Compromised duodenal mucosal integrity in children with short bowel syndrome after adaptation to enteral autonomy

Sanaksenaho, Galina; Mutanen, Annika; Godbole, Nimish; Hukkinen, Maria; Merras‐Salmio, Laura; Kivisaari, Reetta; Kyrönlahti, Antti; Pihlajoki, Marjut; Heikinheimo, Markku; Pakarinen, Mikko P.

doi:10.1016/j.jpedsurg.2020.09.065

Cited by 4 publications

(3 citation statements)

References 39 publications

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“…In a series of 33 pediatric patients with SBS (median age 3 years), duodenal mucosal biopsies showed histologic and molecular signs of both inflammation and increased permeability. Intestinal epithelial barrier function was analyzed by depicting the mucosal mRNA expression of barrier function-regulating genes ( 35 ). In pediatric patients with SBS, liver diseases are associated with infections.…”

Section: Intestinal Origins Of Infections In Short Bowel Syndromementioning

confidence: 99%

Infection Prevention and Management in Pediatric Short Bowel Syndrome

Merras‐Salmio

Pakarinen

2022

Front. Pediatr.

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Short bowel syndrome (SBS) is a rare disease with potentially life-threatening consequences. In addition to intestinal failure-associated liver disease, infections and other complications related to central venous catheters (CVCs) cause a significant burden to patients with SBS and may even necessitate an intestinal transplant eventually. The need for long-term central venous access and the intestinal dysfunction associated with SBS drive the need for intestinal failure-specific approach to prevent and treat infections in patients with SBS. In bacterial infections, the line can often be salvaged with proficient antibiotic therapy. Repeated catheter replacements are predisposed to recurrent infections and thrombotic complications, which may limit the long-term survival of patients with SBS. Protocol-based CVC access procedures and daily care including taurolidine and ethanol catheter locks have been shown to reduce infection rates substantially. Compromised intestinal function in SBS predisposes to small bowel bacterial overgrowth, mucosal injury, and increased permeability. These pathophysiological changes are concentrated in a subset of patients with excessive bowel dilatation and frequent bowel-derived infections. In such patients, reconstructive intestinal surgery may be indicated. Probiotics have not been effective in infection prevention in SBS and carry a significant risk of complications. While more studies focusing on the prevention of infections and their complications are needed, protocol-based approach and multidisciplinary teams in the care of patients with SBS have been shown to reduce complications and improve outcomes.

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Section: Intestinal Origins Of Infections In Short Bowel Syndromementioning

confidence: 99%

Infection Prevention and Management in Pediatric Short Bowel Syndrome

Merras‐Salmio

Pakarinen

2022

Front. Pediatr.

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“…When possible, naso-gastric tubes or gastrostomy feeding are avoided [23]. Feeding is essential and, for the purposes of AGIR purposes, it encourages the natural process of bowel adaptation, which may ultimately lead to proficient surgical handling of dilated bowel [9,24].…”

Section: Intestinal Rehabilitation Programmentioning

confidence: 99%

Current Surgical Concepts and Indications in the Management of the Short Bowel State: A Call for the Use of Multidisciplinary Intestinal Rehabilitation Programs

et al. 2021

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The mainstay of management for short bowel syndrome (SBS) is to promote access to the best quality of care provided by the intestinal rehabilitation program (IRP) in specialized centres. When treating SBS patients, the main goal is to minimize disease-associated complications, as well as achieve enteral autonomy. Surgical strategies should be selected cautiously upon the actual state of the bowel with respect to what it is clinically relevant for that specific patient. To this aim, a personalized and multidisciplinary approach for such a complex syndrome is needed.

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“…In children with SBS, excessive bowel dilatation associates with prolonged PN dependence and worsened outcomes (9). It is thought bowel dilatation impairs motility and promotes bacterial overgrowth (BO), predisposing to bowel derived bloodstream infections and IF-associated liver disease (13)(14)(15). Symptomatic bowel dilatation is commonly treated with autologous intestinal reconstructive (AIR) surgery, designed to reduce harmful dilatation while simultaneously increasing SB length and thereby improving bowel function and outcomes (5,12,15,16).…”

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confidence: 99%

Cutoffs and Characteristics of Abnormal Bowel Dilatation in Pediatric Short Bowel Syndrome

Nieminen,

Hukkinen,

Kivisaari

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Although excessive intestinal dilatation associates with worsened outcomes in pediatric short bowel syndrome (SBS), little is known about the natural history and definition of pathological dilatation. We addressed fore-, mid-, and hindgut dilatation in children with SBS, who had not undergone autologous intestinal reconstruction (AIR) surgery, in relation to controls. Methods: SBS children without history of AIR surgery (n = 59) and age-matched controls without any disclosed intestinal pathology (n = 140) were included. Maximum diameter of duodenum, small bowel (SB), and colon were measured in each intestinal contrast series during 2002 to 2020 and expressed as diameter ratio (DR) to L5 vertebrae height. Predictive ability of DR for weaning off parenteral nutrition (PN) was analyzed with Cox proportional hazards regression models using multiple cutoffs. Results: Duodenum (DDR), SB (SBDR) and colon (CDR) DR were 53%, 183% and 23% higher in SBS patients compared to controls (p<0.01 for all). The maximal DDR and SBDR measured during follow-up associated with current PN dependence and young age. DDR correlated with SBDR (r = 0.586, p<0.01). Patients with maximal DDR less than 1.5, which was also the 99 th percentile for controls, were 2.5-fold more likely to wean off PN (p=0.005), whereas SBDR and CDR were not predictive for PN duration. Conclusions: All segments of remaining bowel, especially SB, dilate above normal levels in children with SBS. In SBS children without AIR surgery, PN dependence and young age associated with duodenal and small intestinal dilatation, while duodenal dilatation also predicted prolonged PN.

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Compromised duodenal mucosal integrity in children with short bowel syndrome after adaptation to enteral autonomy

Cited by 4 publications

References 39 publications

Infection Prevention and Management in Pediatric Short Bowel Syndrome

Infection Prevention and Management in Pediatric Short Bowel Syndrome

Current Surgical Concepts and Indications in the Management of the Short Bowel State: A Call for the Use of Multidisciplinary Intestinal Rehabilitation Programs

Cutoffs and Characteristics of Abnormal Bowel Dilatation in Pediatric Short Bowel Syndrome

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