scholarly journals The Influence of Neocate in Paediatric Short Bowel Syndrome on PN Weaning

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
E. De Greef ◽  
T. Mahler ◽  
A. Janssen ◽  
H. Cuypers ◽  
G. Veereman-Wauters
Keyword(s):  
Amino Acid ◽  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Enteral Feeding ◽  
Bowel Resection ◽  
Persistent Diarrhoea ◽  
Ileocaecal Valve ◽  
Surgical Interventions ◽  
Short Bowel ◽  
Early Introduction

Clinical management of short bowel syndrome remains a multistage process. Although PN is crucial, early introduction of enteral feeding is mandatory. We describe retrospectively 4 patients with an ultrashort bowel who could be weaned off PN on very short terms after introduction of an amino-acid-based formula (Neocate). Patient 1 had congenital short bowel with 50 cm small bowel and 30 cm colon. He had persistent diarrhoea on a semielementary formula. When Neocate was introduced he could be weaned from PN within 6 months. Patient 2 needed multiple surgical interventions because of NEC at D 27. He maintained 40 cm small bowel and an intact colon and remained PN dependent on semielemental formula. After introducing Neocate, PN could be weaned within 3 months. In the next 2 patients, Neocate was introduced as initial enteral feeding after bowel resection following antenatal midgut volvulus. Patient 3 had 20 cm small bowel and an intact colon. PN was weaned after 2 months. Patient 4 had 9 cm small bowel and an intact colon. PN was weaned after 13 months. In all patients Ileocaecal valve (ICV) was preserved. No consensus is reached on the type of formula to use for short bowel syndrome. Compared to recent data in the literature, the weaning period in these 4 patients was significantly shortened on an aminoacid based formula. The reason for this may lie in the antiallergic properties of this formula. We recommend the use of an amino-acid-based formula to induce earlier weaning of PN.

Stimulation of intestinal growth and function with DPP4 inhibition in a mouse short bowel syndrome model

2014 ◽  
Vol 307 (4) ◽  
pp. G410-G419 ◽  
Author(s):  
Ryo Sueyoshi ◽  
Kathleen M. Woods Ignatoski ◽  
Manabu Okawada ◽  
Bolette Hartmann ◽  
Jens Holst ◽  
...  
Keyword(s):  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Plasma Levels ◽  
Bowel Resection ◽  
Small Bowel Resection ◽  
Nuclear Antigen ◽  
Intestinal Growth ◽  
Short Bowel ◽  
Time Points ◽  
Absorptive Function

Glucagon-like peptide-2 (GLP-2) has been shown to be effective in patients with short bowel syndrome (SBS), but it is rapidly inactivated by dipeptidyl peptidase IV (DPP4). We used an orally active DPP4 inhibitor (DPP4-I), MK-0626, to determine the efficacy of this approach to promote adaptation after SBS, determined optimal dosing, and identified further functional actions in a mouse model of SBS. Ten-week-old mice underwent a 50% proximal small bowel resection. Dose optimization was determined over a 3-day post-small bowel resection period. The established optimal dose was given for 7, 30, and 90 days and for 7 days followed by a 23-day washout period. Adaptive response was assessed by morphology, intestinal epithelial cell (IEC) proliferation (proliferating cell nuclear antigen), epithelial barrier function (transepithelial resistance), RT-PCR for intestinal transport proteins and GLP-2 receptor, IGF type 1 receptor, and GLP-2 plasma levels. Glucose-stimulated sodium transport was assessed for intestinal absorptive function. Seven days of DPP4-I treatment facilitated an increase in GLP-2 receptor levels, intestinal growth, and IEC proliferation. Treatment led to differential effects over time, with greater absorptive function at early time points and enhanced proliferation at later time points. Interestingly, adaptation continued in the group treated for 7 days followed by a 23-day washout. DPP4-I enhanced IEC proliferative action up to 90 days postresection, but this action seemed to peak by 30 days, as did GLP-2 plasma levels. Thus DPP4-I treatment may prove to be a viable option for accelerating intestinal adaptation with SBS.

Short- and long-term effects of small bowel resection: a unique histological study in a piglet model of short bowel syndrome

2011 ◽  
Vol 135 (2) ◽  
pp. 195-202 ◽  
Author(s):  
Prue M. Pereira-Fantini ◽  
Sarah L. Thomas ◽  
Guineva Wilson ◽  
Russell G. Taylor ◽  
Magdy Sourial ◽  
...  
Keyword(s):  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Bowel Resection ◽  
Histological Study ◽  
Small Bowel Resection ◽  
Long Term Effects ◽  
Short Bowel ◽  
Short And Long Term

scholarly journals Hypomagnesemia in short bowel syndrome patients

2000 ◽  
Vol 118 (6) ◽  
pp. 169-172 ◽  
Author(s):  
Simone Chaves Miranda ◽  
Michelle Lizzy Bandeira Ribeiro ◽  
Eduardo Ferriolli ◽  
Júlio Sérgio Marchini
Keyword(s):  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Bowel Resection ◽  
Serum Magnesium ◽  
Small Bowel Resection ◽  
University Hospital ◽  
Short Bowel ◽  
Metabolic Unit ◽  
The University

CONTEXT: Magnesium support to small bowel resection patients. OBJECTIVE: Incidence and treatment of hypomagnesemia in patients with extensive small bowel resection. DESIGN: Retrospective study. SETTING: Metabolic Unit of the University Hospital Medical School of Ribeirão Preto, University of São Paulo, Brazil. PATIENTS: Fifteen patients with extensive small bowel resection who developed short bowel syndrome. MAIN MEASUREMENTS: Serum magnesium control of patients with bowel resection. Replacement of magnesium when low values were found. RESULTS: Initial serum magnesium values were obtained 21 to 180 days after surgery. Hypomagnesemia [serum magnesium below 1.5 mEq/l (SD 0.43)] was detected in 40% of the patients [1,19 mEq/l (SD 0.22)]. During the follow-up period, 66% of the patients presented at least two values below reference (1.50 mEq/l). 40% increased their serum values after magnesium therapy. CONCLUSION: Metabolic control of serum magnesium should be followed up after extensive small bowel resection. Hypomagnesemia may be found and should be controlled.

scholarly journals Development and validation of an ambulatory piglet model for short bowel syndrome with ileo-colonic anastomosis

2020 ◽  
Vol 245 (12) ◽  
pp. 1049-1057 ◽  
Author(s):  
Chandrashekhara Manithody ◽  
Christine Denton ◽  
Amber Price ◽  
Keith Blomenkamp ◽  
Yogi Patel ◽  
...  
Keyword(s):  
Small Bowel ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Colonic Anastomosis ◽  
Bowel Resection ◽  
Ileocecal Valve ◽  
Short Bowel ◽  
Therapeutic Modalities

Extensive bowel resection results in short bowel syndrome. Absence of the ileocecal valve and length of remaining bowel are important prognostic factors. Such patients require total parenteral nutrition for survival, which has significant side effects, thus understanding mechanisms driving total parenteral nutrition-associated complications in short bowel syndrome is a major research focus. We hypothesized that we could develop an ambulatory total parenteral nutrition-short bowel syndrome piglet model recapitulating human short bowel syndrome for advanced research. Fourteen neonatal pigs received duodenal, jugular catheters, and a jacket with a miniaturized pump. Animals were randomly allocated to enteral nutrition ( n = 5), total parenteral nutrition only ( n = 5) or total parenteral nutrition with 75% small bowel, ileocecal valve resection, and ileo-colonic anastomosis ( n = 4). Blood, liver, and gut were analyzed. Animals underwent successful bowel resection and anastomosis. Increased bilirubin was noted in short bowel syndrome and total parenteral nutrition. Mean conjugated bilirubin (mg/dL)±SE was 0.036 ± 0.004 for enteral nutrition ( P = 0.03), 1.29 ± 0.613 for total parenteral nutrition ( P = 0.01), and 3.89 ± 0.51 for short bowel syndrome ( P = 0.000064). Linear gut density was reduced in short bowel syndrome and total parenteral nutrition vs. enteral nutrition. The mean linear gut density (g/cm)±SE for distal gut was 0.30 ± 0.02 for enteral nutrition ( P = 0.0005); 0.16 ± 0.01 for total parenteral nutrition ( P = 0.01), and 0.11 ± 0.008 for short bowel syndrome ( P = 0.0001). We noted gut adaptation in short bowel syndrome ( P = 0.015) with significant reduction in gut FXR, gut FGF19, and enhanced hepatic CyP7A1 expression in short bowel syndrome and total parenteral nutrition ( P < 0.05). We successfully created an ambulatory total parenteral nutrition-short bowel syndrome model with distal small bowel and ileocecal valve resection recapitulating human short bowel syndrome. Our model validated total parenteral nutrition-related hyperbilirubinemia and gut changes, as noted in human short bowel syndrome. This model holds great potential for future innovative research and clinical applications. Impact statement Short bowel syndrome is associated with significant comorbidities and mortality. This study is important as unlike current systems, it provides a validated piglet model which mirrors anatomical, histological, and serological characteristics observed in human SBS. This model can be used to advance knowledge into mechanistic pathways and therapeutic modalities to improve outcomes for SBS patients. This study is novel in that in addition to significant reduction in the remnant bowel and noted liver disease, we also developed a method to emulate ileocecal valve resection and described gut adaptive responses which has important clinical implications in humans.

Pediatric Short Bowel Syndrome: Adaptation After Massive Small Bowel Resection

2007 ◽  
Vol 45 (2) ◽  
pp. 213-221 ◽  
Author(s):  
Ljubomir Rossi ◽  
Padmalatha Kadamba ◽  
Claes Hugosson ◽  
Edward B De Vol ◽  
Zakaria Habib ◽  
...  
Keyword(s):  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Bowel Resection ◽  
Small Bowel Resection ◽  
Short Bowel ◽  
Massive Small Bowel Resection

scholarly journals Tis7 deletion reduces survival and induces intestinal anastomotic inflammation and obstruction in high-fat diet-fed mice with short bowel syndrome

2014 ◽  
Vol 307 (6) ◽  
pp. G642-G654 ◽  
Author(s):  
Amy M. Garcia ◽  
Derek Wakeman ◽  
Jianyun Lu ◽  
Christopher Rowley ◽  
Taylor Geisman ◽  
...  
Keyword(s):  
Lipid Metabolism ◽  
Small Bowel ◽  
Short Bowel Syndrome ◽  
High Fat Diet ◽  
Adaptive Response ◽  
Bowel Resection ◽  
Control Diet ◽  
Small Bowel Resection ◽  
High Fat ◽  
Short Bowel

Effective therapies are limited for patients with parenteral nutrition-dependent short bowel syndrome. We previously showed that intestinal expression of the transcriptional coregulator tetradecanoyl phorbol acetate-induced sequence 7 ( tis7) is markedly increased during the adaptive response following massive small bowel resection and tis7 plays a role in normal gut lipid metabolism. Here, we further explore the functional implications of tis7 deletion in intestinal lipid metabolism and the adaptive response following small bowel resection. Intestinal tis7 transgenic ( tis7tg), tis7−/−, and wild-type (WT) littermates were subjected to 50% small bowel resection. Mice were fed a control or a high-saturated-fat (42% energy) diet for 21 days. Survival, body weight recovery, lipid absorption, mucosal lipid analysis, and the morphometric adaptive response were analyzed. Quantitative real-time PCR was performed to identify tis7 downstream gene targets. Postresection survival was markedly reduced in high-fat, but not control, diet-fed tis7−/− mice. Decreased survival was associated with anastomotic inflammation and intestinal obstruction postresection. High-fat, but not control, diet-fed tis7−/− mice had increased intestinal IL-6 expression. Intestinal lipid trafficking was altered in tis7−/− compared with WT mice postresection. In contrast, high-fat diet-fed tis7tg mice had improved survival postresection compared with WT littermates. High-fat diet feeding in the setting of tis7 deletion resulted in postresection anastomotic inflammation and small bowel obstruction. Tolerance of a calorie-rich, high-fat diet postresection may require tis7 and its target genes. The presence of luminal fat in the setting of tis7 deletion promotes an intestinal inflammatory response postresection.

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