Nutritional and medical approaches to intestinal failure

Salazar, Jonathan A.; Carey, Alexandra; Duggan, Christopher

doi:10.1097/mco.0000000000000918

Cited by 5 publications

(8 citation statements)

References 26 publications

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“…Second, those reflecting specific metabolic disturbances or inherent to the specific nutritional support these patients receive and manifested by extraintestinal symptoms and signs (e.g., refeeding syndrome, D-lactic acidosis, IF-associated liver dysfunction, biliary gallstones, or nephrolithiasis [ 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ] ( Table 5 ).…”

Section: Short Bowel Syndrome (Sbs)mentioning

confidence: 99%

“…The treatment of patients with IF is complex and requires a comprehensive approach that frequently necessitates the long-term, if not life-long, use of PN. The appropriate management of this disorder requires an interdisciplinary approach to facilitate intestinal rehabilitation in combination with the treatment of the sequelae of IF [ 73 ]. Recently, guidelines and recommendations have been developed by the American Gastroenterological Association (AGA) [ 55 ], ASPEN [ 85 , 90 ], and ESPEN [ 91 ].…”

Section: Short Bowel Syndrome (Sbs)mentioning

confidence: 99%

“…The clinical management of the patients with IF and SBS includes preventing and treating a range of complications related to the pathophysiology of the small and large intestines (e.g., nephrolithiasis [ 72 , 73 , 74 ], cholelithiasis [ 70 , 71 ], and metabolic bone diseases [ 74 ]) or to the artificial nutritional support systems (IAFLD and catheter-related bloodstream infections). Figure 12 outlines the critical points in the management of these conditions [ 82 , 151 , 152 ].…”

Section: Short Bowel Syndrome (Sbs)mentioning

confidence: 99%

“…On the other hand, losing the ileocecal valve increases the risk of SIBO and enteropathy, resulting in multiple intestinal symptoms that depend on dysbiosis, like bloating, diarrhea, and abdominal discomfort [65,66]. Second, those reflecting specific metabolic disturbances or inherent to the specific nutritional support these patients receive and manifested by extraintestinal symptoms and signs (e.g., refeeding syndrome, D-lactic acidosis, IF-associated liver dysfunction, biliary gallstones, or nephrolithiasis [67][68][69][70][71][72][73][74] (Table 5).…”

Section: Global Outlookmentioning

confidence: 99%

“…Third, those dependent on the insertion of central catheters (e.g., sepsis or central line thrombosis) which are necessary for PN support (Table 5). Second, those reflecting specific metabolic disturbances or inherent to the specific nutritional support these patients receive and manifested by extraintestinal symptoms and signs (e.g., refeeding syndrome, D-lactic acidosis, IF-associated liver dysfunction, biliary gallstones, or nephrolithiasis [67][68][69][70][71][72][73][74] (Table 5).…”

Section: Global Outlookmentioning

confidence: 99%

See 4 more Smart Citations

Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting

Utrilla Fornals,

Costas-Batlle,

Medlin

et al. 2024

Nutrients

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Many patients undergo small bowel and colon surgery for reasons related to malignancy, inflammatory bowel disease (IBD), mesenteric ischemia, and other benign conditions, including post-operative adhesions, hernias, trauma, volvulus, or diverticula. Some patients arrive in the operating theatre severely malnourished due to an underlying disease, while others develop complications (e.g., anastomotic leaks, abscesses, or strictures) that induce a systemic inflammatory response that can increase their energy and protein requirements. Finally, anatomical and functional changes resulting from surgery can affect either nutritional status due to malabsorption or nutritional support (NS) pathways. The dietitian providing NS to these patients needs to understand the pathophysiology underlying these sequelae and collaborate with other professionals, including surgeons, internists, nurses, and pharmacists. The aim of this review is to provide an overview of the nutritional and metabolic consequences of different types of lower gastrointestinal surgery and the role of the dietitian in providing comprehensive patient care. This article reviews the effects of small bowel resection on macronutrient and micronutrient absorption, the effects of colectomies (e.g., ileocolectomy, low anterior resection, abdominoperineal resection, and proctocolectomy) that require special dietary considerations, nutritional considerations specific to ostomized patients, and clinical practice guidelines for caregivers of patients who have undergone a surgery for local and systemic complications of IBD. Finally, we highlight the valuable contribution of the dietitian in the challenging management of short bowel syndrome and intestinal failure.

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Section: Short Bowel Syndrome (Sbs)mentioning

confidence: 99%

Section: Short Bowel Syndrome (Sbs)mentioning

confidence: 99%

Section: Short Bowel Syndrome (Sbs)mentioning

confidence: 99%

Section: Global Outlookmentioning

confidence: 99%

Section: Global Outlookmentioning

confidence: 99%

See 3 more Smart Citations

Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting

Utrilla Fornals,

Costas-Batlle,

Medlin

et al. 2024

Nutrients

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Performance of pan‐enteroscopy in children with intestinal failure due to short bowel syndrome: A single‐center retrospective study

Salazar,

Chan,

Liu

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivesIn pediatric patients with intestinal failure (IF) due to short bowel syndrome, we hypothesized that young children, those with shorter residual small bowel and those with congenital malrotation of the bowel would be more likely to undergo pan‐enteroscopy. We aimed to determine the feasibility and diagnostic yield of pan‐enteroscopy in this cohort.MethodsWe performed a single‐center, retrospective study of pediatric patients with IF due to short bowel syndrome (SBS) who had undergone at least one GI endoscopic evaluation between January 1, 2018 and January 1, 2023.ResultsA pan‐enteroscopy might have been possible in 381 of the 431 procedures (206 patients) reviewed. 44 (21%) patients underwent 54 pan‐enteroscopies. Children with a residual bowel length <35 cm had higher odds of undergoing pan‐enteroscopy (odds ratio [OR] 3.72, 95% confidence interval [CI] [1.32, 10.48], p = 0.01), as did patients with periprocedural glucagon‐like peptide 2 (GLP‐2) analog use (OR 4.30, 95% CI [1.24, 14.95], p = 0.02). Patients with diagnoses other than necrotizing enterocolitis (NEC) tended to be more likely to achieve a pan‐enteroscopy (OR 2.73, 95% CI [0.95,7.88], p = 0.06). Evidence of gross and histopathologic abnormalities were found in 77.8% and 78% of the procedures, respectively. No complications were identified.ConclusionIn a large cohort of children with SBS, pan‐enteroscopy was successfully performed in 14.2% of the procedures and microscopic abnormalities were common. Shorter residual bowel length, underlying diagnoses of non‐NEC, and GLP‐2 analog use were generally associated with successful pan‐enteroscopy, independent of age and several other factors. These data suggest that pan‐enteroscopy is feasible and of high‐yield in a subset of patients with SBS.

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Sublingual asenapine for agitation in malabsorptive states: three patient cases

Burk,

Humphreys,

Waites

et al. 2024

Therapeutic Advances in Psychopharmacology

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Gastric malabsorptive conditions may prevent patients from deriving benefit from orally administered medications intended for enteric absorption. While malabsorption is an increasingly common issue, current data on alternative oral options for agitation in these patients are very sparse. Sublingual (SL) asenapine is absorbed transmucosally, bypassing gut absorption, making it a viable consideration. We report on three patients, one with short bowel syndrome, one with viral gastritis, and one with aortic dissection who were trialed on SL asenapine for agitation after failing alternative antipsychotics. Two of these patients had an extensive history of psychiatric admissions for bipolar disorder and substance-induced psychosis. All three patients had significant reductions in agitation within 1–5 days, with no reported adverse effects. However, benefit of SL asenapine was hindered in two of these patients as they began inappropriately swallowing the medication, reducing bioavailability to nil. Clinicians should consider the use of SL asenapine for medically complex agitated patients where gastric absorption is questionable. There is an urgent need for guidelines on this matter, as well as more, alternative dosage forms for various medications that may help with agitation in this population.

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Nutritional and medical approaches to intestinal failure

Cited by 5 publications

References 26 publications

Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting

Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting

Performance of pan‐enteroscopy in children with intestinal failure due to short bowel syndrome: A single‐center retrospective study

Sublingual asenapine for agitation in malabsorptive states: three patient cases

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