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intestinal rehabilitation

Kwai Lam, Lauren Schwartz, Jennifer Batisti, Kishore R Iyer
BACKGROUND: Teduglutide is a glucagon-like peptide 2 (GLP-2) analog that has been approved for the treatment of adult short bowel syndrome (SBS)-associated intestinal failure (IF; SBS-IF). Teduglutide increases villus height and crypt depth in the small bowel mucosa, promoting nutrition absorption and enteral independence from parenteral nutrition (PN). We aim to report our single-center experience with teduglutide in adult patients with SBS to provide real-world context to its use. METHOD: We conducted a retrospective analysis on patients managed within our tertiary-level intestinal rehabilitation program to identify patients with SBS-IF treated with teduglutide from 2009-2015...
January 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Jason S Hawksworth, Chirag S Desai, Khalid M Khan, Stuart S Kaufman, Nada Yazigi, Raffaele Girlanda, Alexander Kroemer, Thomas M Fishbein, Cal S Matsumoto
Intestine failure-associated liver disease (IFALD) is widely recognized as a lethal complication of long-term parenteral nutrition. The pathophysiology of IFALD is poorly understood but appears to be multifactorial and related to the inflammatory state in the patient with intestinal failure (IF). Visceral transplantation for IFALD includes variants of intestine, liver, or combined liver and intestine transplantation. Graft selection for an individual patient depends on the etiology of intestinal failure, abdominal and vascular anatomy, severity of IFALD, and potential for intestinal rehabilitation...
March 2, 2018: American Journal of Transplantation
Lorenzo Norsa, Solene Artru, Cecile Lambe, Cecile Talbotec, Benedicte Pigneur, Frank Ruemmele, Virginie Colomb, Carmen Capito, Christophe Chardot, Florence Lacaille, Olivier Goulet
BACKGROUND & AIMS: Intestinal rehabilitation is the preferred treatment for children with short bowel syndrome (SBS) whatever the residual bowel length, and depends on the accurate management of long-term parenteral nutrition (PN). If nutritional failure develops, intestinal transplantation (ITx) should be discussed and may be life-saving. This study aimed to evaluate survival, PN dependency and nutritional status in children with neonatal very SBS on PN or after ITx, in order to define indications and timing of both treatments...
February 15, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Frank Daniel Martos-Benítez, Anarelys Gutiérrez-Noyola, Andrés Soto-García, Iraida González-Martínez, Ilionanys Betancourt-Plaza
Nutritional depletion is commonly observed in patients undergoing surgical treatment for a gastrointestinal malignancy. An appropriate nutritional intervention could be associated with improved postoperative outcomes. The study was aimed to determine the effect of a program of gastrointestinal rehabilitation and early postoperative enteral nutrition upon complications and clinical outcomes in patients who experienced gastrointestinal surgery for cancer. This is a prospective study (2013 January-2015 December) of 465 consecutive patients submitted to gastrointestinal surgery for cancer and admitted to an Oncological Intensive Care Unit...
February 10, 2018: Updates in Surgery
Francisco Hernandez, Ane M Andres, Manuel Lopez-Santamaria
PURPOSE OF REVIEW: One of the biggest successes of intestinal rehabilitation programs is that more patients achieve enteral autonomy without transplantation. Many factors are responsible of this accomplishment including new parenteral formulas, better catheter management, surgical management, and the experience of the teams. The purpose of this review is to analyze recent published papers regarding intestinal lengthening procedures trying to find out how many transplantations are avoided and for which patients...
February 5, 2018: Current Opinion in Organ Transplantation
Gabriel E Gondolesi, Francisco Pattín, Hamed Nikkoupur
PURPOSE OF REVIEW: Intestinal failure is a life-threatening medical condition that remains as a rare or orphan disease in most countries. The prevalence of intestinal failure and the therapeutic options available in middle-income countries (MIC) remain unclear. We aim to provide an overview on the current differences in management of intestinal failure patients in MIC from Latin America and Asia. RECENT FINDINGS: In order to fulfil the challenge, and after facing the difficulties of going over a topic with scarce available data, from countries with an extreme variety of social and economic problems, which are closely related to the treatment of intestinal failure patients, we have used both the existing publications and personal surveys to draft this document...
January 30, 2018: Current Opinion in Organ Transplantation
Elie Abi Nader, Cécile Lambe, Cécile Talbotec, Liping Dong, Bénédicte Pigneur, Olivier Goulet
BACKGROUND: Infants with intestinal failure (IF) are at increased risk of malnutrition and require adapted nutrition support. Optimal weight gain during nutrition rehabilitation should occur at the velocity of statural age (adjusted to the 50th percentile of height) and not chronological age. The aim of this study was to assess the relationship between weight gain during catch-up growth, nonprotein energy intake (NPEI) provided by total parenteral nutrition (TPN), and resting energy expenditure (REE) in children with severe malnutrition due to IF...
January 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Iona Ashworth, Alexander Wilson, Samuel Aquilina, Raymond Parascandalo, Victor Mercieca, Jurgen Gerada, Sarah Macdonald, Venetia Simchowitz, Susan Hill
OBJECTIVES: To review long-term outcome of Intestinal Epithelial Dysplasia(IED)/tufting enteropathy(TE) patients treated with parenteral nutrition(PN) at home managed by an intestinal failure(IF) rehabilitation service METHODS:: Infants presenting from 1986-2010 with IF, and TE histology were retrospectively reviewed for up to 30 years. Data collected included: outcome, presentation, nutrition(parenteral/enteral), country of residence, race, EpCAM gene, growth, bone age, occupation. RESULTS: 13 patients (6 male) in Malta and the UK with TE histology were established on home PN...
January 13, 2018: Journal of Pediatric Gastroenterology and Nutrition
Arnaud Roussel, Alexandre Nuzzo, Quentin Pellenc, Yves Castier, Romain De Blic, Pierre Cerceau, Célia Boulitrop, Mathieu Coblence, Sonia Aguir, Pierre Mordant, Léon Maggiori, Audrey Huguet, Annie Sibert, Francisca Joly, Olivier Corcos
BACKGROUND AND OBJECTIVES: Without prompt superior mesenteric artery (SMA) revascularization, acute mesenteric ischemia (AMI) frequently leads to death or short bowel syndrome (SBS). In SBS patients, persistent or chronic intestinal ischemia (PII) of the remnant bowel can lead to recurrences of AMI. Since SMA revascularization is sometimes unfeasible, celiac artery (CA) revascularization may improve blood supply to the remnant bowel. The aim of this study was to describe and to assess our experience of the CA revascularization in case of SMA occlusion unsuitable for revascularization in the setting of PII in SBS patients...
January 2018: International Journal of Surgery
Christina Belza, Kevin Fitzgerald, Nicole de Silva, Yaron Avitzur, Karen Steinberg, Glenda Courtney-Martin, Paul W Wales
OBJECTIVE: The primary goal in intestinal failure (IF) is adaptation and enteral autonomy (EA). Our goals were to determine the proportion of patients treated for IF by an established intestinal rehabilitation program who achieved EA and to assess the predictors of EA. BACKGROUND: There have been considerable advancements in the management of IF over the last 15 years, children with short bowel syndrome with a reduction in mortality. Several studies have discussed variables that may influence the ability to attain EA; however, majority were written when mortality rates were considerably higher compared with the current contemporary experience...
December 4, 2017: Annals of Surgery
Ledycnarf J Holanda, Patrícia M M Silva, Thiago C Amorim, Matheus O Lacerda, Camila R Simão, Edgard Morya
BACKGROUND: Spinal cord injury (SCI) is characterized by a total or partial deficit of sensory and motor pathways. Impairments of this injury compromise muscle recruitment and motor planning, thus reducing functional capacity. SCI patients commonly present psychological, intestinal, urinary, osteomioarticular, tegumentary, cardiorespiratory and neural alterations that aggravate in chronic phase. One of the neurorehabilitation goals is the restoration of these abilities by favoring improvement in the quality of life and functional independence...
December 4, 2017: Journal of Neuroengineering and Rehabilitation
A Lauro, R Cirocchi, N Cautero, A Dazzi, D Pironi, F M Di Matteo, A Santoro, L Pironi, A D Pinna
A systematic bibliographic research concerning patients operated on for SBS was performed: inclusion criteria were adult age, reconnection surgery and SBS < 100 cm. Autologous gastrointestinal reconstruction represented an exclusion criteria. The outcomes of interest were the rate of total parenteral nutrition (TPN) independence and the length of follow-up (minimum 1 year) after surgery. We reviewed our experience from 2003 to 2013 with minimum 1-year follow-up, dealing with reconnection surgery in 13 adults affected by < 100 cm SBS after massive small bowel resection: autologous gastrointestinal reconstruction was not feasible...
July 2017: Il Giornale di Chirurgia
S V Klochkova, A G Kvaratskheliya, N T Alekseeva, D B Nikityuk
Number and size of aggregated lymphoid nodules in the small intestine of mice exposed to radiation using a γ-irradiation unit GOBO-60 with137 Cs source were measured using the methods of visual microscopy and morphometry. Morphological status of the nodules was estimated on days 4, 28, 60, and 90 after the exposure. Significant changes were observed in the lymphoid system of the small intestine after exposure to low-intensity radiation. The size of aggregated lymphoid nodules decreased and the relative number of cells with degenerative changes increased...
December 2017: Bulletin of Experimental Biology and Medicine
Kwai Lam, Thomas Schiano, Maria Isabel Fiel, Kishore Iyer
Long-term parenteral nutrition (PN) may be complicated by PN-associated liver disease (PNALD), and some studies suggest an association between the use of soy-based fat emulsions and PNALD development. Patients' liver function typically improves and PNALD resolves after reducing or stopping a soy-based fat emulsion, and thus lipid minimization has been the primary strategy for managing PNALD in many intestinal rehabilitation programs. However, fat emulsions often cannot be stopped entirely, leading some patients to develop PNALD even after lipid reduction strategies have been implemented...
November 2017: JPEN. Journal of Parenteral and Enteral Nutrition
Guohao Wu
Patients with short bowel syndrome suffer from fluid and electrolyte imbalance and malabsorption due to poor nutrient processing capability of the residual intestine. Nutritional support therapy has been considered as one of the important treatments for short bowel syndrome. For patients with short bowel syndrome, a deep understanding of metabolic changes, and then rational application of nutritional support therapy and intestinal rehabilitation program can save many patients' lives, improve quality of life, and even achieve independence from parenteral nutrition, and return to a normal life...
October 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Rodrigo Uliano Moser da Silva, Fernando Jahn da Silva Abreu, Gabriel M V da Silva, João Vitor Quadra Vieira Dos Santos, Nelson Sivonei da Silva Batezini, Brasil Silva, Tiago Elias Rosito
INTRODUCTION: After the diagnosis of transsexualism is confirmed therapy commences with psychotherapeutic preparation for the conversion, and after conversion, long-term patient rehabilitation is maintained for at least two years. The indication for surgery is chronic discomfort caused by discord with the patient's natural gender, intense dislike of developing secondary sex characteristics and the onset of puberty. The surgical conversion of transsexuals is the main step in the complex care of these problematic patients (1)...
October 17, 2017: International Braz J Urol: Official Journal of the Brazilian Society of Urology
Cristine S Velazco, Brenna S Fullerton, Joseph A Brazzo, Charles R Hong, Tom Jaksic, Carol E Barnewolt
PURPOSE: Small bowel length is the most reliable predictor of enteral independence in pediatric short bowel syndrome. Retrospectively measured bowel lengths on upper GI with small bowel follow-through (UGI/SBFT) were compared to operative measurements. METHODS: A pediatric radiologist and surgical trainees blinded to operative measurements retrospectively analyzed UGI/SBFT studies using the digital radiography curved measurement tool. Children with SBS and severe intestinal failure (parenteral nutrition >90days) at a multidisciplinary intestinal failure program 2002-2015 were included...
December 2017: Journal of Pediatric Surgery
Kyle A Soltys, Geoff Bond, Rakesh Sindhi, Sara K Rassmussen, Armando Ganoza, Ajai Khanna, George Mazariegos
The field of intestinal transplantation has experienced dramatic growth since the first reported cases 3 decades ago. Improvements in operative technique, donor assessment and immunosuppressive protocols have afforded children who suffer from life-threatening complications of intestinal failure a chance at long-term survival. As experience has grown, newer diseases, with more systemic manifestations have arisen as potential indications for transplant. After discussing the historical developments of intestinal transplant as a backdrop, this review focuses on the specific pre-operative indications for transplant as well as the great success that intestinal rehabilitation has witnessed over the past decade...
August 2017: Seminars in Pediatric Surgery
Patrick J Javid, Assaf P Oron, Christopher Duggan, Robert H Squires, Simon P Horslen
BACKGROUND: The advent of regional multidisciplinary intestinal rehabilitation programs has been associated with improved survival in pediatric intestinal failure. Yet, the optimal timing of referral for intestinal rehabilitation remains unknown. We hypothesized that the degree of intestinal failure-associated liver disease (IFALD) at initiation of intestinal rehabilitation would be associated with overall outcome. METHODS: The multicenter, retrospective Pediatric Intestinal Failure Consortium (PIFCon) database was used to identify all subjects with baseline bilirubin data...
September 5, 2017: Journal of Pediatric Surgery
Augusto Lauro, Ignazio R Marino, Kishore R Iyer
Pre-emptive transplantation is a well-established practice for certain types of end-organ failure such as in the use of kidney transplantation. For irreversible intestinal failure, total parenteral nutrition (TPN) remains the gold standard, due to the suboptimal long-term results of intestinal transplantation. As such, the only role for pre-emptive transplantation, if at all, will be for patients identified to be at high risk of complications and mortality while on definitive long-term TPN. In these patients, the timing of early listing and transplantation could become life-saving, taking into account that mortality on the waiting list is still the highest for intestinal candidates...
November 2017: Digestive Diseases and Sciences
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