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

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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Biodistribution of the radiophamarceutical sodium pertechnetate (Na99mTcO4) after massive small bowel resection in rats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502007000600003 ◽

2007 ◽

Vol 22 (6) ◽

pp. 430-435 ◽

Cited By ~ 13

Author(s):

Dâmaso de Araújo Chacon ◽

Irami Araújo-Filho ◽

Arthur Villarim-Neto ◽

Amália Cínthia Meneses Rêgo ◽

Ítalo Medeiros Azevedo ◽

...

Keyword(s):

Small Intestine ◽

Short Bowel Syndrome ◽

Intestinal Mucosa ◽

Intestinal Resection ◽

Small Bowel Resection ◽

Control Group ◽

Short Bowel ◽

Massive Resection ◽

Mucosal Thickness ◽

Misleading Interpretation

PURPOSE: To evaluate the biodistribution of sodium pertecnetate (Na99mTcO4) in organs and tissues, the morphometry of remnant intestinal mucosa and ponderal evolution in rats subjected to massive resection of the small intestine. METHODS: Twenty-one Wistar rats were randomly divided into three groups of 7 animals each. The short bowel (SB) group was subjected to massive resection of the small intestine; the control group (C) rats were not operated on, and soft intestinal handling was performed in sham rats. The animals were weighed weekly. On the 30th postoperative day, 0.l mL of Na99mTcO4, with mean activity of 0.66 MBq was injected intravenously into the orbital plexus. After 30 minutes, the rats were killed with an overdose of anesthetic, and fragments of the liver, spleen, pancreas, stomach, duodenum, small intestine, thyroid, lung, heart, kidney, bladder, muscle, femur and brain were harvested. The biopsies were washed with 0.9% NaCl.,The radioactivity was counted using Gama Counter WizardTM 1470, PerkinElmer. The percentage of radioactivity per gram of tissue (%ATI/g) was calculated. Biopsies of the remaining jejunum were analysed by HE staining to obtain mucosal thickness. Analysis of variance (ANOVA) and the Tukey test for multiple comparisons were used, considering p<0.05 as significant. RESULTS: There were no significant differences in %ATI/g of the Na99mTcO4 in the organs of the groups studied (p>0.05). An increase in the weight of the SB rats was observed after the second postoperative week. The jejunal mucosal thickness of the SB rats was significantly greater than that of C and sham rats (p<0.05). CONCLUSION: In rats with experimentally-produced short bowel syndrome, an adaptive response by the intestinal mucosa reduced weight loss. The biodistribution of Na99mTcO4 was not affected by massive intestinal resection, suggesting that short bowel syndrome is not the cause of misleading interpretation, if an examination using this radiopharmaceutical is indicated.

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Short bowel syndrome in infancy: recent advances and practical management

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101457 ◽

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.

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Increased Intestinal Permeability in Patients With Short Bowel Syndrome is not Affected by Parenteral Nutrition

Physiological Research ◽

10.33549/physiolres.934134 ◽

2019 ◽

pp. 817-825 ◽

Cited By ~ 1

Author(s):

A. CINKAJZLOVÁ ◽

Z. LACINOVÁ ◽

J. KLOUČKOVÁ ◽

P. KAVÁLKOVÁ ◽

H. KRATOCHVÍLOVÁ ◽

...

Keyword(s):

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Intestinal Permeability ◽

Fatty Acid Binding Protein ◽

Binding Protein ◽

Control Group ◽

Fatty Acid Binding ◽

Short Bowel ◽

Glucagon Like Peptide ◽

Circulating Levels

The aim of our study was to assess the presence and degree of intestinal leakage in subjects suffering from short bowel syndrome (SBS) and its modification by parenteral nutrition. To this end we assessed circulating levels of selected makers of intestinal permeability including zonulin, fatty acid binding protein 2 (FABP-2), citrulline and glucagon-like peptide 2 (GLP-2). We also measured lipopolysaccharide binding protein (LBP) as a marker of circulating levels of lipopolysaccharide acting through the CD14 molecule. Eleven SBS and 10 age- and BMI-matched control subjects were included into the study. The effect of parenteral nutrition was assessed after 14 days, 6 and 12 months from its initiation, respectively. At baseline, SBS patients had increased gut permeability as measured by zonulin (47.24±2.14 vs. 39.48±1.20 ng/ml, p=0.006) and LBP (30.32±13.25 vs. 9.77±0.71 µg/ml, p<0.001) compared to healthy controls. Furthermore, SBS subjects had reduced FABP-2, unchanged citrulline and increased sCD14 and GLP-2 relative to control group. Throughout the whole study period the administered parenteral nutrition had no significant effect on any of the studied parameters. Taken together, our data show that patients with short bowel syndrome have increased intestinal permeability that is not affected by parenteral nutrition.

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Impairment of arginine metabolism in rats after massive intestinal resection: effect of parenteral nutrition supplemented with citrulline compared with arginine

Clinical Science ◽

10.1042/cs20070451 ◽

2008 ◽

Vol 115 (5) ◽

pp. 159-166 ◽

Cited By ~ 27

Author(s):

Sylwia Osowska ◽

Nathalie Neveux ◽

Samir Nakib ◽

Virginie Lasserre ◽

Luc Cynober ◽

...

Keyword(s):

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Protein Content ◽

Short Bowel Syndrome ◽

Nitrogen Balance ◽

Extensor Digitorum Longus ◽

Intestinal Resection ◽

Extensor Digitorum ◽

Noticeable Effect ◽

Short Bowel

Arginine homoeostasis is impaired in short bowel syndrome, but its supplementation in short bowel syndrome patients remains controversial. Recently, we demonstrated the benefits of citrulline supplementation by the enteral route in resected rats. Since the first step in managing short bowel syndrome is to initiate total parenteral nutrition, we hypothesized that parenteral citrulline supplementation would be more appropriate in this situation than arginine supplementation. In the present study, 24 rats were assigned to four groups. The sham group underwent transection whereas the three other groups underwent resection (R) of 80% of the small intestine. All rats were then fed exclusively by total parenteral nutrition as follows: supplementation with citrulline (R+CIT), with arginine (R+ARG) or no supplementation (R). All of the rats received isocaloric and isonitrogenous nutrition for 4 days. Nitrogen balance was measured daily. Rats were then killed and the blood was collected and the intestinal mucosa and extensor digitorum longus muscle were removed for amino acid and protein analysis. Citrulline and arginine increased mucosal protein content in the ileum (compared with sham and R, P<0.05). However, only citrulline prevented extensor digitorum longus atrophy (R+CIT, 130±3 mg compared with R, 100±6 mg and R+ARG, 110±2 mg, P<0.05). In addition, arginine worsened nitrogen balance (R+ARG, 104±46 mg/72 h compared with R, 249±69 mg/72 h, P<0.05). Only citrulline was able to prevent muscle atrophy and it was achieved independently from any noticeable effect on the gut in particular because citrulline and arginine share the same effect on mucosal ileal protein content. These results suggest that citrulline should be considered as a potential supplement for total parenteral nutrition of short bowel syndrome patients.

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Home Parenteral Nutrition: The First Twelve Months

Scottish Medical Journal ◽

10.1177/003693308202700213 ◽

1982 ◽

Vol 27 (2) ◽

pp. 177-179 ◽

Cited By ~ 3

Author(s):

C. R. Pennington ◽

Patricia H. Ritchie ◽

R. Pringle

Keyword(s):

Quality Of Life ◽

Crohn’S Disease ◽

Parenteral Nutrition ◽

Hepatic Steatosis ◽

Short Bowel Syndrome ◽

Intestinal Resection ◽

Home Parenteral Nutrition ◽

Short Bowel ◽

Unresolved Problem

A patient was treated by home parenteral nutrition because of alimentary failure due to active Crohn's disease, enterocutaneous fistulae, and the short bowel syndrome following massive intestinal resection. This therapy has now been continued for twelve months during which her symptoms, weight, and quality of life have all improved. Complications included an episode of Staph. Albus bacteraemia, and displacement of the replacement catheter. Hepatic steatosis due to excessive dextrose administration because of apparent allergy to Intralipid constitutes an unresolved problem.

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Jejunal interposition for short bowel syndrome in a septuagenarian

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz095 ◽

2019 ◽

Vol 2019 (4) ◽

Author(s):

Tikfu Gee ◽

Shu Yu Lim ◽

Nadarajan Sudhakaran ◽

Muhammad Firdaus Hassan

Keyword(s):

Weight Loss ◽

Small Bowel ◽

Enteral Nutrition ◽

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Intestinal Resection ◽

Jejunal Interposition ◽

Short Bowel ◽

Intestinal Rehabilitation ◽

Small Intestinal

Abstract Short bowel syndrome in adults occurs as a result of massive small intestinal resection commonly due to severe Crohn’s disease, volvulus or tumors. Diarrhea and weight loss are hallmarks of malabsorption which are aggravated if the colon is removed along with the small intestinal resection. Enteral nutrition autonomy is difficult to achieve in such cases of malabsorption where parenteral nutrition are required more often than not. We report a case of short bowel syndrome with severe malabsorption following extensive small bowel removal. The patient eventually underwent intestinal rehabilitation surgery and achieved independence from parenteral nutrition.

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Growth Hormone, Glutamine, and an Optimal Diet Reduces Parenteral Nutrition in Patients With Short Bowel Syndrome: A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Yearbook of Gastroenterology ◽

10.1016/s0739-5930(08)70386-6 ◽

2006 ◽

Vol 2006 ◽

pp. 198-199

Author(s):

J.L. Rombeau

Keyword(s):

Clinical Trial ◽

Growth Hormone ◽

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Optimal Diet ◽

Double Blind ◽

Short Bowel ◽

Double Blind Clinical Trial

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PARENTERAL NUTRITION WITH OMEGA-3 FATTY ACIDS RESULTS IN HIGH ENDOGENOUS EPA/DHA LEVELS IN SHORT BOWEL SYNDROME PATIENTS

10.1055/s-0037-1603256 ◽

2017 ◽

Author(s):

M Karber ◽

S Pevny ◽

D Thurmann ◽

WH Schunck ◽

KH Weylandt ◽

...

Keyword(s):

Fatty Acids ◽

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

Short Bowel

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Incidence and Outcomes of Home Parenteral Nutrition in Patients With Crohn Disease in Olmsted County, Minnesota

Crohn's & Colitis 360 ◽

10.1093/crocol/otaa083 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Zeinab Bakhshi ◽

Siddhant Yadav ◽

Bradley R Salonen ◽

Sara L Bonnes ◽

Jithinraj Edakkanambeth Varayil ◽

...

Keyword(s):

Weight Loss ◽

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Crohn Disease ◽

Severe Disease ◽

Bloodstream Infections ◽

Home Parenteral Nutrition ◽

Average Weight ◽

Olmsted County ◽

Short Bowel

Abstract Background We sought to estimate the incidence of home parenteral nutrition (HPN) use in a population-based cohort of patients with Crohn disease (CD), and to assess clinical outcomes and complications associated with HPN. Methods We used the Rochester Epidemiology Project (REP) to identify residents of Olmsted County, who were diagnosed with CD between 1970 and 2011, and required HPN. Results Fourteen out of 429 patients (3.3%) with CD received HPN (86% female). Eleven patients (79%) had moderate–severe CD and 12 patients (86%) had fistulizing disease. Thirteen patients (93%) underwent surgery, primarily due to obstruction. Among CD incidence cases, the cumulative incidence of HPN from the date of CD diagnosis was 0% at 1 year, 0.5% at 5 years, 0.8% at 10 years, and 2.4% at 20 years. Indications for HPN included short bowel syndrome in 64%, malnutrition in 29%, and bowel rest in 21%. The median duration of HPN was 2.5 years. There was an average weight gain of 1.2 kg at 6 months, an average weight loss of 1.4 kg at 1 year, and a further weight loss of 2.2 kg at 2 years from the start of HPN. Patients were hospitalized a mean of 5 times after the start of HPN, mainly due to catheter-related bloodstream infections and thrombosis. Conclusions Less than 4% of patients with CD need HPN. Most have moderate to severe disease with short bowel syndrome or malnutrition. Possible reasons for the patients’ weight loss could be noncompliance, and increased metabolic needs because of active disease.

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