Characteristics of adult intestinal failure centers: An international multicenter survey

Lakananurak, Narisorn; Moccia, Lisa; Wall, Elizabeth; Herlitz, Jean; Catron, Hilary; Lozano, Edward; Delgado, Adela; Vanuytsel, Tim; Mercer, David F.; Pevny, Sophie; Berner-Hansen, Mark; Gramlich, Leah

doi:10.1002/ncp.10926

Cited by 4 publications

(3 citation statements)

References 18 publications

(39 reference statements)

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“…The gaps determined by the group were then prioritized, and a questionnaire was developed to address these gaps. The methods of this process have been described in detail previously [ 12 , 13 ]. HSO was considered one of the major problems in patients with SBS.…”

Section: Methodsmentioning

confidence: 99%

Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey

et al. 2023

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Background: International practice guidelines for high-stool-output (HSO) management in short bowel syndrome (SBS) are available, but data on implementation are lacking. This study describes the approach used to manage HSO in SBS patients across different global regions. Methods: This is an international multicenter study evaluating medical management of HSO in SBS patients using a questionnaire survey. Thirty-three intestinal-failure centers were invited to complete the survey as one multidisciplinary team. Results: Survey response rate was 91%. Dietary recommendations varied based on anatomy and geographic region. For patients without colon-in-continuity (CiC), clinical practices were generally consistent with ESPEN guidelines, including separation of fluid from solid food (90%), a high-sodium diet (90%), and a low-simple-sugar diet (75%). For CiC patients, practices less closely followed guidelines, such as a low-fat diet (35%) or a high-sodium diet (50%). First-line antimotility and antisecretory medications were loperamide and proton-pump inhibitors. Other therapeutic agents (e.g., pancreatic enzymes and bile acid binders) were utilized in real-world practices, and usage varied based on intestinal anatomy. Conclusion: Expert centers largely followed published HSO-management guidelines for SBS patients without CiC, but clinical practices deviated substantially for CiC patients. Determining the reasons for this discrepancy might inform future development of practice guidelines.

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Section: Methodsmentioning

confidence: 99%

Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey

et al. 2023

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“…This is common in pediatric programs, in which much of the advancement in the field has been driven by pediatric surgeons, but is decidedly less so in adult programs, which are themselves rarer. [1][2][3] Ideally, the surgeon's role is to be in close partnership with the rest of the IF team, to be present in clinic, and to handle all the surgical issues that arise in the short bowel syndrome (SBS) population. This is probably best done with a specifically designated surgeon in that role, wherever possible, but patient volume is likely to act as a limit outside of the larger dedicated IF programs.…”

Section: The Surgeon's Role In An Intestinal Failure Teammentioning

confidence: 99%

“…Many of the more developed programs will also have a dedicated surgeon who focuses all or a significant part of their practice on IF and related issues. This is common in pediatric programs, in which much of the advancement in the field has been driven by pediatric surgeons, but is decidedly less so in adult programs, which are themselves rarer 1–3 …”

Section: The Surgeon's Role In An Intestinal Failure Teammentioning

confidence: 99%

Surgical considerations in the management of short bowel syndrome

Mercer

2023

Nut in Clin Prac

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Patients with short bowel syndrome (SBS) are optimally managed in centers of expertise with dedicated multidisciplinary intestinal failure (IF) teams. Over the life of a patient with SBS, many different surgical concerns may arise requiring intervention. These can range from reasonably simple procedures, such as the creation or maintenance of gastrostomy tube and enterostomies, to complex reconstructions of multiple enterocutaneous fistulas or the performance of intestine-containing transplants. This review will cover the development of a surgeon's role on the IF team; common surgical issues arising in patients with SBS, with a focus on decision-making rather than technique; and, finally, a brief overview of transplantation and some related decision-making issues.

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Chronic Intestinal Failure and Short Bowel Syndrome in Adults: Principles and Perspectives for the Portuguese Health System

Vara-Luiz,

Glória,

Mendes

et al. 2024

GE Port J Gastroenterol

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Background: Short bowel syndrome is a devastating malabsorptive condition and the most common cause of chronic intestinal failure (CIF). Patients need parenteral support for months or years. Ideally, it should be delivered at home, reducing limitations in everyday life activities. Summary: The Portuguese Health Directive 017/2020 was the first step in the regulation of home CIF management, and more patients are now being treated in an ambulatory setting. However, much work still needs to be performed in this area. Our country lacks a network of units capable of providing home parenteral nutrition (HPN), and only a few centers have expertise to take care of these complex patients: fluid support, oral, enteral, and parenteral nutrition; disease/HPN-related complications; pharmacologic treatment; and surgical prevention/treatment. Providing adequate transition from pediatric to adult care is a mandatory issue that should only be addressed by expert centers. Key Messages: Implementation of a national network, as well as the creation of an intestinal failure registry, with an initial focus on adult patients, will start a new era in the identification and management of these complex CIF patients.

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Characteristics of adult intestinal failure centers: An international multicenter survey

Cited by 4 publications

References 18 publications

Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey

Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey

Surgical considerations in the management of short bowel syndrome

Chronic Intestinal Failure and Short Bowel Syndrome in Adults: Principles and Perspectives for the Portuguese Health System

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