Influence of bacterial overgrowth and intestinal inflammation on duration of parenteral nutrition in children with short bowel syndrome

Kaufman, Stuart S.; Loseke, Candace A.; Lupo, James V.; Young, Rosemary J.; Murray, Nancy D.; Pinch, Lewis W.; Vanderhoof, Jon A.

doi:10.1016/s0022-3476(97)80058-3

Cited by 240 publications

(184 citation statements)

References 15 publications

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“…The findings of friability, loss of vascular pattern, and patchy erythema, and prominent eosinophilia are consistent with prior reports of allergic disease [15]. Patients with persistent symptoms of bacterial overgrowth [11] despite antibiotics, or a complicated clinical picture that did not easily lend to this diagnosis, underwent diagnostic endoscopies. Because treatment of bacterial overgrowth is best based on speciation and sensitivities, we tailored patients' antibiotic regimens accordingly [12].…”

Section: Discussionsupporting

confidence: 87%

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High diagnostic yield of gastrointestinal endoscopy in children with intestinal failure

Ching

Modi

Jaksic

et al. 2008

Journal of Pediatric Surgery

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Purpose-Children with intestinal failure (IF) often have gastrointestinal (GI) symptoms, including bleeding, increased stool output, and feeding intolerance. The use of endoscopic assessment of these symptoms has not been previously reported. This report evaluates the diagnostic yield of GI endoscopy in the setting of IF.Methods-After institutional review board approval, we reviewed the medical records (including endoscopy, pathology and microbiology data) of patients with IF who underwent GI endoscopies between September 1999 and March 2007.Results-Twenty-seven patients underwent 61 GI endoscopies: 34 esophagogastroduodenoscopies, 17 colonoscopies, 7 flexible sigmoidoscopies, and 3 ileoscopies. Indications for endoscopy, which were not mutually exclusive, included chronic diarrhea (39%, n = 24), GI bleeding (36%, n = 22), suspected bacterial overgrowth (36%, n = 22), and suspected peptic disease (15%, n = 9). Based on gross endoscopic appearance, histopathology, or microbiology, 43 (70%) procedures yielded abnormalities. These included infectious (20%, n = 12), anatomical (18%, n = 11), peptic (15%, n = 9), allergic (15%, n = 9), and other (2%, n = 1) findings. Eleven (73%) of 15 duodenal cultures grew a spectrum of 17 bacterial species. Overall, 24 (89%) of 27 patients had gross endoscopic, histopathologic, or microbiologic abnormalities. Conclusions-In

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Section: Discussionsupporting

confidence: 87%

“…Twelve patients were found to have infectious findings, and all but 2 of these patients had bacteria grown from duodenal aspirates, confirming a diagnosis of bacterial overgrowth [11,12]. For these 2 patients who did not have duodenal aspirates performed, histopathology revealed severe villous blunting consistent with bacterial overgrowth.…”

Section: Resultsmentioning

confidence: 82%

High diagnostic yield of gastrointestinal endoscopy in children with intestinal failure

Ching

Modi

Jaksic

et al. 2008

Journal of Pediatric Surgery

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“…Based on evidence derived largely from animal models (36) and limited human studies (2,4,14,18,20,33,35,38), common events that occur in human SBS may contribute to gut barrier dysfunction. These include small bowel bacterial overgrowth (SBBO), systemic or local infection, splanchnic hypoperfusion, gut mucosal inflammation, use of PN, lack of enteral feeding, and malnutrition, all of which may cause erosion of mucosal anatomic and immune barriers (36).…”

mentioning

confidence: 99%

Detectable serum flagellin and lipopolysaccharide and upregulated anti-flagellin and lipopolysaccharide immunoglobulins in human short bowel syndrome

Ziegler

Luo²,

Estívariz³

et al. 2008

American Journal of Physiology-Regulatory, Integrative and Comp

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DP, Gewirtz AT. Detectable serum flagellin and lipopolysaccharide and upregulated anti-flagellin and lipopolysaccharide immunoglobulins in human short bowel syndrome. Am J Physiol Regul Integr Comp Physiol 294: R402-R410, 2008. First published November 14, 2007 doi:10.1152/ajpregu.00650.2007.-Gut barrier dysfunction may occur in short bowel syndrome (SBS). We hypothesized that systemic exposure to flagellin and lipopolysaccharide (LPS) in SBS might regulate specific immune responses. We analyzed serial serum samples obtained from parenteral nutrition (PN)-dependent patients with SBS versus non-SBS control serum. Serum from 23 adult SBS patients was obtained at baseline and 4, 8, 12, 16, 20, and 24 wk in a trial of modified diet with or without growth hormone. Control serum was obtained from 48 healthy adults and 37 adults requiring PN during critical illness. Serum flagellin was detected by an ELISA recognizing an array of gram-negative flagellins, and LPS was detected by limulus assay. Serum flagellin-and LPS-specific immunoglobulin levels (IgM, IgA, and IgG) were determined by ELISA. Serum flagellin and LPS were undetectable in control subjects. In contrast, serum flagellin, LPS, or both were detected in 14 SBS patients (61%) during one or more time points [flagellin alone, 5/23 (22%); LPS alone, 6/23 (26%); or flagellin ϩ LPS, 3/23 (13%)]. Flagellin-specific serum IgM, IgA, and IgG levels were markedly increased in SBS patients compared with both control populations and remained elevated during the 6-mo study period. LPS-specific IgA was significantly higher in SBS patients compared with healthy controls; LPS-specific IgM, IgA, and IgG levels each decreased over time in association with PN weaning. We conclude that adults with PN-dependent SBS are systemically exposed to flagellin and LPS, presumably from the gut lumen. This likely regulates innate and adaptive immune responses to these specific bacterial products. parenteral nutrition; intestinal barrier function SHORT BOWEL SYNDROME (SBS) occurs after massive small bowel resection and is an important clinical entity, with significant morbidity and mortality (13,36). SBS is characterized by chronic diarrhea and malabsorption, dehydration and malnutrition, and, in patients requiring parenteral nutrition (PN), frequent infections (13,36). Unfortunately, SBS and PN administration are each associated with infection by enteric gramnegative bacteria, suggesting that failure of the gut barrier occurs (2,4,5,18,20,22,24,25,33,34).

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“…Studies in adults have shown that the presence of little or no colon and less than 50-100 cm of jejunum results in permanent parenteral nutrition [43,44]. However, the results are inconclusive for infants and children, and it seems that colon loss is not a strong predictor for weaning off parenteral nutrition [22,45,46]. …”

Section: Pathophysiological Consequences Of Psbsmentioning

confidence: 99%

Short-Bowel Syndrome in Children — An Update in Management Strategies

Zavras¹,

Misiakos²,

Velaoras³

et al. 2015

Pediatric Nursing, Psychiatric and Surgical Issues

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Influence of bacterial overgrowth and intestinal inflammation on duration of parenteral nutrition in children with short bowel syndrome

Cited by 240 publications

References 15 publications

High diagnostic yield of gastrointestinal endoscopy in children with intestinal failure

High diagnostic yield of gastrointestinal endoscopy in children with intestinal failure

Detectable serum flagellin and lipopolysaccharide and upregulated anti-flagellin and lipopolysaccharide immunoglobulins in human short bowel syndrome

Short-Bowel Syndrome in Children — An Update in Management Strategies

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