scholarly journals Treatment of short bowel syndrome in children. Value of the Intestinal Rehabilitation Program

2016 ◽  
Vol 62 (6) ◽  
pp. 575-583 ◽  
Author(s):  
Uenis Tannuri ◽  
Fabio de Barros ◽  
Ana Cristina Aoun Tannuri
Keyword(s):  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Intestinal Failure ◽  
Rehabilitation Program ◽  
Pediatric Care ◽  
Watery Diarrhea ◽  
Constant Weight ◽  
Short Bowel ◽  
Recommended Treatment ◽  
Intestinal Rehabilitation

Summary The main cause of acute intestinal failure is short bowel syndrome, generally as a result of resection of extensive segments of small intestine. As a result, the main symptoms are watery diarrhea, malabsorption syndrome, chronic malnutrition, and death, if the patient is not properly treated. If the length of the remaining intestine is greater than 30 cm, complete adaptation is possible and the patient may not require parenteral nutrition. The currently recommended treatment includes the use of prolonged parenteral nutrition and enteral nutrition, always aimed at constant weight gain, in conjunction with surgeries aimed at elongating the dilated bowel. This set of procedures constitutes what is called an Intestinal Rehabilitation Program. This therapy was used in 16 children in periods ranging from 8 months to 7.5 years, with survival in 75% of the cases. Finally, the last resort to be used in children with complete resection of the small bowel is an intestinal transplant. However, to date there is no record of a Brazilian child that has survived this procedure, despite it being attempted in seven patients. We conclude that the results of the intestinal rehabilitation program are encouraging for the continuation of this type of treatment and stimulate the creation of the program in other pediatric care institutions.

scholarly journals Short bowel syndrome in infancy: recent advances and practical management

2020 ◽  
pp. flgastro-2020-101457
Author(s):  
Elena Cernat ◽  
Chloe Corlett ◽  
Natalia Iglesias ◽  
Nkem Onyeador ◽  
Julie Steele ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Intestinal Failure ◽  
Rare Condition ◽  
Oral Feeding ◽  
Short Bowel ◽  
Intestinal Continuity ◽  
Gastrointestinal Reconstruction ◽  
Lipid Reduction

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.

Intestinal Failure and Short Bowel Syndrome in Crohn’s Disease: A Systematic Review

2021 ◽  
pp. 77-86
Author(s):  
Hayslan Theobaldo Boemer ◽  
Ana Valéria Garcia Ramirez ◽  
Durval Ribas Filho
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Short Bowel Syndrome ◽  
Intestinal Failure ◽  
Intestinal Secretion ◽  
Surgical Interventions ◽  
Short Bowel ◽  
Intestinal Length ◽  
Intestinal Rehabilitation ◽  
Long Term Prognosis

Crohn's disease (CD) is an inflammatory, chronic and progressive disease that affects the digestive tract. Despite optimized drug therapy, the risk of multiple surgical interventions over the years is high, leading the patient to develop short bowel syndrome (SBS). Thus, adequate management in the postoperative period directly interferes with the long-term prognosis. Initially, most of these patients, due to hydro electrolytic disorders and absorptive incapacity inherent in SBS, will need parenteral nutritional support. According to the patient's residual digestive profile and according to nutritional management (oral, enteral, and/or parenteral), the intestine will evolve in its adaptive capacity. During this period, control agents are used for motility and intestinal secretion and, if necessary, GLP-2 agonists (intestinotrophic). In cases refractory to these treatments, we can still indicate surgical procedures to control motility, increasing intestinal length, and, finally, transplantation. CD is recurrent, and patients with SBS need a multidisciplinary approach with continuous monitoring to provide better intestinal rehabilitation and consequent quality of life.

Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome

2017 ◽  
Vol 65 (5) ◽  
pp. 588-596 ◽  
Author(s):  
Russell J. Merritt ◽  
Valeria Cohran ◽  
Bram P. Raphael ◽  
Timothy Sentongo ◽  
Diana Volpert ◽  
...  
Keyword(s):  
Short Bowel Syndrome ◽  
Intestinal Failure ◽  
Short Bowel ◽  
Rehabilitation Programs ◽  
Intestinal Rehabilitation
Sign in / Sign up

Export Citation Format

Share Document