Nutritional Issues in the Short Bowel Syndrome - Total Parenteral Nutrition, Enteral Nutrition and the Role of Transplantation

2015 ◽  
pp. 75-90 ◽  
Author(s):  
Stephen J.D. O'Keefe
Keyword(s):  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Short Bowel

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.

Preliminary Experience With Intestinal Transplantation in Infants and Children

PEDIATRICS ◽  
1996 ◽  
Vol 97 (4) ◽  
pp. 443-448
Author(s):  
Alan N. Langnas ◽  
B. W. Shaw ◽  
Dean L. Antonson ◽  
Stuart S. Kaufman ◽  
David R. Mack ◽  
...  
Keyword(s):  
Small Bowel ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Gastrointestinal Disease ◽  
Intestinal Transplantation ◽  
Infants And Children ◽  
Short Bowel ◽  
In Infants And Children

Objective. This report discusses the preliminary experience with intestinal transplantation in children at the University of Nebraska Medical Center. Patients. During the past 4 years, 16 intestinal transplants have been performed in infants and children. Thirteen have been combined liver and bowel transplants, and the remainder were isolated intestinal transplants. Nearly half of the patients were younger than 1 year of age at the time of surgery, and the vast majority were younger than 5 years of age. All but one had short bowel syndrome. Results. The 1-year actuarial patient and graft survival rates for recipients of liver and small bowel transplants were 76% and 61%, respectively. Eight of 13 patients who received liver and small bowel transplants remain alive at the time of this writing, with a mean length of follow-up of 263 (range, 7 to 1223) days. Six patients are currently free of total parenteral nutrition. All three patients receiving isolated intestinal transplants are alive and free of parenteral nutrition. The mean length of follow-up is 384 (range, 330 to 450) days. Major complications have included severe infections and rejection. Lymphoproliferative disease, graft-versus-host disease, and chylous ascites have not been major problems. Conclusions. Although intestinal transplantation is in its infancy, these preliminary results suggest combined liver and bowel transplants and isolated intestinal transplantation may be viable options for some patients with intestinal failure caused by short bowel syndrome or other gastrointestinal disease in whom long-term total parenteral nutrition is not an attractive option.

Alveolar Bone Loss in Two Children With Short-Bowel Syndrome Receiving Total Parenteral Nutrition

1991 ◽  
Vol 62 (4) ◽  
pp. 272-275 ◽  
Author(s):  
Kevin B. Wright ◽  
Gideon Holan ◽  
Paul S. Casamassimo ◽  
Dennis R. King
Keyword(s):  
Bone Loss ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Alveolar Bone ◽  
Alveolar Bone Loss ◽  
Short Bowel
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