scholarly journals Chyme Reinfusion in Intestinal Failure Related to Temporary Double Enterostomies and Enteroatmospheric Fistulas

Nutrients ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1376
Author(s):  
Denis Picot ◽  
Sabrina Layec ◽  
Eloi Seynhaeve ◽  
Laurence Dussaulx ◽  
Florence Trivin ◽  
...  
Keyword(s):  
Small Bowel ◽  
Nutritional Status ◽  
Intestinal Failure ◽  
Oral Feeding ◽  
Lipid Absorption ◽  
Small Bowel Length ◽  
Liver Tests ◽  
High Output ◽  
At Home

Some temporary double enterostomies (DES) or entero-atmospheric fistulas (EAF) have high output and are responsible for Type 2 intestinal failure. Intravenous supplementations (IVS) for parenteral nutrition and hydration compensate for intestinal losses. Chyme reinfusion (CR) artificially restores continuity pending surgical closure. CR treats intestinal failure and is recommended by European Society for Clinical Nutrition and Metabolism (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN) when possible. The objective of this study was to show changes in nutritional status, intestinal function, liver tests, IVS needs during CR, and the feasibility of continuing it at home. A retrospective study of 306 admitted patients treated with CR from 2000 to 2018 was conducted. CR was permanent such that a peristaltic pump sucked the upstream chyme and reinfused it immediately in a tube inserted into the downstream intestine. Weight, plasma albumin, daily volumes of intestinal and fecal losses, intestinal nitrogen, and lipid absorption coefficients, plasma citrulline, liver tests, and calculated indices were compared before and during CR in patients who had both measurements. The patients included 185 males and 121 females and were 63 ± 15 years old. There were 37 (12%), 269 (88%) patients with EAF and DES, respectively. The proximal small bowel length from the duodeno-jejunal angle was 108 ± 67 cm (n = 232), and the length of distal small intestine was 117 ± 72 cm (n = 253). The median CR start was 5 d (quartile 25–75%, 2–10) after admission and continued for 64 d (45–95), including 81 patients at home for 47 d (28–74). Oral feeding was exclusive 171(56%), with enteral supplement 122 (42%), or with IVS 23 (7%). Before CR, 211 (69%) patients had IVS for nutrition (77%) or for hydration (23%). IVS were stopped in 188 (89%) 2 d (0–7) after the beginning of CR and continued in 23 (11%) with lower volumes. Nutritional status improved with respect to weight gain (+3.5 ± 8.4%) and albumin (+5.4 ± 5.8 g/L). Intestinal failure was cured in the majority of cases as evidenced by the decrease in intestinal losses by 2096 ± 959 mL/d, the increase in absorption of nitrogen 32 ± 20%, of lipids 43 ± 30%, and the improvement of citrulline 13.1 ± 8.1 µmol/L. The citrulline increase was correlated with the length of the distal intestine. The number of patients with at least one liver test >2N decreased from 84–40%. In cases of Type 2 intestinal failure related to DES or FAE with an accessible and functional distal small bowel segment, CR restored intestinal functions, reduced the need of IVS by 89% and helped improve nutritional status and liver tests. There were no vital complications or infectious diarrhea described to date. CR can become the first-line treatment for intestinal failure related to double enterostomy and high output fistulas.

Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure

2010 ◽  
Vol 29 (2) ◽  
pp. 235-242 ◽  
Author(s):  
Denis Picot ◽  
Laurence Garin ◽  
Florence Trivin ◽  
Michel P. Kossovsky ◽  
Dominique Darmaun ◽  
...  
Keyword(s):  
Small Bowel ◽  
Intestinal Failure ◽  
Small Bowel Length ◽  
Plasma Citrulline ◽  
Bowel Length ◽  
Acute Intestinal Failure

Remaining Small Bowel Length Can Predict the High Rate of Total Parenteral Nutrition Complications in Intestinal Failure?

2017 ◽  
Vol 101 ◽  
pp. S126-S127
Author(s):  
Canbak Tolga ◽  
Aylin Acar ◽  
Kerem H. Tolan ◽  
Sibel Serin ◽  
Senay G. Tomruk ◽  
...  
Keyword(s):  
Small Bowel ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Intestinal Failure ◽  
High Rate ◽  
Small Bowel Length ◽  
Bowel Length

scholarly journals The colon as an energy salvage organ for children with short bowel syndrome

2019 ◽  
Vol 109 (4) ◽  
pp. 1112-1118 ◽  
Author(s):  
Lorenzo Norsa ◽  
Cécile Lambe ◽  
Sabine Abi Abboud ◽  
Laurence Barbot-Trystram ◽  
Alberto Ferrari ◽  
...  
Keyword(s):  
Small Bowel ◽  
Intestinal Absorption ◽  
Absorption Rate ◽  
Small Bowel Length ◽  
Short Bowel ◽  
Plasma Citrulline ◽  
Type 3

ABSTRACT Background The main cause of intestinal failure is short bowel syndrome (SBS). The management goal for children with SBS is to promote intestinal adaptation while preserving growth and development with the use of parenteral nutrition (PN). Objectives This study evaluated the intestinal absorption rate in children with SBS, focusing on the role of the remnant colon. In addition, the relation between intestinal absorption rate, citrulline concentration, and small bowel length was studied. Methods Thirty-two children with SBS on PN were included. They were divided into 3 groups according to the European Society for Clinical Nutrition and Metabolism (ESPEN) anatomical classification system: type 1 SBS (n = 9), type 2 (n = 13), and type 3 (n = 10). Intestinal absorption rate was assessed by a stool balance analysis of a 3-d collection of stools. Plasma citrulline concentrations were measured and the level of PN dependency was calculated. Results The total energy absorption rate did not differ significantly between the 3 groups: 68% (61–79% ) for type 1, 60% (40–77%) for type 2, and 60% (40–77%) for type 3 ( P = 0.45). Children with type 2 or 3 SBS had significantly shorter small bowel length than children with type 1: 28 cm (19–36 cm) and 16 cm (2–29 cm), respectively, compared with 60 cm (45–78 cm) ( P = 0.04). Plasma citrulline concentrations were lower in type 3 SBS but not significantly different: 15 µmol/L (11–25 µmol/L) in type 1, 14 µmol/L (7–21 µmol/L) in type 2 , and 9 µmol/L (6–14 µmol/L) in type 3 ( P = 0.141). A multivariate analysis confirmed the role of the remnant colon in providing additional energy absorption. Conclusion This study demonstrated the importance of the colon as a salvage organ in children with SBS. Plasma citrulline concentrations should be interpreted according to the type of SBS. Efforts should focus on conservative surgery, early re-establishment of a colon in continuity, and preserving the intestinal microbiota.

scholarly journals Clinical outcomes in pediatric intestinal failure: a meta-analysis and meta-regression

2019 ◽  
Vol 110 (2) ◽  
pp. 430-436 ◽  
Author(s):  
Aureliane Chantal Stania Pierret ◽  
James Thomas Wilkinson ◽  
Matthias Zilbauer ◽  
Jake Peter Mann
Keyword(s):  
Small Bowel ◽  
Mortality Rate ◽  
Meta Analysis ◽  
Intestinal Failure ◽  
Long Term Outcomes ◽  
Neurodevelopmental Outcomes ◽  
Small Bowel Length ◽  
Meta Regression

ABSTRACT Background Intestinal failure (IF) is associated with significant morbidity and mortality, yet specific parameters that determine medium- and long-term outcomes remain ill defined. Objective The aim of this study was to determine the long-term outcomes in childhood IF and identify patient characteristics associated with clinical endpoints. Design MEDLINE and EMBASE were searched for cohorts of >10 pediatric-onset IF patients with >12 mo follow-up. Random-effects meta-analysis and meta-regression weighted by follow-up duration were used to calculate clinical outcome rates and patient factors associated with outcomes. Primary outcome was mortality rate; secondary outcomes included neurodevelopmental status, transplantation, IF-associated liver disease (IFALD), enteral autonomy, and sepsis. Results In total, 175 cohorts (9318 patients and 34,549 y follow-up) were included in the meta-analysis. Overall mortality was 5.2% per y (95% CI: 4.3, 6.0) and was associated with sepsis and IFALD on meta-regression. Mortality rate improved with time from 5.9% per y pre-2000 to 4.5% per y post-2005. Sepsis rate was also predictive of IFALD and liver failure. Enteral autonomy was associated with small bowel length but not presence of ileo-cecal valve. There was a relative lack of data on neurodevelopmental outcomes. Conclusions Sepsis is the primary modifiable factor associated with mortality and liver failure, whereas enteral autonomy correlates with small-bowel length. No clear parameters have been identified that accurately predict neurodevelopmental outcomes, and hence further research is needed. Together, our findings are helpful for parental counseling and resource planning, and support targeting reduction in sepsis.

Effects of Arm Swing Exercise Program on HbA1c and Nutritional Status in Adults with Type 2 Diabetes in Community

2018 ◽  
Vol 14 (01) ◽  
pp. 23-28
Author(s):  
Jenjira Wanna ◽  
Sangthong Terathongkum ◽  
Varaporn Thipsuwannakool
Keyword(s):  
Type 2 Diabetes ◽  
Nutritional Status ◽  
Exercise Program ◽  
Arm Swing

Body composition in patients with type 2 intestinal failure

2021 ◽  
Author(s):  
Maja Kopczynska ◽  
Maria P. Barrett ◽  
Anabelle Cloutier ◽  
Kirstine Farrer ◽  
Michael Taylor ◽  
...  
Keyword(s):  
Body Composition ◽  
Intestinal Failure

scholarly journals O5 The prevalence of cow’s milk protein allergy in infants with gastroschisis and intestinal failure type 2 and 3

2021 ◽  
Author(s):  
Kornilia Nikaki ◽  
Tracey Johnson ◽  
Haidee Norton ◽  
Gabis Chana ◽  
Amrita Garcha ◽  
...  
Keyword(s):  
Milk Protein ◽  
Intestinal Failure ◽  
Cow’S Milk ◽  
Cow's Milk ◽  
Failure Type ◽  
Cow’S Milk Protein

scholarly journals Home-Measured Blood Pressure Is Associated with Handgrip Strength in Patients with Type 2 Diabetes: The KAMOGAWA-HBP Study

2021 ◽  
Vol 10 (9) ◽  
pp. 1913
Author(s):  
Tomonori Kimura ◽  
Emi Ushigome ◽  
Yoshitaka Hashimoto ◽  
Naoko Nakanishi ◽  
Masahide Hamaguchi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Pulse Pressure ◽  
Handgrip Strength ◽  
Cross Sectional Study ◽  
Home Blood Pressure ◽  
Cross Sectional ◽  
The Relationship ◽  
At Home

The association between blood pressure measured at home and handgrip strength in patients with diabetes has not been investigated. Therefore, in this study, we aimed to assess this association among patients with type 2 diabetes. In this cross-sectional study, 157 patients with type 2 diabetes underwent muscle tests and morning and evening blood-pressure measurements at home in triplicate for 14 consecutive days throughout the study period. Univariate and multivariate regression analyses were conducted to analyze the relationship between home blood-pressure parameters and handgrip strength. The average age and hemoglobin A1c of the patients were 70.5 years and 7.1%, respectively. Morning diastolic blood pressure of [β (95% confidence interval; CI): 0.20 (0.03, 0.37)] was associated with handgrip strength in men, while morning systolic blood pressure of [−0.09 (−0.15, −0.04)], morning pulse pressure of [−0.14 (−0.21, −0.08)], and evening pulse pressure of [−0.12 (−0.19, −0.04)] were associated with handgrip strength in women. Home-measured blood pressure was associated with handgrip strength. Sex differences were found in the relationship between home blood-pressure parameters and handgrip strength.

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