Oral Feeding Difficulties in Children With Short Bowel Syndrome: A Narrative Review

Short bowel syndrome (SBS) is a rare condition characterised by extensive loss of intestinal mass secondary to congenital or acquired disease. The outcomes are determined by dependency on parenteral nutrition (PN), its possible complications and factors that influence intestinal adaptation. In order to achieve the best results, patients should be managed by a specialised multidisciplinary team with the aims of promoting growth and development, stimulating intestinal adaptation and preventing possible complications. This involves timely surgical management aimed at rescuing maximum bowel length and eventually re-establishing intestinal continuity where appropriate. A combination of enteral and parenteral nutrition needs to be targeted towards maintaining a balance between fulfilling the nutritional and metabolic needs of the child while preventing or at least minimising potential complications. Enteral nutrition and establishment of oral feeding play a fundamental role in stimulating bowel adaptation and promoting enteral autonomy. Other measures to promote enteral autonomy include the chyme recycling in patients where bowel is not in continuity, autologous gastrointestinal reconstruction and pharmacological treatments, including promising new therapies like teduglutide. Strategies such as lipid reduction, changing the type of lipid emulsion and cycling PN are associated with a reduction in the rates of intestinal failure–associated liver disease. Even though vast improvements have been made in the surgical and medical management of SBS, there is still lack of consensus in many aspects and collaboration is essential.

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IGF-I treatment facilitates transition from parenteral to enteral nutrition in rats with short bowel syndrome

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00247.2002 ◽

2003 ◽

Vol 284 (2) ◽

pp. R363-R371 ◽

Cited By ~ 35

Author(s):

Melanie B. Gillingham ◽

Elizabeth M. Dahly ◽

Sangita G. Murali ◽

Denise M. Ney

Keyword(s):

Body Weight ◽

Growth Factor ◽

Enteral Nutrition ◽

Short Bowel Syndrome ◽

Oral Feeding ◽

Final Body Weight ◽

Short Bowel ◽

Sustained Effects ◽

Igf I ◽

Mucosal Protein

The goal of growth factor treatment in patients with short bowel syndrome (SBS) is to facilitate transition from parenteral to enteral feedings. Ideal use of growth factors would be acute treatment that produces sustained effects. We investigated the ability of acute insulin-like growth factor I (IGF-I) treatment to facilitate weaning from total parenteral nutrition (TPN) to enteral feeding in a rat model of SBS. After a 60% jejunoileal resection + cecectomy, rats treated with IGF-I or vehicle were maintained exclusively with TPN for 4 days and transitioned to oral feeding. TPN and IGF-I were stopped 7 days after resection, and rats were maintained with oral feeding for 10 more days. In IGF-I-treated rats, serum concentration of IGF-I and final body weight were significantly greater because of a proportionate increase in carcass lean body mass than in vehicle-treated rats. Acute IGF-I treatment induced sustained jejunal hyperplasia on the basis of significantly greater concentrations of jejunal mucosal protein and DNA without a change in histology or sucrase activity. These results demonstrate that acute IGF-I facilitates weaning from parenteral to enteral nutrition in association with maintenance of a greater body weight and serum IGF-I concentration in rats with SBS.

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COPPER AND MAGNESIUM DEFICIENCIES IN PATIENTS WITH SHORT BOWEL SYNDROME RECEIVING PARENTERAL NUTRITION OR ORAL FEEDING

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032015000200004 ◽

2015 ◽

Vol 52 (2) ◽

pp. 94-99 ◽

Cited By ~ 8

Author(s):

Camila Bitu Moreno BRAGA ◽

Iahel Manon de Lima FERREIRA ◽

Júlio Sérgio MARCHINI ◽

Selma Freire de Carvalho da CUNHA

Keyword(s):

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Intestinal Resection ◽

Oral Feeding ◽

Control Group ◽

Sodium Potassium ◽

Short Bowel ◽

Electrolyte Disturbances ◽

Feeding Methods ◽

And Gender

Background Patients with short bowel syndrome have significant fluid and electrolytes loss. Objective Evaluate the mineral and electrolyte status in short bowel syndrome patients receiving intermittent parenteral nutrition or oral feeding. Methods Twenty two adults with short bowel syndrome, of whom 11 were parenteral nutrition dependent (PN group), and the 11 remaining had been weaned off parenteral nutrition for at least 1 year and received all nutrients by oral feeding (OF group). The study also included 14 healthy volunteers paired by age and gender (control group). Food ingestion, anthropometry, serum or plasma levels of sodium, potassium, phosphorus, magnesium, calcium, zinc, iron and copper were evaluated. PN group subjects were evaluated before starting a new parenteral nutrition cycle. Results The levels of sodium, potassium, phosphorus, calcium and zinc were similar between the groups. The magnesium value was lower in the PN group (1.0 ± 0.4 mEq /L) than other groups. Furthermore, this electrolyte was lower in the OF group (1.4 ± 0.3 mEq /L) when compared to the Control group (1.8 ± 0.1 mEq/L). Lower values of copper (69±24 vs 73±26 vs 109±16 µg/dL) were documented, respectively, for the PN and OF groups when compared to the control group. Conclusion Hypomagnesemia and hypocupremia are electrolyte disturbances commonly observed in short bowel syndrome. Patients with massive intestinal resection require monitoring and supplementation in order to prevent magnesium and copper deficiencies.

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