Remnant Small Bowel Length in Pediatric Short Bowel Syndrome and the Correlation with Intestinal Dysbiosis and Linear Growth

Engelstad, Holly J.; Barron, Lauren; Moen, Joseph; Wylie, Todd; Wylie, Kristine M.; Rubin, Deborah C.; Davidson, Nicholas O.; Cade, W. Todd; Warner, Barbara B.; Warner, Brad W.

doi:10.1016/j.jamcollsurg.2018.07.657

Cited by 28 publications

(16 citation statements)

References 34 publications

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“…42,47 A recent study unravelled an association of Firmicutes with a remnant small bowel length >35 cm. 48 The gut microbiome diversity of the SBS cohort in this study was not reduced as previously reported 25,41 One factor may be the use of biopsies instead of luminal content or stool and the high amount of enteral feeds. Previously, jejunal aspirates in SBS patients, especially with enteral feeds showed a greater diversity than stool samples.…”

Section: Discussionsupporting

confidence: 72%

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Digestive enzyme expression in the large intestine of children with short bowel syndrome in a late stage of adaptation

et al. 2020

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Background and aims: Intestinal adaptation in short bowel syndrome (SBS) includes morphologic processes and functional mechanisms. This study investigated whether digestive enzyme expression in the duodenum and colon is upregulated in SBS patients. Method: Sucrase‐isomaltase (SI), lactase‐phlorizin hydrolase (LPH), and neutral Aminopeptidase N (ApN) were analyzed in duodenal and colonic biopsies from nine SBS patients in a late stage of adaptation as well as healthy and disease controls by immunoelectron microscopy (IEM), Western blots, and enzyme activities. Furthermore, proliferation rates and intestinal microbiota were analyzed in the mucosal specimen. Results: We found significantly increased amounts of SI, LPH, and ApN in colonocytes in most SBS patients with large variation and strongest effect for SI and ApN. Digestive enzyme expression was only partially elevated in duodenal enterocytes due to a low proliferation level measured by Ki‐67 staining. Microbiome analysis revealed high amounts of Lactobacillus resp. low amounts of Proteobacteria in SBS patients with preservation of colon and ileocecal valve. Colonic expression was associated with a better clinical course in single cases. Conclusion: In SBS patients disaccharidases and peptidases can be upregulated in the colon. Stimulation of this colonic intestinalization process by drugs, nutrients, and pre‐ or probiotics might offer better therapeutic approaches.

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Section: Discussionsupporting

confidence: 72%

“…The association between an increased abundance of the LPS producers, proteobacteria, with inflammation in the distal small bowel as well as hepatic injury in SBS remains controversial . A recent study unravelled an association of Firmicutes with a remnant small bowel length >35 cm …”

Section: Discussionmentioning

confidence: 99%

Digestive enzyme expression in the large intestine of children with short bowel syndrome in a late stage of adaptation

et al. 2020

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“…In clinical practice, intestinal insufficiency may be indirectly measured by the level of PN required for normal or catch up growth [75]. Patients with less remaining bowel require more PN and a residual length of 15-40 cm is associated with PN weaning [50,51,[76][77][78]. The primary metabolic complication associated with PN is intestinal failure associated liver disease (IFALD), which is characterized by direct hyperbilirubinemia, elevated transaminases, and liver synthetic dysfunction [53].…”

Section: Parenteral Nutritionmentioning

confidence: 99%

Nutrition in Necrotizing Enterocolitis and Following Intestinal Resection

Courtney

Steinberger

et al. 2020

Nutrients

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This review aims to discuss the role of nutrition and feeding practices in necrotizing enterocolitis (NEC), NEC prevention, and its complications, including surgical treatment. A thorough PubMed search was performed with a focus on meta-analyses and randomized controlled trials when available. There are several variables in nutrition and the feeding of preterm infants with the intention of preventing necrotizing enterocolitis (NEC). Starting feeds later rather than earlier, advancing feeds slowly and continuous feeds have not been shown to prevent NEC and breast milk remains the only effective prevention strategy. The lack of medical treatment options for NEC often leads to disease progression requiring surgical resection. Following resection, intestinal adaptation occurs, during which villi lengthen and crypts deepen to increase the functional capacity of remaining bowel. The effect of macronutrients on intestinal adaptation has been extensively studied in animal models. Clinically, the length and portion of intestine that is resected may lead to patients requiring parenteral nutrition, which is also reviewed here. There remain significant gaps in knowledge surrounding many of the nutritional aspects of NEC and more research is needed to determine optimal feeding approaches to prevent NEC, particularly in infants younger than 28 weeks and <1000 grams. Additional research is also needed to identify biomarkers reflecting intestinal recovery following NEC diagnosis individualize when feedings should be safely resumed for each patient.

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“…For example, Engelstad et al studied the intestinal microbiota in pediatric short bowel syndrome (SBS) patients compared to intestinal length. They noted that those with the shortest remaining bowel required more parenteral nutrition support, had larger relative abundance of Proteobacteria , and had decreased gut microbial diversity [ 41 ].…”

Section: Gut–liver Axismentioning

confidence: 99%

“…They were also found to have gut microbiota compositions with >75% Proteobacteria. [ 41 ] In addition, Bacteroides fragilis , a species within the phylum Bacteroidetes, has been associated with intestinal inflammation and increased intestinal permeability [ 42 , 43 , 44 , 45 ]. It is hypothesized that such gut alterations enable bacterial translocation across the intestinal mucosa, resulting in cytokine- and endotoxin-mediated modulation of key hepatobiliary receptors [ 46 , 47 , 48 ].…”

Section: Gut–liver Axismentioning

confidence: 99%

Role of the Gut–Liver Axis in Driving Parenteral Nutrition-Associated Injury

et al. 2018

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For decades, parenteral nutrition (PN) has been a successful method for intravenous delivery of nutrition and remains an essential therapy for individuals with intolerance of enteral feedings or impaired gut function. Although the benefits of PN are evident, its use does not come without a significant risk of complications. For instance, parenteral nutrition-associated liver disease (PNALD)—a well-described cholestatic liver injury—and atrophic changes in the gut have both been described in patients receiving PN. Although several mechanisms for these changes have been postulated, data have revealed that the introduction of enteral nutrition may mitigate this injury. This observation has led to the hypothesis that gut-derived signals, originating in response to the presence of luminal contents, may contribute to a decrease in damage to the liver and gut. This review seeks to present the current knowledge regarding the modulation of what is known as the “gut–liver axis” and the gut-derived signals which play a role in PN-associated injury.

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Remnant Small Bowel Length in Pediatric Short Bowel Syndrome and the Correlation with Intestinal Dysbiosis and Linear Growth

Cited by 28 publications

References 34 publications

Digestive enzyme expression in the large intestine of children with short bowel syndrome in a late stage of adaptation

Digestive enzyme expression in the large intestine of children with short bowel syndrome in a late stage of adaptation

Nutrition in Necrotizing Enterocolitis and Following Intestinal Resection

Role of the Gut–Liver Axis in Driving Parenteral Nutrition-Associated Injury

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