Medical management of short gut syndrome

Bhatia, Jatinder; Gates, Amy; Parish, Anjali

doi:10.1038/jp.2010.100

Cited by 9 publications

(5 citation statements)

References 11 publications

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“…Articles that did not provide a definition for SBS were excluded (n = 216, 88%). Of the remaining 27 articles, more than half (n = 15, 55%) specify the small bowel being involved in the etiology of SBS 12,14–27 . An emphasis on a functional definition of SBS was observed in eight articles, 20,23,24,27–32 and only one article included a specific residual bowel length in the definition 33 …”

Section: Definitionsmentioning

confidence: 99%

ASPEN definitions in pediatric intestinal failure

Modi

Galloway

Gura

et al. 2021

J Parenter Enteral Nutr

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Pediatric intestinal failure (PIF) is a relatively rare disease entity that requires focused interdisciplinary care and specialized nutrition management. There has long been a lack of consensus in the definition of key terms related to PIF because of its rarity and a plethora of small studies rather than large trials. As such, the American Society for Parenteral and Enteral Nutrition (ASPEN) PIF Section, composed of clinicians from a variety of disciplines caring for children with intestinal failure, is uniquely poised to provide insight into this definition void. This document is the product of an effort by the Section to create evidence‐based consensus definitions, with the goal of allowing for appropriate comparisons between clinical studies and measurement of long‐term patient outcomes. This paper has been approved by the ASPEN Board of Directors.

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Section: Definitionsmentioning

confidence: 99%

ASPEN definitions in pediatric intestinal failure

Modi

Galloway

Gura

et al. 2021

J Parenter Enteral Nutr

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show abstract

“…Therefore, ideally, a combination of long-chain and medium-chain triglycerides, along with a low total fat content should be employed. [36] In the postoperative period, in patients of SBS, two feeding strategies may be utilized-continuous tube feed, which has the advantage of an overall increased absorption of nutrients, [38] and intermittent feeding may be employed, which is more physiological leading to a better stimulus for the secretion of the various GI enzymes and hormones, including gall bladder draining. Generally, in the postoperative period, continuous enteral feed is started swiftly.…”

Section: Parenteral Nutritionmentioning

confidence: 99%

Short Bowel Syndrome in neonates and early infancy

2023

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Short bowel syndrome (SBS) is the commonest cause of intestinal failure in neonates. SBS results from widespread damage to the small intestine, leading to loss of functional capacity of this organ. This is generally secondary to conditions like necrotizing enterocolitis, gastroschisis, intestinal atresia, and midgut volvulus. The small bowel usually adapts to this damage in due course of time. The clinician's role usually entails the management of parenteral nutrition and the fluid and electrolyte balance to tide over this phase. The management should be initiated as soon as the diagnosis is suspected, especially post-surgical resection of the bowel. This should comprise enteral nutrition, with proactive monitoring and supplementation of electrolytes and micronutrients. Intestinal lengthening procedures like the Serial transverse enteroplasty (STEP), and Longitudinal intestinal lengthening and tailoring (LILT) may be considered in infants, where medical therapy fails to correct the pathology. The intricate nature of the condition warrants a multi-disciplinary approach, involving clinicians, intensivists, and surgeons, which ensures the best neonatal outcomes, in terms of the survival rates in these babies.

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“…The medical management of SBS focuses on replacing electrolyte and nutrient losses, replacing lost fluid, limiting diarrhea and maintaining adequate body weight and growth percentiles. The ultimate goal of treatment is to allow the residual intestine to adapt to resume full EN [ 135 , 136 ].…”

Section: Pharmacotherapeutic Optionsmentioning

confidence: 99%

An Overview of Short-Bowel Syndrome in Pediatric Patients: Focus on Clinical Management and Prevention of Complications

2023

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Short-bowel syndrome (SBS) in pediatric age is defined as a malabsorptive state, resulting from congenital malformations, significant small intestine surgical resection or disease-associated loss of absorption. SBS is the leading cause of intestinal failure in children and the underlying cause in 50% of patients on home parental nutrition. It is a life-altering and life-threatening disease due to the inability of the residual intestinal function to maintain nutritional homeostasis of protein, fluid, electrolyte or micronutrient without parenteral or enteral supplementation. The use of parenteral nutrition (PN) has improved medical care in SBS, decreasing mortality and improving the overall prognosis. However, the long-term use of PN is associated with the incidence of many complications, including liver disease and catheter-associated malfunction and bloodstream infections (CRBSIs). This manuscript is a narrative review of the current available evidence on the management of SBS in the pediatric population, focusing on prognostic factors and outcome. The literature review showed that in recent years, the standardization of management has demonstrated to improve the quality of life in these complex patients. Moreover, the development of knowledge in clinical practice has led to a reduction in mortality and morbidity. Diagnostic and therapeutic decisions should be made by a multidisciplinary team that includes neonatologists, pediatric surgeons, gastroenterologists, pediatricians, nutritionists and nurses. A significant improvement in prognosis can occur through the careful monitoring of nutritional status, avoiding dependence on PN and favoring an early introduction of enteral nutrition, and through the prevention, diagnosis and aggressive treatment of CRSBIs and SIBO. Multicenter initiatives, such as research consortium or data registries, are mandatory in order to personalize the management of these patients, improve their quality of life and reduce the cost of care.

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Medical management of short gut syndrome

Cited by 9 publications

References 11 publications

ASPEN definitions in pediatric intestinal failure

ASPEN definitions in pediatric intestinal failure

Short Bowel Syndrome in neonates and early infancy

An Overview of Short-Bowel Syndrome in Pediatric Patients: Focus on Clinical Management and Prevention of Complications

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