Short bowel syndrome in infancy and childhood

Grosfeld, Jay L.; Rescoria, Frederick J.; West, Karen W.

doi:10.1016/0002-9610(86)90009-7

Cited by 124 publications

(47 citation statements)

References 38 publications

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“…It is most common in preterm infants, and necrotizing enterocolitis is the most common cause (1)(2)(3). Necrotizing enterocolitis usually results in loss of ileum and right colon and carries a significant mortality (4).…”

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confidence: 99%

Role of glucagon-like peptide–2 deficiency in neonatal short-bowel syndrome using neonatal piglets

et al. 2013

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Background: Short-bowel syndrome (SBS) is the most common cause of neonatal intestinal failure. Recovery requires intestinal adaptation, dependent on enteral nutrition (EN) and growth factors such as glucagon-like peptide-2 (GLP-2), which is secreted from L cells in the ileum. Neonatal SBS often results in loss of ileum; therefore, we hypothesized that without ileum, endogenous GLP-2 production would be inadequate to promote adaptation. We compared endogenous GLP-2 production and adaptation in neonatal animals with SBS, with and without ileum. Methods: Neonatal piglets (4-6 d) were randomized to 75% mid-intestinal resection, 75% distal-intestinal resection, or sham control without resection. Postoperatively, all piglets commenced parenteral nutrition (PN), tapering as EN was increased to maintain specific growth. results: The resected SBS piglets developed intestinal failure, requiring a longer duration of PN support and experiencing fat malabsorption. The piglets without ileum were not able to wean from PN during the study and did not show adaptation, specifically growth in intestinal length or crypt hyperplasia on histology of the jejunum. Adaptation was observed in the resected SBS piglets with ileum, and these piglets also had an increased plasma GLP-2 level that was not observed in piglets without ileum. conclusion: SBS piglets with ileum undergo adaptation associated with increased endogenous GLP-2 production. SBS piglets without ileum undergo limited adaptation and severe intestinal failure, requiring prolonged PN support. This appears to be related to a deficiency in endogenous GLP-2 production. n eonatal intestinal failure secondary to short-bowel syndrome (SBS) has a particularly poor outcome. It is most common in preterm infants, and necrotizing enterocolitis is the most common cause (1-3). Necrotizing enterocolitis usually results in loss of ileum and right colon and carries a significant mortality (4).After intestinal resection, adaptation of the remnant intestine is essential for survival, compensating for the reduced absorptive surface area, both structurally and functionally (5). This process is regulated by several factors, including the stage of intestinal development, site and length of resection, the underlying disease, nutritional status, and gut-derived hormones and growth factors (6). Among the growth factors, glucagon-like peptide-2 (GLP-2) is considered to have an important role in inducing small-intestinal adaptation after resection. GLP-2 acts specifically at the GLP-2 receptor (GLP-2R), which is expressed throughout the small and large intestines but with greatest concentration in the jejunum (7). GLP-2 is uniquely trophic for the intestine (8). It can stimulate residual small-intestinal adaptation by increasing crypt cell proliferation and inhibiting apoptosis, thereby increasing villus height, crypt depth, mucosal mass, and overall small-intestinal length and weight (9-11). Functionally, GLP-2 increases activities of mucosal enzymes and therefore increases digestion and absorption (...

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confidence: 99%

Role of glucagon-like peptide–2 deficiency in neonatal short-bowel syndrome using neonatal piglets

et al. 2013

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“…The analysis by Grosfeld et al 34 of 60 infants showed that cholestasis was reversible if the patient was switched from TPN to complete enteral feeding and if the total bilirubin was less than 30 mg/dL. If the total bilirubin was greater than 30 mg/dL, reversal did not occur.…”

Section: Problems Associated With Tpnmentioning

confidence: 99%

Current Status of Intestinal Transplantation

Todo

Tzakis

Abu‐Elmagd

et al. 2014

Regenerative Medicine Applications in Organ Transplantation

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Experimental Intestinal TransplantationFifty years after Alex Carrel performed the first attempts at canine intestinal transplantation in 1902,1 two major works were carried out independently at the University of Minnesota and Northwestern University. In 1959, Lillehei et al. 2 reported a technique for isolated intestinal transplantation in dogs. Lillehei and co-workers removed the entire small bowel, except for short segments at the proximal jejunum and distal ileum, on a vascular pedicle of the superior mesenteric artery and the superior mesenteric vein. The graft was immersed in cold normal saline and transplanted orthotopiAdvances in Surgery ', vol 27 295

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“…T he infan t population must contend with necrotizing enterocolitis, atresias, volvuli and abdominal wall defects with resultant herniation and vascular compromise (3,4). The adult is more likely to be faced with repeated resection as a consequence of Crohn's disease (5 ), while in the elderly, resection is most likely due to mesenteric infarct (6).…”

Section: S Urgical T Reatment Of Manymentioning

confidence: 99%

“…Development of improved supportive care and total parenteral nutrition have prolonged survival and made this condition prevalent ( 4,(9)(10)(11). Parenteral nutrition has allowed continued intravenous feeding during intolerance to oral nutrition , and patients with extremely sh ort bowel can now exist entirely o n h o me to t al p a re nteral nutrition (12,13).…”

Section: S Urgical T Reatment Of Manymentioning

confidence: 99%

Short Bowel Syndrome: Intestinal Adaptation and Medical Therapy

Buie¹,

Og²,

Fedorak³

1990

Canadian Journal of Gastroenterology

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Short bowel syndrome is a clinical entity, a consequence of significant loss of intestinal surface area, and manifests a variable picture of diarrhea, steatorrhea, malabsorprion and weight loss. Previously high mortality rates have been reduced by the early use of parenteral nutrition and have subsequently resulted in increased survival and prevalence of the condition. Ultimate patient survival is dependent on the intrinsic adaptive ability of residual intestine and this, in tum, is dependent upon length, type, functional state and the presence or absence of an ileocecal valve. The mechanisms of intestinal adaptation are not entirely understood; however, they can be grouped into three broad categories: luminal nutrition, hormonal factors, and pancreaticobiliary secretion. Medical treatment of short bowel syndrome remains supportive and centres around the control of th ree pathophysiological defects: decreased intestinal transit time, gastric hypersecretion, and reduced functional mucosa! surface area.

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Short bowel syndrome in infancy and childhood

Cited by 124 publications

References 38 publications

Role of glucagon-like peptide–2 deficiency in neonatal short-bowel syndrome using neonatal piglets

Role of glucagon-like peptide–2 deficiency in neonatal short-bowel syndrome using neonatal piglets

Current Status of Intestinal Transplantation

Short Bowel Syndrome: Intestinal Adaptation and Medical Therapy

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