Management of intestinal failure - parenteral nutrition, experimental small bowel transplantation and preservation injury of small bowel allograft

1999 ◽  
Author(s):  
Kwong-leung Chan
Keyword(s):  
Small Bowel ◽  
Parenteral Nutrition ◽  
Small Bowel Transplantation ◽  
Intestinal Failure ◽  
Preservation Injury

scholarly journals Causes and Prognosis of Intestinal Failure in Crohn’s Disease: An 18-year Experience From a National Centre

2020 ◽  
Vol 14 (11) ◽  
pp. 1558-1564 ◽  
Author(s):  
Mattias Soop ◽  
Haroon Khan ◽  
Emma Nixon ◽  
Antje Teubner ◽  
Arun Abraham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Parenteral Nutrition ◽  
Intestinal Failure ◽  
Anastomotic Dehiscence ◽  
Septic Complication ◽  
Kaplan Meier

Abstract Background and Aims Intestinal failure [IF] is a feared complication of Crohn’s disease [CD]. Although cumulative loss of small bowel due to bowel resections is thought to be the dominant cause, the causes and outcomes have not been reported. Methods Consecutive adult patients referred to a national intestinal failure unit over 2000–2018 with a diagnosis of CD, and subsequently treated with parenteral nutrition during at least 12 months, were included in this longitudinal cohort study. Data were extracted from a prospective institutional clinical database and patient records. Results A total of 121 patients were included. Of these, 62 [51%] of patients developed IF as a consequence of abdominal sepsis complicating abdominal surgery; small bowel resection, primary disease activity, and proximal stoma were less common causes [31%, 12%, and 6%, respectively]. Further, 32 had perianastomotic sepsis, and 15 of those had documented risk factors for anastomotic dehiscence. On Kaplan-Meier analysis, 40% of all patients regained nutritional autonomy within 10 years and none did subsequently; 14% of patients developed intestinal failure-associated liver disease. On Kaplan-Meier analysis, projected mean age of death was 74 years.2 Conclusions IF is a severe complication of CD, with 60% of patients permanently dependent on parenteral nutrition. The most frequent event leading directly to IF was a septic complication following abdominal surgery, in many cases following intestinal anastomosis in the presence of significant risk factors for anastomotic dehiscence. A reduced need for abdominal surgery, an increased awareness of perioperative risk factors, and structured pre-operative optimisation may reduce the incidence of IF in CD.

scholarly journals Plasma citrulline levels and acute cellular rejection early after small bowel transplantation in pigs

2009 ◽  
Vol 54 (No. 5) ◽  
pp. 215-222 ◽  
Author(s):  
E. Honsova ◽  
A. Lodererova ◽  
P. Balaz ◽  
M. Oliverius
Keyword(s):  
Small Bowel ◽  
Small Bowel Transplantation ◽  
Intestinal Failure ◽  
Acute Cellular Rejection ◽  
Control Group ◽  
Plasma Citrulline ◽  
Potential Biomarker ◽  
Histologic Evaluation ◽  
Group B ◽  
Cellular Rejection

Small bowel transplantations (SBT) are increasingly performed to treat patients with irreversible intestinal failure or short-bowel syndrome. Histologic evaluation of small bowel allograft biopsies is important for the diagnosis of acute cellular rejection (ACR). A reliable serological marker of ACR after SBT is still unknown. Recently, citrulline was identified as a potential biomarker of reduced enterocyte mass. The aim of our study was to analyze rejection and plasma citrulline levels early after SBT in pigs. 24 pigs were used and divided into four groups. Group A, autologous SBT (<I>n</I> = 3) as a control group; Group B, allogeneic SBT with tacrolimus monotherapy (<I>n</I> = 7); Group C, allogeneic SBT immunosuppressed with tacrolimus and sirolimus (<I>n</I> = 8); and Group D, without immunosuppresion (<I>n</I> = 6). The observation period was 30 days. Mucosal biopsies were obtained on Days 0, 3, 5, 7, 10, 14, 20, 28 and simultaneously plasma citrulline levels were measured. ACR was classified according to standardized grading schema on a scale of indeterminate, mild, moderate, and severe. There were no significant differences in citrulline plasma levels between cases with mild ACR and indeterminate for ACR. A significant decline in plasma citrulline levels occurred in cases of moderate and severe rejection. Plasma citrulline levels constituted a marker of more advanced injury of small bowel epithelium.

Small-Bowel Allograft Biopsies in the Management of Small-Intestinal and Multivisceral Transplant Recipients: Histopathologic Review and Clinical Correlations

2012 ◽  
Vol 136 (7) ◽  
pp. 761-771 ◽  
Author(s):  
Helen Remotti ◽  
Sukanya Subramanian ◽  
Mercedes Martinez ◽  
Tomoaki Kato ◽  
Margret S. Magid
Keyword(s):  
New York ◽  
Small Bowel ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Small Bowel Transplantation ◽  
Intestinal Failure ◽  
Lymphoproliferative Disease ◽  
Close Monitoring ◽  
Columbia University ◽  
Barr Virus

Context.—Intestinal transplant has become a standard treatment option in the management of patients with irreversible intestinal failure. The histologic evaluation of small-bowel allograft biopsy specimens plays a central role in assessing the integrity of the graft. It is essential for the management of acute cellular and chronic rejection; detection of infections, particularly with respect to specific viruses (cytomegalovirus, adenovirus, Epstein-Barr virus); and immunosuppression-related lymphoproliferative disease. Objective.—To provide a comprehensive review of the literature and illustrate key histologic findings in small-bowel biopsy specimen evaluation of patients with small-bowel or multivisceral transplants. Data Sources.—Literature review using PubMed (US National Library of Medicine) and data obtained from national and international transplant registries in addition to case material at Columbia University, Presbyterian Hospital, and Mount Sinai Medical Center, New York, New York. Conclusions.—Key to the success of small-bowel transplantation and multivisceral transplantation are the close monitoring and appropriate clinical management of patients in the posttransplant period, requiring coordinated input from all members of the transplant team with the integration of clinical, laboratory, and histopathologic parameters.

scholarly journals Chronic Intestinal Pseudo-obstruction

2018 ◽  
Vol 31 (02) ◽  
pp. 099-107 ◽  
Author(s):  
Khalil El-Chammas ◽  
Manu Sood
Keyword(s):  
Chronic Pain ◽  
Parenteral Nutrition ◽  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Small Bowel Transplantation ◽  
Intestinal Failure ◽  
Enteric Neurons ◽  
Nutrition Support ◽  
Team Approach ◽  
Intestinal Pseudo Obstruction

AbstractChronic intestinal pseudo-obstruction (CIP) is defined by either continuous or intermittent symptoms of bowel obstruction in the absence of fixed lumen excluding lesion. CIP includes a heterogeneous group of disorders which result either from diseases affecting the enteric neurons and smooth muscle lining or those involving the autonomic innervation of the bowel. Symptoms associated with CIP are nonspecific, which can sometimes contribute to the delay in recognizing the condition and making the correct diagnosis. The diagnostic workup should include imaging and manometry studies and, occasionally, full-thickness bowel biopsies for histopathological examination may be required. Multidisciplinary team approach for the management of these patients is recommended, and the team members should include a gastroenterologist, surgeon, chronic pain specialist, clinical nutritionist, and a psychologist. The treatment goals should include optimizing the nutritional status and preventing or delaying the development of intestinal failure. The majority of the patients require enteral or parenteral nutrition support, and chronic pain is a common and distressing symptom. Small bowel transplantation may be required if patients develop liver complications due to parenteral nutrition, have difficult central line access, or have poor quality of life and worsening pain despite aggressive medical management.

ISOLATED LIVER TRANSPLANT AND SEQUENTIAL SMALL BOWEL TRANSPLANTATION FOR INTESTINAL FAILURE AND RELATED LIVER DISEASE IN CHILDREN

2000 ◽  
Vol 69 (11) ◽  
pp. 2323-2326 ◽  
Author(s):  
Paolo Muiesan ◽  
Anil Dhawan ◽  
Manuele Novelli ◽  
Giorgina Mieli-Vergani ◽  
Mohamed Rela ◽  
...  
Keyword(s):  
Liver Disease ◽  
Small Bowel ◽  
Liver Transplant ◽  
Small Bowel Transplantation ◽  
Intestinal Failure ◽  
Related Liver Disease ◽  
Isolated Liver

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
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