scanning of the abdomen (abdominal CAT scan), magnetic resonance imaging (MRI) of the abdomen, or an abdominal ultrasound. Upper GI series, also called a barium swallow, uses X-rays and fluoroscopy to help diagnose problems of the upper GI tract.

Short Bowel Syndrome Treatment

The treatment approach for short bowel syndrome is tailored to individual symptoms and factors such as the extent of small intestine loss, overall health, and patient preferences. A multidisciplinary team, including gastroenterologists, surgeons, dietitians, and other healthcare professionals, collaborates to create a personalized plan. Treatment options encompass TPN, enteral feeding, dietary adjustments, oral rehydration solutions, medications, and surgery. Intestinal adaptation, a process enhancing the remaining small bowel's absorption capabilities, is a key focus, and nutritional management is vital. TPN, though associated with complications, may be required, with advances like recombinant growth hormone and glucagon-like peptide analogs offering alternatives. Medications address symptoms and may include GATTEX, anti-diarrheals, acid reducers, and growth hormones. Surgical interventions range from non-transplant procedures, such as artificially lengthening the intestines, to transplant surgeries, like small bowel transplants, considered in severe cases. The goal is to improve nutrient absorption, minimize reliance on TPN, and enhance overall quality of life for individuals with short bowel syndrome.

Short Bowel Syndrome Epidemiology

The short bowel syndrome epidemiology chapter in the report provides historical as well as forecasted epidemiology segmented by prevalence of home parenteral nutrition (HPN) use, diagnosed prevalent cases of short bowel syndrome, age-specific cases of short bowel syndrome, gender-specific cases of short bowel syndrome, etiology-specific cases of short bowel syndrome in the 7MM covering the United States, EU4 (Germany, France, Italy, and Spain), and the United Kingdom, and Japan from 2020 to 2034.

• In 2024, the US accounted for the highest number of prevalent SBS cases in the 7MM, with approximately 14,000 cases, followed by the EU4 and the UK. Surgical complications, in particular, continue to be a leading contributor to the prevalence of SBS in the country.
• Short bowel syndrome is more common in females as compared to males. In the United States, more than 67% of short bowel syndrome patients were females. Anatomical differences are a key factor; women typically start with a shorter baseline length of the small intestine than men, so extensive resections leave them at greater risk for developing SBS after bowel surgery.
• In the United States, around 29% and ~24% short bowel syndrome cases were caused by surgical complications and mesenteric infarction, respectively, in 2024. SBS primarily arises from surgical complications, mesenteric ischemia, Crohn's disease, neoplasms, and radiation enteritis, with surgical complications and ileus representing the largest share of cases.
• In EU4 and the UK, Germany accounted for the highest prevalent cases of short bowel syndrome, while Spain accounted for the least prevalent cases in 2024.

Short Bowel Syndrome Drug Chapters

The drug chapter segment of the Short Bowel Syndrome report encloses a detailed analysis of the marketed and the late-stage (Phase III and II) pipeline drugs. The marketed drugs segment encloses GATTEX/REVESTIVE (Takeda). Furthermore, the current key players for the upcoming emerging drugs include VectivBio/Ironwood (apraglutide), Zealand Pharma (glepaglutide), Hanmi Pharmaceutical (HM15912), and others. The drug chapter also helps understand the short bowel syndrome clinical trial details, expressive pharmacological action, agreements and collaborations, approval and patent details, and the latest news and press releases.

Marketed Drugs

GATTEX/REVESTIVE: Takeda (Shire Pharmaceuticals)

GATTEX is a novel, recombinant analogue of human GLP-2, a naturally occurring protein involved in the rehabilitation of the intestinal lining. It has been developed to reduce dependence on parenteral nutrition in adult patients with SBS. Teduglutide has received ODD for the treatment of SBS from the EMA and the US FDA.

GATTEX was first approved by the FDA in December 2012 for adults with SBS on parenteral support, with its indication expanded in May 2019 to include pediatric patients aged 1 year and older.

In April 2023, the Committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion recommending a change to the terms of the marketing authorization for REVESTIVE. The CHMP adopted an extension to the existing indication as teduglutide for the treatment of patients 4 months corrected gestational age and above with short bowel syndrome.

Emerging Drugs

Apraglutide: VectivBio/Ironwood

Apraglutide is an investigational, next-generation, long-acting synthetic GLP-2 analog being evaluated as a potential once-weekly treatment for patients with SBS-IF.

• In August 2025, according to the Q2 2025 corporate highlights, following discussions with the US FDA in April 2025, the company is finalizing a confirmatory apraglutide Phase III trial design for patients with SBS who are dependent on parenteral support and plans to align with the FDA in Q4 of 2025. Pending alignment with the FDA, Ironwood expects to initiate a confirmatory Phase III trial in the 1H of 2026.
• In April 2025, Ironwood Pharmaceuticals announced that, based on a recent discussion with the US FDA, a confirmatory Phase III trial is needed to seek approval of apraglutide for patients with SBS-IF who are dependent on parenteral support.

Glepaglutide: Zealand Pharma

Glepaglutide is a long-acting GLP-2 analog in development as a potential treatment option for SBS. Glepaglutide is being developed as a liquid product in an autoinjector designed for subcutaneous administration, aimed to reduce or eliminate the need for parenteral support in people living with SBS. The US FDA has granted ODD for glepaglutide for the treatment of SBS.

• As per the Q2 2025 presentation in August 2025, the company had completed the Type A meeting with the US FDA, ensuring the alignment on the design of EASE-5, and anticipates the initiation of the Phase III trial (EASE-5) in H2 2025 to support resubmission in the US.
• The company is anticipating the potential approval of glepaglutide for the treatment of adult patients with SBS in H1 2026 in Europe. Additionally, the company is engaging in partnership discussions for future commercialization.
• In June 2025, Zealand Pharma announced the submission of an MAA to the EMA for glepaglutide for the treatment of adult patients with SBS. The submission was based on results from a pivotal Phase III trial (EASE-1), supported by interim results from two ongoing long-term extension trials (EASE-2 and EASE-3) and results from a mechanistic trial (EASE-4).

Drug Class Insights

The landscape of short bowel syndrome drug development is evolving with GLP-2 agonists such as GATTEX, glepaglutide, and apraglutide.

GLP-2 agonists: GLP-2 agonists are a class of therapeutic agents that mimic the action of GLP-2, a hormone involved in the regulation of the gastrointestinal tract. GLP-2 is known for its intestinotrophic effects, meaning it promotes growth and maintenance of the small intestine. GLP-2 agonists are primarily used in the treatment of conditions such as short bowel syndrome, where there is a reduced length or function of the small intestine, leading to challenges in nutrient absorption. GATTEX, an approved GLP-2 agonist, demonstrates higher effectiveness in reducing TPN dependence for short bowel syndrome patients with stomas compared to those with catheters, holding a larger market share among stoma patients. Despite efficacy, GATTEX requires daily subcutaneous injections due to its short half-life, and its lyophilized powder formulation involves a complex reconstitution process. Glepaglutide and apraglutide are emerging therapies showing promise in addressing GATTEX limitations, potentially offering improved efficacy, longer duration of action, and easier administration.

Short Bowel Syndrome Market Outlook

The treatment of short bowel syndrome is individualized, taking into account the severity and specific symptoms of each patient. TPN, involving intravenous fluids with nutrient therapy, may be necessary to address potential nutrient deficiencies. While TPN can be transitioned to home care, prolonged use poses risks such as infections, blood clotting, and potential harm to the liver and kidneys. Patients often use additional medications, such as anti-diarrheals, to alleviate short bowel syndrome symptoms. Chronic intestinal failure (CIF) in short bowel syndrome is marked by the inability to achieve optimal intestinal adaptation for maintaining oral/enteral autonomy.

Surgical management is a crucial strategy for short bowel syndrome patients. Those on parenteral nutrition with rapid transit may benefit from interventions like reversing intestinal segments or interposing segments of the colon into the small bowel. Individuals with less than 60 cm of small bowel and complications from parenteral nutrition may be considered for intestinal transplantation. For patients with dilated bowel due to obstruction, treatments like intestinal tapering or strictureplasty are options based on the length of the remaining bowel. Tapering with lengthening may be considered for remnants less than 90 cm in adults or less than 30 cm in children.

The management of short bowel syndrome involves a multidisciplinary team, including gastroenterologists and nutrition specialists, due to the complexity and varied clinical implications of the condition.

• The total market size in the US for short bowel syndrome was estimated to be nearly USD 2,100 million in 2024, which is expected to increase due to the launch of emerging therapies and label expansion of current therapies.
• GATTEX was approved by the FDA and EMA in 2012 for adult SBS patients on parenteral nutrition, and later expanded to pediatric use. With upcoming patent expiries and expected generics in Europe, a revenue decline is anticipated.
• Companies are actively working on developing therapies for short bowel syndrome, with drugs like glepaglutide, apraglutide, and HM15912 undergoing assessment for potential market availability in the future.
• Although GATTEX is more expensive than standard care, it delivers better patient outcomes by increasing quality-adjusted life years. A drawback of GATTEX lies in its composition, featuring a single amino acid substitution compared to the natural GLP-2, resulting in an extended half-life of 1-2 h (contrasting with the ~7-minute half-life of human GLP-2). Despite this prolonged duration, GATTEX still necessitates daily subcutaneous injections due to its short half-life.
• The SBS market is on the brink of change, with next-generation GLP-2 analogs expected to enter from 2026. Glepaglutide is likely to launch first in Europe, potentially securing an early advantage, while the entry of generic GATTEX around the same time is set to intensify competition.
• As a novel, oral, plant-based prescription therapy, MYTESI (crofelemer) offers a unique non-injectable alternative in the SBS treatment landscape-potentially addressing unmet needs for patients seeking less invasive options.

Short Bowel Syndrome Drugs Uptake

This section focuses on the uptake rate of potential drugs expected to be launched in the market during 2024-2034, which depends on the competitive landscape, safety, efficacy data, and order of entry. It is important to understand that the key players evaluating their novel therapies in the pivotal and confirmatory trials should remain vigilant when selecting appropriate comparators to stand the greatest chance of a positive opinion from regulatory bodies, leading to approval, smooth launch, and rapid uptake.

Short Bowel Syndrome Pipeline Activities

The report provides insights into different therapeutic candidates in the Phase III and Phase II stages. It also analyzes key players involved in developing targeted therapeutics.

Pipeline Development Activities

The report covers information on collaborations, acquisitions and mergers, licensing, and patent details for short bowel syndrome emerging therapies.

KOL Views

To keep up with the real-world scenario in current and emerging market trends, we take opinions from Key Industry leaders working in the domain through primary research to fill the data gaps and validate our secondary research. Industry experts contacted for insights on the evolving treatment landscape, patient reliance on conventional therapies, patient therapy switching acceptability, and drug uptake, along with challenges related to accessibility, including Medical/scientific writers, Neonatal and Paediatric Surgeons, Consultant Gastroenterologists, and others.

Delveinsight's analysts connected with 20+ KOLs to gather insights; however, interviews were conducted with 10+ KOLs in the 7MM. Centers such as the American Gastroenterological Association, USA, Lennard Jones Intestinal Failure Unit, UK, Gastroenterology and Endoscopy Unit, University of the Study of Milan, Italy, etc., were contacted. Their opinion helps understand and validate current and emerging therapy treatment patterns or short bowel syndrome market trends.

Qualitative Analysis

We perform qualitative and market Intelligence analysis using various approaches, such as SWOT analysis and Analyst views. In the SWOT analysis, strengths, weaknesses, opportunities, and threats in terms of disease diagnosis, patient awareness, patient burden, competitive landscape, cost-effectiveness, and geographical accessibility of therapies are provided. These pointers are based on the Analyst's discretion and assessment of the patient burden, cost analysis, and existing and evolving treatment landscape.

Market Access and Reimbursement

Market Access refers to the ability of all patients to have access to a given product quickly, conveniently, and affordably. Reimbursement is the negotiation of a price between the manufacturer and payer that allows the manufacturer access to that market. It is provided to reduce the high costs and make essential drugs affordable.

In the base scenario, teduglutide costs USD 949,910/QALY gained. In one-way sensitivity analyses, only reducing teduglutide cost decreased the cost/QALY gained to below the typical threshold of USD 100,000/QALY gained. Specifically, the cost of teduglutide would need to be reduced by >65% for it to reach the threshold value. Probabilistic sensitivity analysis favored no teduglutide use in 80% of iterations at a USD 100,000/QALY threshold. However, teduglutide therapy was cost-saving in 13% of model iterations.

Takeda Patient Support

Eligible patients may pay as little as USD 0 for each GATTEX prescription, subject to meeting all eligibility requirements.

Scope of the Report:

• The report covers a segment of key events, an executive summary, and a descriptive overview of Short Bowel Syndrome, explaining its causes, signs and symptoms, pathogenesis, and currently available therapies.
• Comprehensive insight has been provided into the epidemiology segments and forecasts, the future growth potential of the diagnosis rate, disease progression, and treatment guidelines.
• Additionally, an all-inclusive account of the current and emerging therapies and the elaborate profiles of late-stage and prominent therapies will impact the current treatment landscape.
• A detailed review of the Short Bowel Syndrome market, historical and forecasted market size, market share by therapies, detailed assumptions, and rationale behind our approach is included in the report, covering the 7MM drug outreach.
• The report provides an edge while developing business strategies by understanding trends through SWOT analysis and expert insights/KOL views, patient journey, and treatment preferences that help in shaping and driving the seven major markets of Short Bowel Syndrome.

Short Bowel Syndrome Report Insights

• Patient Population
• Therapeutic Approaches
• Short Bowel Syndrome Pipeline Analysis
• Short Bowel Syndrome Market Size and Trends
• Existing and Future Market Opportunity

Report Key Strengths

• Ten-Year Forecast
• The 7MM Coverage
• Short Bowel Syndrome Epidemiology Segmentation
• Key Cross Competition
• Drugs Uptake and Key Market Forecast Assumptions

Short Bowel Syndrome Report Assessment

• Current Treatment Practices
• Unmet Needs
• Pipeline Product Profiles
• Market Attractiveness
• Analyst Views
• Qualitative Analysis (SWOT)

FAQs:

• What is the historical and forecasted Short Bowel Syndrome patient pool in the United States, EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan?
• What was the Short Bowel Syndrome total market size, the market size by therapies, market share (%) distribution in 2020, and what would it look like by 2034? What are the contributing factors for this growth?
• Which therapy is going to be the largest contributor by 2034?
• What will be the impact of GATTEX's expected patent expiry?
• What is GATTEX's competitive position compared to apraglutide and glepaglutide in the short bowel syndrome market?
• How does Sonefpeglutide differentiate itself from existing GLP-2 agonists like GATTEX, and what potential advantages or innovations does it bring to the landscape of Short Bowel Syndrome treatments, considering factors such as dosing frequency, administration method, and clinical efficacy?
• What are the pricing variations among different geographies for approved and off-label therapies?
• How would the market drivers, barriers, and future opportunities affect the market dynamics and subsequent analysis of the associated trends?
• What are the recent novel therapies, targets, mechanisms of action, and technologies developed to overcome the limitations of existing therapies?
• Patient acceptability in terms of preferred treatment options as per real-world scenarios?
• What are the country-specific accessibility issues of expensive, recently approved therapies?

Reasons to Buy:

• The report will help in developing business strategies by understanding the latest trends and changing treatment dynamics driving the Short Bowel Syndrome Market.
• Insights on patient burden/disease prevalence, evolution in diagnosis, and factors contributing to the change in the epidemiology of the disease during the forecast years.
• Understand the existing market opportunities in varying geographies and the growth potential over the coming years.
• Distribution of historical and current patient share based on real-world prescription data along with reported sales of approved products in the US, EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan.
• Identifying strong upcoming players in the market will help devise strategies to help get ahead of competitors.
• Highlights of access and reimbursement policies of approved therapies, barriers to accessibility of expensive off-label therapies, and patient assistance programs.
• To understand Key Opinion Leaders' perspectives around the accessibility, acceptability, and compliance-related challenges of existing treatment to overcome barriers in the future.
• Detailed insights into the unmet needs of the existing market so that the upcoming players can strengthen their development and launch strategy.