scholarly journals To Wean or Not to Wean: The Role of Autologous Reconstructive Surgery in the Natural History of Pediatric Short Bowel Syndrome on Behalf of Italian Society for Gastroenterology, Hepatology and Nutrition (SIGENP)

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2136
Author(s):  
Teresa Capriati ◽  
Antonella Mosca ◽  
Tommaso Alterio ◽  
Maria Immacolata Spagnuolo ◽  
Paolo Gandullia ◽  
...  
Keyword(s):  
Short Bowel Syndrome ◽  
Reconstructive Surgery ◽  
Intestinal Adaptation ◽  
Primary Diagnosis ◽  
Primary Objective ◽  
Poor Growth ◽  
Short Bowel ◽  
History Of ◽  
Selection Of

Pediatric Short Bowel Syndrome (SBS) can require prolonged parenteral nutrition (PN). Over the years, SBS management has been implemented by autologous gastrointestinal reconstructive surgery (AGIR). The primary objective of the present review was to assess the effect of AGIR on weaning off PN. We also evaluated how AGIR impacts survival, the need for transplantation (Tx) and the development of liver disease (LD). We conducted a systematic literature search to identify studies published from January 1999 to the present and 947 patients were identified. PN alone was weakly associated with higher probability of weaning from PN (OR = 1.1, p = 0.03) and of surviving (OR = 1.05, p = 0.01). Adjusting for age, the probability of weaning off PN but of not surviving remained significantly associated with PN alone (OR = 1.08, p = 0.03). Finally, adjusting for age and primary diagnosis (gastroschisis), any association was lost. The prevalence of TX and LD did not differ by groups. In conclusion, in view of the low benefit in terms of intestinal adaptation and of the not negligible rate of complications (20%), a careful selection of candidates for AGIR should be required. Bowel dilation associated with failure of advancing EN and poor growth, should be criteria to refer for AGIR.

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

Short bowel syndrome: the role of GLP-2 on improving outcome

2009 ◽  
Vol 12 (5) ◽  
pp. 526-532 ◽  
Author(s):  
Katharina Wallis ◽  
Julian RF Walters ◽  
Simon Gabe
Keyword(s):  
Short Bowel Syndrome ◽  
Short Bowel

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.

scholarly journals Congenital Short Bowel Syndrome: A Case Report and Review of the Literature

2008 ◽  
Vol 22 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Mohammed Hasosah ◽  
Daniel A Lemberg ◽  
Eric Skarsgard ◽  
Richard Schreiber
Keyword(s):  
Small Bowel ◽  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Rare Condition ◽  
Normal Growth ◽  
Upper Gastrointestinal Endoscopy ◽  
Term Survival ◽  
Short Bowel ◽  
Upper Gastrointestinal

Congenital short bowel syndrome (SBS) is a rare condition of the newborn, with several reports demonstrating high mortality. A six-week-old boy presented with chronic diarrhea and failure to thrive. An upper gastrointestinal endoscopy showed a straight duodenum, and multiple small bowel biopsies were histologically normal. An upper gastrointestinal series showed malrotation. At laparotomy, the small bowel was 50 cm in length, confirming the diagnosis of congenital SBS. Parenteral nutrition was initiated and enteral feeding with an amino acid-based formula containing long-chain fatty acids was introduced early and gradually advanced. At the last follow-up examination at 24 months, he was thriving on a regular diet, with normal growth and development. Long-term survival of children with congenital SBS is now possible if enteral feeds are introduced early to promote intestinal adaptation, with subsequent weaning off parenteral nutrition.

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