scholarly journals Short Bowel Syndrome: Intestinal Adaptation and Medical Therapy

1990 ◽  
Vol 4 (2) ◽  
pp. 70-78
Author(s):  
WD Buie ◽  
OG Thurston ◽  
Richard N Fedorak
Keyword(s):  
Surface Area ◽  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Ileocecal Valve ◽  
Significant Loss ◽  
Intestinal Transit Time ◽  
Short Bowel ◽  
Early Use ◽  
Adaptive Ability ◽  
Mucosal Surface Area

Short bowel syndrome is a clinical entity, a consequence of significant loss of intestinal surface area, and manifests a variable picture of diarrhea, steatorrhea, malabsorprion and weight loss. Previously high mortality rates have been reduced by the early use of parenteral nutrition and have subsequently resulted in increased survival and prevalence of the condition. Ultimate patient survival is dependent on the intrinsic adaptive ability of residual intestine and this, in turn, is dependent upon length, type, functional state and the presence or absence of an ileocecal valve. The mechanisms of intestinal adaptation are not entirely understood; however, they can be grouped into three broad categories: luminal nutrition, hormonal factors, and pancreaticobiliary secretion. Medical treatment of short bowel syndrome remains supportive and centres around the control of three pathophysiological defects: decreased intestinal transit time, gastric hypersecretion, and reduced functional mucosal surface area.

scholarly journals Serial transverse enteroplasty and nipple valve construction, two life saving techniques for patients with short bowel syndrome, a report of 5 cases

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mojtaba Shafiekhani ◽  
Nazanin Azadeh ◽  
Kiarash Ashrafzadeh ◽  
Maryam Esmaeili ◽  
Hamed Nikoupour
Keyword(s):  
Small Intestine ◽  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Ileocecal Valve ◽  
Intestinal Transit Time ◽  
Short Bowel ◽  
Nipple Valve ◽  
Gastrointestinal Reconstruction ◽  
Serial Transverse Enteroplasty

Abstract Background Various abdominal pathologies end up with surgical resection of small intestine. When the small intestine remnant is too short for adequate fluid and micronutrients absorption, short bowel syndrome is diagnosed. The disabling condition needs a multidisciplinary approach to design parenteral nutrition, care for thrombotic, hepatic and infectious complications and gradually wean the patient from parenteral nutrition. Various surgical techniques have been introduced to increase absorptive mucosa and enhance the intestinal adaptation process. Serial transverse enteroplasty and nipple valve reconstruction are among the procedures, which will be discussed in the current article. Case presentation Herein, we presented 5 cases of short bowel syndrome as a consequence of abdominal laparotomies, patients were referred to our center to receive parenteral nutrition and to be prepared for the final autologous gastrointestinal reconstruction or intestinal transplantation, if indicated. Conclusion Patient’s age, performance status and bowel remnant length determines the appropriate technique for autologous gastrointestinal reconstruction. Serial transverse enteroplasty is designed to increase bowel’s length by creating zigzag patterns through dilated bowel loops. Presence of ileocecal valve is crucial to delay intestinal transit time and to prevent colonic bacterial transfer to ileum. Patient’s with ileocecal valve loss benefit from creating an artificial valve, namely, nipple valve.

scholarly journals Long-Term Results of Serial Transverse Enteroplasty with Neovalve Creation for Extreme Short Bowel Syndrome: Report of Two Cases

2017 ◽  
Vol 11 (1) ◽  
pp. 229-240 ◽  
Author(s):  
Mireia Botey ◽  
Antonio Alastrué ◽  
Henrik Haetta ◽  
Jaume Fernández-Llamazares ◽  
Arantxa Clavell ◽  
...  
Keyword(s):  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Ileocecal Valve ◽  
Long Term Results ◽  
Minimum Length ◽  
Short Bowel ◽  
First Case ◽  
Serial Transverse Enteroplasty

Objective: The aim of this article was to determine whether serial transverse enteroplasty (STEP) and the creation of a new ileocecal valve in extreme short bowel syndrome (SBS) cases (<45 cm) is effective in intestinal adaptation and improvement of nutritional parameters and serum citrulline levels. Patients and Methods: We present 2 cases of SBS treated with STEP. Enterectomy was performed for massive intestinal ischemia secondary to a gastrointestinal stromal tumor in the first case and to catastrophic antiphospholipid syndrome in the second. After enterectomy, the short residual bowel measured 34 cm in the first patient and 45 cm in the second. In both cases STEP, cholecystectomy, and gastrostomy were performed. In the first case a Brooke neovalve was created, and in the other the ileocecal valve was preserved. Results: Both patients could finally be weaned off total parenteral nutrition (TPN) and gastrostomy feeding, maintaining a good nutritional status 1 year after surgery. Conclusions: In extreme SBS, a minimum length of 80–90 cm of functioning small bowel and an intact ileocecal valve are necessary. We plead for the use of STEP with preservation of the ileocecal valve or creation of a neovalve using the Brooke technique in order to achieve the ultimate goal, which is to wean patients off TPN. After a critical review of different surgical techniques, a treatment algorithm is proposed.

Glucagon-like peptide-2 induces intestinal adaptation in parenterally fed rats with short bowel syndrome

2004 ◽  
Vol 286 (6) ◽  
pp. G964-G972 ◽  
Author(s):  
Gary R. Martin ◽  
Laurie E. Wallace ◽  
David L. Sigalet
Keyword(s):  
Short Bowel Syndrome ◽  
Intestinal Permeability ◽  
Therapeutic Potential ◽  
Intestinal Adaptation ◽  
Intestinal Resection ◽  
Sprague Dawley ◽  
Short Bowel ◽  
Intravenous Saline ◽  
Glucagon Like Peptide ◽  
Mucosal Surface Area

Glucagon-like peptide-2 (GLP-2) is an intestinal trophic enteroendocrine peptide that is associated with intestinal adaptation following resection. Herein, we investigate the effects of GLP-2 in a total parenteral nutrition (TPN)-supported model of experimental short bowel syndrome. Juvenile Sprague-Dawley rats underwent a 90% small intestinal resection and jugular catheter insertion. Rats were randomized to three groups: enteral diet and intravenous saline infusion, TPN only, or TPN + 10 μg·kg−1·h−1 GLP-2. Nutritional maintenance was isocaloric and isonitrogenous. After 7 days, intestinal permeability was assessed by quantifying the urinary recovery of gavaged carbohydrate probes. The following day, animals were euthanized, and intestinal tissue was processed for morphological and crypt cell proliferation (CCP) analysis, apoptosis (caspase-3), and expression of SGLT-1 and GLUT-5 transport proteins. TPN plus GLP-2 treatment resulted in increased bowel and body weight, villus height, intestinal mucosal surface area, CCP, and reduced intestinal permeability compared with the TPN alone animals ( P < 0.05). GLP-2 treatment induced increases in serum GLP-2 levels and intestinal SGLT-1 expression ( P < 0.01) compared with either TPN or enteral groups. No differences were seen in the villus apoptotic index between resection groups. Enterally fed resected animals had a significant decrease in crypt apoptotic indexes compared with nontreated animals. This study demonstrates that GLP-2 alone, without enteral feeding, stimulates indexes of intestinal adaptation. Secondly, villus hypertrophy associated with adaptation was predominantly due to an increase in CCP and not to changes in apoptotic rates. Further studies are warranted to establish the mechanisms of action and therapeutic potential of GLP-2.

scholarly journals Experiencia con el uso de teduglutide en pacientes pediátricos con fallo intestinal en un centro de Argentina

2020 ◽  
Author(s):  
María Inés Martínez ◽  
Carolina Rumbo ◽  
Dolores García Hervás ◽  
Julio Trentadue ◽  
Gabriel Gondolesi ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Treatment Time ◽  
Intestinal Adaptation ◽  
Ileocecal Valve ◽  
The United States ◽  
Synthetic Analogue ◽  
Older Children ◽  
Short Bowel ◽  
A Prospective Study

Introduction. Teduglutide is a synthetic analogue of the glucagon-like peptide type 2, recently approved in Europe and in the United States for paediatric use, to promote intestinal adaptation in short bowel syndrome cases. The experience in children is limited. Objective. The aim of this work is to present the evolution of the first paediatric series treated with teduglutide in Argentina. Material and methods. A prospective study was realized on patient records under 18 years treated in a rehabilitation and intestine transplant unit since 2017. Of 62 children with short bowel syndrome, 5 received teduglutide 0.05 mg/kg/subcutaneous day. Diagnostics, type of anatomy and evolution of parenteral nutrition requirements were realized . Results. Etiology of short bowel syndrome: 3 congenital malformations: 2 atresias, 1 gastroschisis, two causes in older children: 1 volvulus and 1 abdominal trauma. Anatomy. Three patients type 2A, one type 2B and one type 3A, the length of the remaining intestine (mean and DS) 25.7 ± 19 cm, 1 with ileocecal valve and colon, 4 left hemicolon. The age at the beginning of parenteral nutrition was 6.2 ± 0.4 years, time on previous parenteral nutrition was 7.1 ± 4 years. The treatment time with teduglutide was 52.2 ± 39 weeks. The parenteral nutrition requirements were reduced by 56 ± 48%, in all patients, and could be suspended in 2 (at the 29th and 24th weeks of treatment). There was no deterioration of the z score of BMI/age (initial 0.16 ± 0.3 vs. 0.14 ± 1.02), nor of the height/age (-2.01 ± 1.5 vs. -1.76 ± 1.42). Conclusion. It was concluded that the use of teduglutide as a therapeutic alternative in the short bowel syndrome in paediatrics was effective and safe in this group of patients, allowing the restoration of intestinal sufficiency or reducing the requirements of parenteral nutrition.

scholarly journals Short Bowel Syndrome: Surgical Therapy

1990 ◽  
Vol 4 (4) ◽  
pp. 167-173
Author(s):  
W Donald Buie ◽  
Olin G Thurston ◽  
Richard N Fedorak
Keyword(s):  
Small Bowel ◽  
Short Bowel Syndrome ◽  
Surgical Therapy ◽  
Small Bowel Transplantation ◽  
Important Advance ◽  
Intestinal Transit Time ◽  
Short Bowel ◽  
Gastric Hypersecretion ◽  
Optimal Medical Management ◽  
Mucosal Surface Area

Many surgical solutions to short bowel syndrome have been proposed; however, none has proven to be uniformly successful. Some of these solutions, combined with optimal medical management, may represent the patient's only hope for survival without parenteral nutrition. Most forms of surgical therapy are supportive and aim at controlling three basic pathophysiological defects: decreased intestinal transit time, gastric hypersecretion, and reduced functional mucosal surface area. Conservative resection and, thus, prevention of short bowel syndrome remains the best form of treatment at present. In the future, small bowel transplantation may prove to be an important advance in therapy; however, this remains largely experimental due to continued problems with rejection.

scholarly journals Effect of subcutaneous insulin on intestinal adaptation in a rat model of short bowel syndrome

2004 ◽  
Vol 21 (3) ◽  
pp. 132-137 ◽  
Author(s):  
Igor Sukhotnik ◽  
Jorge Mogilner ◽  
Raanan Shamir ◽  
Naim Shehadeh ◽  
Jacob Bejar ◽  
...  
Keyword(s):  
Short Bowel Syndrome ◽  
Rat Model ◽  
Intestinal Adaptation ◽  
Subcutaneous Insulin ◽  
Short Bowel

scholarly journals Clinical case and short review of extreme short bowel syndrome: an update 21 years after

2016 ◽  
Vol 10 (1) ◽  
pp. 45
Author(s):  
Pasquale Mansueto ◽  
Aurelio Seidita ◽  
Salvatore Iacono ◽  
Antonio Carroccio
Keyword(s):  
Small Intestine ◽  
Short Bowel Syndrome ◽  
Clinical Case ◽  
Ileocecal Valve ◽  
Short Review ◽  
Short Bowel ◽  
Massive Resection ◽  
Low Weight ◽  
Clinical Conditions

Short bowel syndrome refers to the malabsorptive state caused by loss of significant portions of the small intestine, whose clinical framework is characterized by malnutrition, diarrhea, dehydration, weight loss, and low-weight-related symptoms/signs. These clinical conditions seem to be related to the length of resection. Twenty-one years ago we reported the clinical case of an infant, who underwent a massive resection of the loops of the small intestine, of the cecum and of part of the ascending colon, due to intestinal malrotation with volvulus. The residual small intestine measured just 11 cm and consisted of the duodenum and a small part of jejunum, in the absence of the ileocecal valve, configuring the case of a <em>ultra-short bowel syndrome</em>. In this report, we update the case, reporting the patient succeeded to obtain a good weight gain and to conduct a quite normal lifestyle, despite the long-term consequences of such resection.

scholarly journals The comparison of the intestinal adaptation effects of subcutaneous and oral insulin in a rats with short bowel syndrome

2013 ◽  
Vol 10 (2) ◽  
pp. 91 ◽  
Author(s):  
Burak Tander ◽  
Ender Ariturk ◽  
Riza Rizalar ◽  
Omer Alici ◽  
Ferit Bernay ◽  
...  
Keyword(s):  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Oral Insulin ◽  
Short Bowel ◽  
Adaptation Effects

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.

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