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Aim: to assess the prescription of oral nutritional supplements (ONS) in the Northern Area of Gran Canaria in the period 2016-2021. Materials and methods: based on electronic prescription data, the first ONS prescription during 2016-2021 was analyzed considering age, gender, nutritional requirements (NR), body mass index (BmI), percentage of weight loss (%WL), albumin and number of prescribed ONS per patient. Results: 10,595 prescriptions were identified corresponding to 6661 patients with the following characteristics: 46.3 % men, mean age 72.84 ± 15.93 years, BMI 20.60 ± 3.98 kg/m², %WL 11.89 ± 8.32 %; albumin 3.08 ± 0.63 g/dl. The most frequent etiologies of DRE were: neoplasms 42.6 %; degenerative processes of the CNS 28.9 %; stroke 3.9 %; short bowel syndrome 6.9 %, and inflammatory bowel disease (IBD) 5.5 %. The percentages of NR covered by the prescribed ONS were: 100 % in 8.9 % of cases, 50 % in 36.9 %, and 25 % in 54.2 %; 40.4 % of patients received 1 unit of ONS daily, 36.3 % took 2 units of ONS, and 23 % received > 3 units of ONS per day. Greater NR were associated with a greater number of ONS (p < 0.001), but 40.8 % of patients who needed to cover > 50 % of NR received only one unit of ONS. Conclusion: a significant percentage of patients with disease-related malnutrition (DRM) do not receive a number of ONS according to their NR. [ABSTRACT FROM AUTHOR]

Background: teduglutide is an agonist of glucagon-related peptide (aGLP2) effective as a treatment for patients with short bowel syndrome (SBS), an entity that affects quality of life, usually requires home parenteral nutrition (HPN) and generates significant health costs. The objective of the present narrative review was to assess the real-life experience reported with teduglutide. Methods and results: in real life, one meta-analysis and studies published with 440 patients indicate that Teduglutide is effective after the period of intestinal adaptation after surgery, reducing the need for HPN and in some cases even allowing it to be suspended. The response is heterogeneous, increasing progressively up to 2 years after the start of treatment and reaching 82 % in some series. The presence of colon in continuity is a negative predictor of early response, but a positive predictive factor for the withdrawal of HPN. The most common side effects are gastrointestinal in the early stages of treatment. There are late complications related to the stoma or the occurrence of colon polyps, although the frequency of the latter is very low. In adults, data on improved quality of life and cost-effectiveness are scarce. Conclusions: teduglutide is effective and safe and data from pivotal trials for the treatment of patients with SBS are confirmed in real life and can reduce or even stop HPN in some cases. Although it seems cost-effective, more studies are needed to identify those patients with the greatest benefit. [ABSTRACT FROM AUTHOR]

Introduction: In order to develop evidence-based recommendations and expert consensus for the nutritional management of patients with short bowel syndrome (SBS), we conducted a systematic literature search using the PRISMA methodology plus a critical appraisal following the GRADE scale procedures. Pharmacological treatment with antisecretory drugs, antidiarrheal drugs, and somatostatin contributes to reducing intestinal losses. Nutritional support is based on parenteral nutrition; however, oral intake and/or enteral nutrition should be introduced as soon as possible. In the chronic phase, the diet should have as few restrictions as possible, and be adapted to the SBS type. Home parenteral nutrition (HPN) should be individualized. Single-lumen catheters are recommended and taurolidine should be used for locking the catheter. The HPN's lipid content must be greater than 1 g/kg per week but not exceed 1 g/kg per day, and omega-6 fatty acids (ω6 FAs) should be reduced. Trace element vials with low doses of manganese should be used. Patients with chronic SBS who require long-term HPN/fluid therapy despite optimized treatment should be considered for teduglutide treatment. All patients require a multidisciplinary approach and specialized follow-up. These recommendations and suggestions regarding nutritional management in SBS patients have direct clinical applicability. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: teduglutide (TED) is indicated for the treatment of patients with short-bowel syndrome (SBS) who are dependent on parenteral support. Case report: we report the case of a 60-year-old woman with SBS treated with TED. She had previously undergone multiple surgical resections due to Crohn's disease. Her remnant bowel included only the duodenum and 50-60 centimeters of jejunum. The patient was dependent on intravenous fluids (2,320 mL/48 h) and had a high stoma output (3,000 mL/day). After four months of TED the jejunostomy output had decreased to 2,200 mL/day with a thicker consistency, and intravenous fluid therapy was reduced to 2,010 mL/48 h. TED was withdrawn due to acute pancreatitis and enlargement of two supraumbilical hernias with high strangulation risk. Discussion: pancreatitis has been reported in clinical studies, and determination of amylase and lipase is recommended in all patients receiving TED. In contrast, there are no recommendations for the surveillance of hernia enlargement in patients on TED therapy, but we suggest the need for surveillance based on this case report. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: home parenteral nutrition (NPD) is a complex technique that involves multidisciplinary follow-up. Objectives: descriptive analysis of all patients included in the NPD program. Methods: retrospective study of patients with NPD between 1985 and 2017 in our center, a tertiary university hospital. Results: we analyzed 61 patients (32 men, mean age: 51.2 years). The most common underlying pathology was neoplasia (32.8%), with short bowel syndrome (SIC) being the main indication of NPD (70.5%). Forty-five patients received partial NPD and 16 total. The tunnelled vein catheter was the most common venous access used. 20 patients suspended it for complete oral intake (19 the first 5 years), 26 were deceased (18 the first 5 years) and 15 maintain it. Neoplasia was the most frequent cause of death (46.2%) and in 15.4% liver disease was associated with NPD. The median duration of NPD was 25 months [1-394]; being in 24 patients longer than 5 years (8 dead, only 1 for oncologic cause not related to the NPD). Fifty-four per cent had catheter infections, being isolated 55.2% Staphylococcus coagulase negative, with an infection rate of 1.04 per 1000 days of catheterization. Conclusions: NPD is a useful therapeutic strategy in intestinal failure. The SIC is the most frequent indication in our case study. The underlying pathology, such as neoplasia, will determine the prognosis. Catheter infection is the more frequent complication, so it is necessary to strengthen health education and antiseptic prophylaxis. [ABSTRACT FROM AUTHOR]

Aim: to communicate HPN data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2017.Material and Methods: descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2017 to December 31st, 2017.Results: there were 308 patients from 45 Spanish hospitals (54.5% women), 38 children and 270 adults, with 3,012 episodes, which represent a prevalence rate of 6.61 patients/million inhabitants/year 2017. The most frequent diagnosis in adults was "palliative cancer" (25.6%), followed by "others". In children, it was Hirschsprung's disease with six cases (15.8%). The first indication was short bowel syndrome in both children (55.3%) and adults (33.7%). The most frequently used type of catheter was tunneled in both children (73.4%) and adults (38.2%). Ending 81 episodes, the most frequent cause was death (62.9%) and transition to oral feeding (34.7%).Conclusions: the progressive increase of collaborating centers and professionals in the registry of patients receiving NPD is maintained. The main indications of HPN and the motive for ending have remained stable. [ABSTRACT FROM AUTHOR]

Short bowel syndrome (SBS) is a well-known cause of intestinal failure (IF) (1). SBS occurs after extensive resection of the small bowel (RSB) resulting in a bowel length of less than 150/200 cm. The colon may have been partially or completely removed. SBS patients experience severe water and nutrient malabsorption, so that they are often managed with parenteral nutrition (PN) to supplement their oral intake (2-4). A complete understanding of the pathophysiology of SBS and postoperative adaptations may allow identifying the spontaneous processes that compensate for the reduction in absorptive surface. A better knowledge of these adaptive mechanisms may help to improve the management of patient nutrition, to reduce the need for PN and to prevent D-encephalopathy episodes. This review focuses on the overall adaptations described in adult SBS patients but does not review pediatric cases. [ABSTRACT FROM AUTHOR]

Background: Teduglutide is an enterotrophic analogue of glucagon-like peptide-2, with an indirect and poorly understood mechanism of action, approved for the rehabilitation of short-bowel syndrome. This study aims to analyze the response of tissue growth factors to surgical injury and teduglutide administration on an animal model of intestinal anastomosis.Methods: Wistar rats (n = 59) were distributed into four groups: "ileal resection" or "laparotomy", each one subdivided into "postoperative teduglutide administration" or "no treatment"; and sacrificed at the third or the seventh day, with ileal sample harvesting. Gene expression of insulin-like growth factor 1 (Igf1), vascular endothelial growth factor a (Vegfa), transforming growth factor β1 (Tgfβ1), connective tissue growth factor (Ctgf), fibroblast growth factor 2 (Fgf2), fibroblast growth factor 7 (Fgf7), epidermal growth factor (Egf), heparin-binding epidermal-like growth factor (Hbegf), platelet-derived growth factor b (Pdgfb) and glucagon-like peptide 2 receptor (Glp2r)was studied by real-time polymerase chain reaction.Results: Upregulation of Fgf7, Fgf2, Egf, Vegfaand Glp2rat the third day and of Pdgfat the seventh day was verified in the perianastomotic segment. Teduglutide administration was associated with higher fold-change of relative gene expression of Vegfa(3.6 ± 1.3 vs.1.9 ± 2.0, p = 0.0001), Hbegf(2.2 ± 2.3 vs. 1.1 ± 0.9, p = 0.001), Igf1(1.6 ± 7.6 vs. 0.9 ± 0.7, p = 0.002) and Ctgf(1.1 ± 2.1 vs. 0.6 ± 2.0, p = 0.013); and lower fold-change of Tgfβ1, Fgf7and Glp2r.Conclusions: Those results underscore the recognized role of Igf1and Hbegfas molecular mediators of the effects of teduglutide and suggest that other humoral factors, like Vegfand Ctgf, may also be relevant in the perioperative context. Induction of Vegfa, Igf1and Ctgfgene expressions might indicate a favorable influence of teduglutide on the intestinal anastomotic healing. [ABSTRACT FROM AUTHOR]

Introducción: La asistencia de patologías de alta complejidad en el domicilio ha demostrado ofrecer importantes beneficios para el paciente y el sistema sanitario. Existen escasas experiencias de esta modalidad de atención desde el Sistema Público de Salud en pediatría en Latinoamérica. Objetivo: Realizar un análisis socio-sanitario de la factibilidad de la implementación de la NPD en pacientes con síndrome de intestino corto (SIC) desde un Hospital Público. Material y métodos: Se incluyeron pacientes con SIC grave asistidos entre años 1985-2009. Se analizó: edad, longitud del intestino delgado remanente (LIR), tiempo transcurrido entre la indicación de NPD y el inicio efectivo de la misma, tiempo de duración de NPD, modalidad de tratamiento y evolución clínica. Determinantes sociales: lugar de procedencia, condiciones habitacionales, condiciones laborales, nivel educativo, tipo de seguridad social y Necesidades Básicas Insatisfechas (NBI). Se dividieron en dos grupos: 1- pacientes en los cuales fue factible la implementación de la NPD en el momento de su indicación, 2- pacientes en los que no fue factible su implementación. Resultados: Se incluyeron 61 pacientes, LIR media de 21,7 ± 11,6 cm. Fue factible iniciar la NPD en 32 pacientes (52,4%) (G1) y no factible en 29 (47,6%) (G2). La modalidad del tratamiento domiciliario fue: en autocuidado 25 (81%) y con apoyo de enfermería en 7 (19%). En relación a los determinantes sociales, aquellos que se asociaron a la factibilidad de la NPD fueron: más de un responsable adulto para el tratamiento (p 0,03), nivel educativo del cuidador (p 0,01), condiciones habitacionales adecuadas (p 0,02) y el NBI (p 0,07). 17 pacientes (28%) lograron su adaptación, 6 (10%) recibieron transplante intestinal, 19 (31%) fallecieron y 19 (31%) continúan en NPD. Conclusión: La NPD es factible de ser realizada desde el Hospital Público. Los diferentes determinantes sociales influyen en ésta factibilidad por lo que la asistencia debe ser realizada por un equipo interdisciplinario contemplando aspectos integrales del niño y su familia.Introduction: The intensive care of patients at home had probed important beneficialness for the patient and the Health System. There are very few experiences of this kind of care from the Public Hospitals. Objetive: To develop a social-sanitary analysis of the feasibility of the implementation of HPN on patients with short bowel syndrome (SBS) from a Public Hospital. Material and methods: Patients hospitalized between 1985-2009 were included. We analyzed: age, residual intestine length (RIL), time between de indication and the beginning of HPN, HPN duration, treatment modality and clinical outcome. Social determinants: home place, habitat conditions, employment conditions, educational level, social security and Low Socioeconomic Status (LSS). The group were divided in two: 1- patients with feasibility of HPN when it was prescribed; 2- patients without feasibility of HPN. Results: 61 patients were included, RIL x: 21.7 ± 11.6 cm. The HPN was feasible (G1) in 32 patients (52.4%) and no feasible (G2) in 29 (47.6%). The home treatment modality was in self-caring 25 (81%) and with nurses support 7 (19 %). The social determinants associated with the HPN feasibility were: more than one takecare (p 0.03), educational level (p 0.01), adequate habitat conditions (p 0.02) and Low Socioeconomis Status (LSS) (p 0.07). 17 patients reached intestinal adaptation (28%), 6 (10%) were transplanted, 19 (31%) died and 19 (31%) are actually on HPN. Conclusion: The HPN realized from the Public Hospital is feasible. Different social determinants were observed. The care of this group of patients must be done by an interdisciplinary group including general aspects of the child and the family.

Background: Parenteral nutrition (PN) is used to control the nutritional state after severe intestinal resections. Whenever possible, enteral nutrition (EN) is used to promote intestinal rehabilitation and reduce PN dependency. Our aim is to verify whether EN + oral intake (OI) in severe short bowel syndrome (SBS) surgical adult patients can maintain adequate nutritional status in the long term. Methods: This longitudinal retrospective study included 10 patients followed for 7 post-operative years. Body mass index (BMI), percentage of involuntary loss of usual body weight (UWL), free fat mass (FFM), and fat mass (FM) composition assessed by bioelectric impedance, and laboratory tests were evaluated at 6, 12, 24, 36, 48, 60, 72, and 84 months after surgery. Energy and protein offered in HPN and at long term by HEN+ oral intake (OI), was evaluated at the same periods. The statistical model of generalized estimating equations with p < 0,05 was used. Results: With long term EN + OI there was a progressive increase in the UWL, a decrease in BMI, FFM, and FM (p < 0,05). PN weaning was possible in eight patients. Infection due to central venous catheter (CVC) contamination was the most common complication (1.2 episodes CVC/patient/year). There was an increase in energy and protein intake supply provided by HEN+OI (p < 0.05). All patients survived for at least 2 years, seven for 5 years and six for 7 years of follow-up. Conclusions: In the long term SBS surgical adult patients fed with HEN+OI couldn't maintain adequate nutritional status with loss of FM and FFM.Antecedentes: La nutrición parenteral (NP) se emplea para controlar el estado nutricional después de resecciones intestinales extensas. Siempre que sea posible, se empleará la nutrición enteral (NE) para favorecer la rehabilitación intestinal y reducir la dependencia de la NP. Nuestro propósito fue verificar si la NE + ingesta oral (IO) en el síndrome del intestino corto (SIC) grave en pacientes adultos quirúrgicos puede mantener un estado nutricional adecuado a largo plazo. Métodos: Este estudio longitudinal retrospectivo incluyó 10 pacientes seguidos durante 7 años tras la intervención quirúrgica. Se evaluaron el índice de masa corporal (IMC), el porcentaje de pérdida involuntaria del peso corporal habitual (PCH), la masa grasa libre (MGL) y la composición de la masa grasa (MG) mediante impedancia bioeléctrica, así como los datos de laboratorio a los 6, 12, 24, 36, 48, 60, 72 y 84 meses tras la cirugía. Se evaluaron en los mismos periodos la energía y las proteínas aportadas con la NPD y a largo plazo con la NED + ingesta oral (IO). Se utilizó un modelo estadístico de ecuaciones estimativas generalizadas con una p < 0,05. Resultados: Con la NE + IO a largo plazo hubo un aumento progresivo del PCH, una descenso del IMC, la MGL y la MG (p < 0,05). La retirada de la NP fue posible en ocho pacientes. La complicación más frecuente fue la infección por contaminación del catéter venoso central (CVC) (1,2 episodios CVC/paciente/año). Hubo un aumento en el consumo de energía y proteínas proporcionadas por la NED + IO (p < 0,05). Todos los pacientes sobrevivieron al menos dos años, siete durante 5 años y seis durante los 7 años de seguimiento. Conclusiones: los pacientes adultos con SIC quirúrgico nutridos a largo plazo con NED + IO no pudieron mantener un adecuado estado nutricional con una pérdida de MG y de MGL.

Introducción: El síndrome de intestino corto es una insuficiencia grave intestinal cuya etiología más frecuente en adultos son la isquemia intestinal y la enfermedad inflamatoria y en niños las malformaciones congénitas, el vólvulo y la enterocolitis necrotizante, obligando al uso de la NPT. Pero el intestino está íntimamente relacionado con el hígado a través de la circulación entero-hepática y de diferentes sistemas endocrinos entero-hepáticos. La resección intestinal y la Nutrición Parenteral alterarán esta relación, pudiendo variar la composición del tejido hepático y su histomorfología. El objetivo de este trabajo es conocer más concretamente estos posibles cambios. Materiales y métodos: Utilizamos 3 grupos experimentales: Grupo A (10cobayos), sometidos a una anestesia y laparotomía simple y nutridos durante 10 días con NPT. Grupo B (10cobayos), con resección intestinal yeyuno-ileal total y nutridos durante 10 días con NPT. Grupo Ctr (6 cobayos), sometidos a anestesia y laparotomía simple y nutridos oralmente. Tras este período se estudiaron muestras de sangre y de tejido hepático, tanto para el estudio de la grasa hepática (grasa total, proporciones de lípidos neutros y polares, proporciones de fosfolípidos y de ácidos grasos) como para estudio histológico. Resultados: Los animales de los grupos A y B, sometidos a NPT, presentan incrementos significativos en la glucemia y en los triglicéridos séricos, y descensos en el coles-terol. Disminuyen el peso y la proporción de grasa por g de hígado, máxime en el GB, así como el cociente LP/LN en los GA y GB. Se modifican las proporciones de fosfolí-pidos, disminuyendo el fosfatidilinositol y aumentando la fosfatidiletanolamina; disminuyendo también el cociente de los AG w6/w3. Histológicamente, aparece una esteato-hepatitis, con disminución marcada de la densidad mito-condrial, siendo mas intensos en el GB. Conclusión: la NPT altera la composición de la grasa hepática y la histomorfológica del hígado. El SIUC tiene más mecanismos lesionales, potenciándose el daño hepático causado por la NPT.Background & Aims: Short Bowel syndrome is a serious intestinal insufficiency. The most common etiology in adults nowadays is intestinal ischemia and inflammatory disease, while in children the most common are congenital anomalies, volvolus and necrotizing entero-colaitis, which makes the TPN obligatory. However the intestine is intimately related to the liver through the entero-hepatic circulation and different endocrinological entero-hepatic systems. Massive intestinal resections and TPN would alter this relationship, and could change the hepatic tissue composition and its histomor-phology. The aim of this work is to know these changes in more detail. Materials and methods: We used 3 experimental groups: Group A (10 guinea pigs), which was given anesthetic and a simple laparotomy and fed for 10 days with NPT. Group B (10 guinea pigs), underwent total thin intestine resection and were fed for 10 days with NTP. The control group (6 guinea pigs) underwent anesthetic and a simple sham laparotomy and were fed orally. After this period blood and hepatic tissue samples were taken in order to study the liver fat (total fat, proportion of neutral and polar lipids, proportion of phospholipids and fatty acids). Liver biopsies were taken and studied under an optical microscope. Results: The animals from group A and B, underwent NPT, showed a significant increase in glycemie and serum triglycerides, decreasing the cholesterol in GB. There was a significant decrease in weight and in the proportion of fat per g of the liver tissue, at a maximum level in GB, and an even higher decrease in the LP/LN ratio in GA and GB. There was also a change in the proportion of phospholipids, decreasing the Phosphatidili-nositol and increasing the Phosphatidiletanolamine. There was also a decrease in the AG w6/w3 ratio. Histo-logically appear a steatohepatitys, with a striking decrease in the mitochondrial density, being more intensive in GB. Conclusions: NPT alters the composition of the hepatic fat and the hystomorphology of the liver. The short bowel syndrome have more lesional mechanisms, favouring the hepatic damage caused by NPT.

El intestino humano es un órgano complejo de longitud variable, oscilando entre 3 y 8 m, dependiendo de características individuales y de las técnicas empleadas en su medida. La función principal del intestino es conseguir una adecuada incorporación de nutrientes al organismo, y esto se lleva a cabo a través de los procesos de digestión y absorción de nutrientes. Cuando estas funciones fracasan, aparecen la Maldigestión y la Malabsorción, que presentan unos datos clínicos característicos y que deberían ser estudiadas mediante una serie de técnicas específicas para cada uno de los pasos digestivos y cada uno de los nutrientes (tests de malabsorción grasa, de proteínas y de hidratos de carbono).The human intestine is a complex and variable in lenght organ, oscillating between 3 and 8 metres, depending on the individual characteristics and the techniques used to measure it. The main function of the intestine is to get a suitable incorporation of food into the body and this is carried out by menas of the digestion and food absorption processes. When these functions fail, Maldigestion and Malabsorption appear. These have characteristic clinical data and must be studied with the help of specific techniques for every digestive step and every food (fat malabsorption, proteins and carbohydrates tests).

Los resultados más recientes del trasplante intestinal (TI), con una supervivencia inmediata al procedimiento superior al 80% de los casos, y una gran proporción de supervivientes que consiguen autonomía digestiva completa y desempeñan actividades acordes con su edad, permiten considerar el TI como el tratamiento de elección en enfermos con fallo intestinal irreversible en los que es previsible una mala evolución con nutrición parenteral. El daño hepático asociado a la administración de nutrición parenteral es la indicación más frecuente de TI, especialmente en los niños, más susceptibles que los adultos a desarrollar esta complicación. Otras indicaciones aceptadas de TI son el fallo intestinal irreversible asociado a pérdida significativa de accesos venosos profundos, infecciones graves con riesgo vital asociadas al uso de catéteres centrales, y casos de fracaso intestinal que conducen habitualmente a muerte precoz, como cuadros de intestino ultracorto, diarreas intratables, y fallo intestinal asociado a elevada morbilidad y mala calidad de vida. El TI se practica en clínica humana bajo tres modalidades técnicas: trasplante de intestino aislado, trasplante combinado de hígado intestino y trasplante multivisceral. Refinamientos de las técnicas originales, que incluyen reducciones de los injertos hepáticos y/o intestinales, la opción con injerto de donante vivo, etc. permiten actualmente cubrir las diferentes necesidades, a la vez que incrementar la probabilidad de acceso al trasplante, objetivo especialmente necesario en niños muy pequeños o de muy bajo peso candidatos a trasplante hepatointestinal. Uno de los aspectos más interesantes de los programas de TI es haber permitido la evolución hacia Unidades de Rehabilitación Intestinal, que integran en un equipo multidisciplinar las tres modalidades de tratamiento: soporte nutricional, farmacoterapia y cirugía. Estas Unidades optimizan los resultados, minimizan los costes y permiten ofrecer un tratamiento individualizado y adaptado a las necesidades individuales.The most recent outcomes on bowel transplantation (BT), with a survival rate immediately after transplant higher than 80% and a great rate of survivors achieving complete digestive autonomy and able to carry out activities according to their age allow for considering BT as the first choice therapy in patients with irreversible intestinal failure in whom poor prognosis with parenteral nutrition is foreseen. Parenteral nutrition-associated liver damage is the most frequent indication for BT, especially in children that are more susceptible than adults to develop this complication. Other accepted indications for BT are irreversible intestinal failure in association with loss of deep venous accesses, life-threatening severe infections associated with the use of central catheters, and those cases of intestinal failure usually leading to early death, such as ultra-short bowel syndromes, refractory diarrheas, and intestinal failure associated to high morbidity and poor quality of life. BT is performed in human clinical practice under three technical modalities: isolated bowel transplant, combined liver-bowel transplant, and multi-visceral transplantation. Currently, refinements of original techniques including reduction of liver and/or intestinal grafts, grafts from living donors, etc., allow for overcoming the different needs as well as increasing the likelihood of having access to transplantation, which is a desirable goal specially in very young or very low-weighted children candidate to liver-bowel transplant. One of the most interesting issues in BT programs is having given access to the Intestinal Rehabilitation Units, which comprise the three therapeutic modalities by means of a multidisciplinary team: nutritional support, pharmacotherapy, and surgery. These Units optimize the outcomes, minimize costs, and allow for offering a management adapted to individual needs.

El Fallo Intestinal en sus formas graves representa una de las patologías de manejo más complejo, tanto en niños como adultos. En adultos las causas más frecuentes son la Pseudoobstrucción Intestinal Crónica y el Síndrome del Intestino Corto severo que sigue a las grandes resecciones intestinales, sobre todo las debidas a isquemia mesentérica masiva, en el marco de cardiopatías que cursan con fibrilación auricular. El tratamiento fundamental tras la estabilización del paciente, está representado por el soporte nutricional por las vías parenteral y/o enteral, constituyendo la tolerancia a la dieta oral, el éxito final de la adaptación intestinal en estos procesos. La cirugía puede estar indicada en algunos casos para incrementar la superficie absortiva. La Nutrición Parenteral es una medida de apoyo fundamental, que a veces hay que mantener durante un tiempo prolongado, e incluso adquirir carácter permanente, salvo que complicaciones ligadas a la técnica, o la evolución clínica desfavorable, obliguen a alternativas quirúrgicas extremas como el trasplante intestinal. El tratamiento hormonal con factores estimulantes del trofismo abre nuevas alternativas que ya se están ensayando en humanos.Severe forms of intestinal failure represent one of the most complex pathologies to manage, in both children and adults. In adults, the most common causes are chronic intestinal pseudo-obstruction and severe short bowel syndrome following large intestinal resections, particularly due to massive mesenteric ischemic, within the context of cardiopathies occurring with atrial fibrillation. The essential management after stabilizing the patient consists in nutritional support, either by parenteral or enteral routes, with tolerance to oral diet being the final goal of intestinal adaptation in these pathologies. Surgery may be indicated in some cases to increase the absorptive surface area. Parenteral nutrition is an essential support measure that sometimes has to be maintained for long time, even forever, except for technique-related complications or unfavorable clinical course that would lead to extreme surgical alternatives such as intestinal transplantation. Hormonal therapy with trophism-stimulating factors opens new alternatives that are already being tried in humans.

Background: institutions with multidisciplinary teams have shown improvements in patient outcomes with intestinal failure. Multidisciplinary approach allows an integral management and effective communication between families and care teams.Objective: describe the multidisciplinary management and outcome in pediatric patients with intestinal failure.Methods: retrospective study in patients 18 years old or less, with intestinal failure and Total Parenteral Nutrition (TPN) required. Simple frequencies and percentages were used for qualitative variables, and central tendency and dispersion measures were used for quantitative variables.Results: 33 patients with a median follow up of 281 days were evaluated. The median duration of the TPN was 68 days and the mean of catheter-related infections was 2.26 per patient. In 31 patients oral or enteral nutrition was provided, starting in 61.3% of cases through tube and continuous infusion. As concomitant treatment 72.7% of children received ursodeoxycholic acid, 67.7%, cholestyramine 57.6% loperamide, 48.5% antibiotics and 36.4% probiotic. The families of 24 patients were evaluated by social work professionals. Intestinal autonomy was achieved in 69.7% of cases, 72.7% of them showed an improvement in the score z of weight and showed an end albumin significantly higher than the initial (p value: 0.012).Conclusions: the management of patients with intestinal failure is a challenge for health institutions and require care based on a standardized protocol and a multidisciplinary group. [ABSTRACT FROM AUTHOR]

El síndrome de intestino corto aparece por la reducción de la superficie absortiva intestinal efectiva por pérdida funcional o anatómica de una parte de intestino delgado. Se presenta el caso de una mujer de 35 años con síndrome de intestino corto severo secundario a isquemia intestinal aguda en la edad adulta, que presenta a los 5 años de evolución episodios de mareos con inestabilidad en la marcha y pérdida de fuerza en las manos, llegándose al diagnóstico de acidosis D-láctica. La acidosis D-láctica representa una complicación infrecuente, pero importante por su sintomatología, de este síndrome. Se debe a un cambio en la flora intestinal debido a un sobrecrecimiento de bacterias acidolácticas, que producen D-lactato. Debe sospecharse en aquellos casos de acidosis sin causa aparente y manifestaciones neurológicas sin focalidad en pacientes con síndrome de intestino corto o intervenidos de by-pass yeyuno-ileal. El tratamiento apropiado resuelve con frecuencia los síntomas neurológicos y previene o reduce las recurrencias.The short bowel syndrome appears for the reduction of intestinal absorptive surface due to functional or anatomical loss of part of the small bowel. We present the case of a 35-year-old woman with severe short bowel syndrome secondary to acute intestinal ischemia in adults, who presented at 5 years of evolution episodes of dizziness with gait instability and loss of strength in hands. The diagnosis was D-lactic acidosis. D-lactic acidosis is a rare complication, but important for their symptoms, of this syndrome. It is due to a change in intestinal flora secondary to an overgrowth of lactic acid bacteria that produce D-lactate. D-lactic acidosis should be looked for in cases of metabolic acidosis in which the identity of acidosis is not apparent, neurological manifestations without focality and the patient has short bowel syndrome or patients who have had jejunoileal bypass surgery. Appropiate treatment usually results in resolution of neurologic symptoms and prevents or reduces further recurrences.

Introduction: Intestinal failure is being an entity with higher prevalence in the pediatric age, especially due to bowel resections causing the appearance of a short bowel syndrome. Objectives: To determine the prevalence and etiology of cases of short bowel syndrome (SIC) and Intestinal Failure (FI) existing in Andalusia. Analyze factors involved in evolution, the number of transplant patients and to know the time required to achieve enteral autonomy, studying whether there are differences in management between different participants. Methods: Multicenter retrospective descriptive observational study in which are collected data of patients diagnosed with short bowel syndrome or intestinal failure in 6 hospitals in Andalusia in the period from 1 January 2008 to 31 January 2014. Results: 25 patients. Average age at diagnosis 7.4 months. Average length of remnant intestine: 113.8 cm; 64% of patients with <75 cm length remaining intestine. We show that: the early introduction of enteral nutrition is a factor favoring the suspension of the NP (p = 0'033); and that the prevention of liver disease associated with parenteral nutrition (EHANP) is favored by: the use of fewer lipid Parenteral Nutrition (p = 0'008), a greater length of remaining intestine (p = 0'049 ), the early introduction of enteral nutrition (p = 0'009) and a lower gestational age (p = 0'006). Discussion: Early Introduction of NE is essential for intestinal adaptation, weaning from PN and avoid the appearance of EHANP. The use of low amounts of lipids prevents development of EHANP. [ABSTRACT FROM AUTHOR]

Short bowel syndrome (SBS) is characterized by a significant reduction in the effective intestinal surface by an anatomical or functional loss of the small intestine. It mainly occurs after extensive bowel resection, intestinal intrinsic disease or surgical bypass. The main complications are malabsorption, maldigestion, malnutrition, dehydratation y, potentially, lethal metabolic lesions. The treatment is based on appropiate, individualized nutritional support; however, the most recent outcomes on bowel transplantation (BT) and a great rate of survivors achieving complete digestive autonomy and able to carry out activities according to theirage allow for considering BT as the first choice therapy in patients with irreversible intestinal failure in whom poor prognosis with parenteral nutrition is foreseen. In this paper the most outstanding aspects of SBS are revised. [ABSTRACT FROM AUTHOR]

La resección intestinal amplia produce suficientes alteraciones como para requerir soporte nutricional especializado. Las medidas básicas de tratamiento, especial-mente en la fase aguda tras la resección intestinal o en presencia de complicaciones graves sobre pacientes con intestino corto, incluyen la repleción de fluidos y electro-litos y la instauración de soporte nutricional con el fin de prevenir la malnutrición. La nutrición enteral es el principal factor estimulador de la adaptación del intestino remanente. No obstante, su aplicación presenta dificultades en las fases agudas, por lo que los pacientes deben ser tratados frecuentemente con nutrición parenteral. La presencia de desnutrición puede ser también de importancia en los pacientes con enfermedad inflamatoria intestinal. El soporte nutricional está indicado en estos casos como tratamiento primario de la enfermedad, como tratamiento de la desnutrición o como tratamiento perioperatorio en los pacientes que requieren cirugía. A pesar de la patología digestiva, existen datos para recomendar la nutrición enteral como método inicial para el aporte de nutrientes en los pacientes que lo precisen.Large intestinal resection produces a sufficient number of impairments as to require specialized nutritional support. Basic treatment measures, especially during the acute phase after intestinal resection or in the presence of severe complications in patients with short bowel syndrome, include fluid and electrolytes reposition and nutritional support implementation in order to prevent hyponutrition. Enteral nutrition is the main stimulating factor for adaptation of the remaining bowel. However, its application has some difficulties during the acute phase, and thus patients must be frequently treated with parenteral nutrition. The presence of hyponutrition may be also important in patients with intestinal inflammatory disease. Nutritional support is indicated in these cases as the primary treatment modality for the disease, as hyponutrition treatment, or as perioperative treatment in patients needing surgery. In spite of the digestive pathology, there are data to recommend enteral nutrition as the initial method for nutrients provision in patients that need it.

Introduction: Short bowel syndrome is associated with weight loss due to nutrient, electrolyte and fluid malabsorption. In view of the pathophysiology of SBS, all patients would be expected to exhibit similar clinical signs and symptoms, whereas many variations occur probably due to the adaptive capacity of the remaining small intestine in order to compensate for the resected area. Objective: To determine whether there is a difference in nutritional status and food intake between patients receiving PNT, patients who do not receive PNT but are monitored on an ambulatory basis, and control subjects, and 2) to determine body composition by two different methods, i.e., electrical bioimpedance and skin fold measurement. Methods: This was a case-control study where the subjects were divided into three groups: parenteral group (PG) – adults with a history of SBS intermittently using PNT; ambulatory group (AG) – adults with a history of SBS who do not receive PNT; control group (CG) – adults with no history of intestinal resections and/or use of PNT. The volunteers were submitted to measurements of body weight, height, body composition by bioimpedance analysis and assessment of food intake using a food frequency questionnaire. Univariate analysis of variance (ANOVA) with the aid of the SAS® 9.2. software, using the PROC GLM feature. The Student t-test was used to compare the instruments for the assessment of body composition, with the aid of the PROC TTEST feature of the SAS® 9.2 software. Results: Thirty-two volunteers, 19 women and 13 men, participated in the study. The PNT group consisted of 9 volunteers, 4 women and 5 men, with a mean (± SD) age of 57 ± 9 years. The nutrition status and food intake were different between the groups. There was no difference in percent body fat measured by anthropometry and bioimpedance analysis. Discussion and conclusion: Large resections, as well as the resected portions, explain the greater nutritional impairment of PG compared to AG and CG, although no significant difference in food consumption was detected between these three groups. Since the use of PNT can lead to a state of hyperhydration, the results of BIA should be interpreted with caution, in view of the fact that the lean mass determined by this method varies positively with the hydration state of an individual. [ABSTRACT FROM AUTHOR]

Background: The hepatopathy associated with short bowel syndrome (SBS) is a multifactorial disease associated with poor prognosis. Besides intestinal transplantation, no other treatment has been shown effective. The current study evaluated the efficacy of betaine for the treatment of hepatopathy associated with SBS. Methods: A prospective, unicentric, non-placebo controlled trial was carried out. After initial evaluation, 10g of betaine anhydrous was administrated to SBS patients in two divided doses for three months. The hepatic steatosis was assessed through nuclear magnetic resonance (NMR), the inflammatory response by interleukin- 6 (IL-6), tumor necrosis factor-α (TNF-α) and ferritin, besides the hepatic lesion through hepatic enzymes and bilirubin. Furthermore, the effect of betaine on homocysteine was evaluated as well as its safety and tolerability in this group of patients. Results: After three months supplementation, patients showed decreased percentage of hepatic fat (p = 0.03) through triphasic NMR examination. There was no significant reduction of serum levels for inflammatory proteins and hepatic lesion markers. Homocysteinemia also did not present significant decrease. The most prevalent side effects were diarrhea and nausea, reported in 62% of the participants; however, these symptoms were transient and not severe enough to justify the treatment interruption. Parenteral nutrition-dependent patients did not present different hepatic lesion degree compared to patients who do not need the prolonged use of it. Conclusions: Betaine was shown to be a potential agent for the treatment of hepatopathy associated with SBS, which was evidenced by NMR, although the markers for hepatic lesion have not presented significant decrease. [ABSTRACT FROM AUTHOR]

The short bowel syndrome (SIC) is a complex entity characterized by a malabsorptive state usually secondary to extensive intestinal resection originating a clinical, metabolic and/or nutritional disorder due to the reduction of the effective intestinal absorptive surface. The diagnosis is essentially clinical and, due to the patients malabsorptive process, it requires nutritional support to maintain their basic requirements, as the case reported. The clinical features of SIC patients depend on the grade of the alteration of function of the the small intestine or the impairment secondary to the surgical resection. We know that electrolytes are absorbed predominantly in the proximal gut. The regulation of ion/mineral levels depend on both the intestinal absorption and the renal excretion. We present an unusual case of SIC with only low absortion of magnesium. We discuss the most outstanding aspects of the case and review the literature. [ABSTRACT FROM AUTHOR]

The short bowel syndrome (SBS) is due to loss of bowel after surgery. Characterized by generalized nutrients malabsorption, its signs and symptoms include electrolyte imbalance, deficiency of vitamins, minerals and nutrients that can lead to death. Parenteral and enteral nutrition have a key role in its treatment. Objective: To describe the clinical course of a patient with SBS during continuous use of enteral nutrition supplemented with symbiotic. Case report: A seven-year-old male underwent an emergency laparotomy at 18 months old with a massive bowel resection, remaining about 20 cm of the small intestine and the entire colon. He was dependent of exclusive parenteral nutrition for over a year, leading to the occurrence of numerous infectious complications. Due to complications caused by prolonged use of central venous access, was unable to continue to receive the parenteral nutrition. Enteral nutrition by a nasogastric tube and supplemental symbiotic was the nutritional therapy option for him. The assessment of the volume of losses by the colostomy was measured daily. Results: There was a significant reduction of losses by colostomy, especially in the first days after introduction of the enteral nutrition plus symbiotic supplementation, as well as significant decrease in gas production. Conclusion: Despite the lack of evidence for a formal recommendation on the use of symbiotic for SBS patients, its use in the nutritional therapy of this patient resulted in reduced electrolyte loss electrolyte and consequent improvement of his clinical and nutritional condition. [ABSTRACT FROM AUTHOR]

Background: Citrullinemia is been reported as a quantitative parameter of the enterocyte mass and function. Aim: The objective of this research is to analyse the value of fasting and stimulated citrullinemias in the intestinal function evaluation. Methods: A case-control study was undertaken, including 11 patients with short bowel syndrome, 13 patients submitted to malabsorptive bariatric surgery and 11 healthy controls. Plasma levels of amino acids were determined, before and after a stimulation test with oral L-glutamine, by ion exchange chromatography. Results: Citrullinemia was inferior in short bowel patients (28,6 ± 11,3 versus 35,5 ± 11 in operated obese versus 32,2 ± 6,6 pmol/L in controls; n.s.) and lower than 25,5 μmol/L in 54,5% of them (versus 16,7%;p = 0,041 accuracy = 74 %; odds ratio = 3, 95 % CI 1,2-7,6). ΔCitrullihemia80 (relative variation of citrullinemia at the 80th minute of test) was lower in short bowel patients; its diagnostic accuracy was similar to baseline citrullinemia and also not significant. ΔCitrullinemia80 revealed a high predictive capacity of a short bowel inferior or equal to 50 cm (auR.O.C. = 82,3%; 95%CI 61,7-102,8;p = 0,038). Conclusions: In short bowel syndrome context, citrullihernia stimulation test with oral L-glutamine is feasible and it may improve the predictive capacity of severity. Further investigation is required to determine its clinical relevance and applicability. [ABSTRACT FROM AUTHOR]

Home parenteral nutrition (HPN) has a key role in the management of permanent or transient intestinal failure in the pediatric patient. Although its use is not without complications. We review our experience since the beginning of the program in 1993. Patients and methods: Longitudinal and retrospective study of the clinical records from 25 infants and children (11 boys, 14 girls) who received HPN in this period. If a patient received HPN in periods separated more than 3 months we consider a different episode. In this way, 32 episodes were described. Quantitative data are presented as mean or median and qualitative as frequency. Complications are presented as complication rate per 1,000 days of HPN. Results: 16 patients started HPN younger than 1 year. Total length of HPN was 9,986 days, median 174 days (range 7 to 2,444 days). Main indication was short bowel syndrome (n = 6); motility disorders (n = 6); chronic diarrhea (n = 5), malnutrition (n = 3) and other causes (n = 5). 47 catheters were used; mean length 212.5 days, median 120 days (range: 7 to 930). Most of central venous catheters were tunnelled catheters (n = 42); subcutaneous ports (n=3) and in two cases periferically inserted central catheters (PICCS). Complication rate per 1,000 days of HPN was: 3.4 for catheter-related infections, 0.1 for obstruction; 0.9 for leakage, and 0.1 for accidental removal. Most common microorganisms were Staphylococcus coagulase negative (47%), Gram negative bacteria (21%), Staphylococcus aureus (15%), fungi (9%) and others in 9%. Parenteral nutrition-associated liver disease was present in 4 patients. 21 patients were weaned off HPN, 3 patients deceased because of underlying disease, 2 patients underwent intestinal transplantation, while 5 patients continue in the program. Conclusions: Every year two new patients enter in the program. 65% of patients were weaned off HPN. Infectious complications were the most frequent (rate 3.4 infections per 1,000 days of HPN). Mean length of HPN was 174 days, and 120 days for cathete. [ABSTRACT FROM AUTHOR]

Introduction: The intensive care of patients at home had probed important benefits for the patient and the Health System. There are very few experiences of this kind of care from the Public Hospitals. Objective: To develop a social-sanitary analysis of the feasibility of the implementation of HPN on patients with short bowel syndrome (SBS) from a Public Hospital. Material and methods: Patients hospitalized between 1985-2009 were included. We analyzed: age, residual intestine length (RIL), time between the indication and the beginning of HPN, HPN duration, treatment modality and clinical outcome. Social determinants: home place, habitat conditions, employment conditions, educational level, social security and Low Socioeconomic Status (LSS). The group were divided in two: 1- patients with feasibility of HPN when it was prescribed; 2- patients without feasibility of HPN. Results: 61 patients were included, RIL x: 21.7 ± 11.6 cm. The HPN was feasible (G1) in 32 patients (52.4%) and no feasible (G2) in 29 (47.6%). The home treatment modality was in self-caring 25 (81%) and with nurses support 7 (19 %). The social determinants associated with the HPN feasibility were: more than one takecare (p 0.03), educational level (p 0.01), adequate habitat conditions (p 0.02) and Low Socioeconomic Status (LSS) (p 0.07). 17 patients reached intestinal adaptation (28%), 6 (10%) were transplanted, 19 (31%) died and 19 (31%) are actually on HPN. Conclusion: The HPN realized from the Public Hospital is feasible. Different social determinants were observed. The care of this group of patients must be done by an interdisciplinary group including general aspects of the child and the family. [ABSTRACT FROM AUTHOR]

Objectives: To report the Group Registry NADYA-SENPE data about home parenteral nutrition (HPN) in Spain in 2010. Material and methods: A descriptive study of the database of the national registry of HPN of NADYA-SENPE (December 10,2009 to December 10,2010). For the calculation of prevalence the latest data published by the Institute National Statistics Office (01/01/2009) was used. Results: There were registered 148 patients from 23 hospitals, 86 women (58.11%) and 9 children (6.08%). The average age of the 139 patients older than 14 years was 53.06 ± 15.41 years. The average duration of HPN was 316.97 days/patient. The most common diagnosis in those younger than 14 years was short bowel traumatic with 5 cases (55.55%) and in those older than 14 years, palliative care cancer with 29 cases (19.59%). The reason for the indication for HPN was short bowel syndrome in 74 cases (47%). The access via most frequently recorded was tunneled catheter in 36 cases (22.78%) followed by implanted port-catheters in 13 cases (8.23%) and other pathways in 3 cases (1.90%). There were 23 catheter-related infections (82.14%) which represented 0.49/1,000 days of PN, all of which occurred in cases older than 14 years. During the year 24 episodes of HPN ended, the most frequent cause was the transition to oral nutrition in 12 episodes (50%). It was reported that patients had a normal activity in 70 episodes of HPN (44.30%) with complete autonomy in 88 episodes (55.69%). Some patients 39 (24.68%) were potential candidates for intestinal transplantation. Conclusions: The number of registered patients is slightly lower than the previous year, although the number of participating hospitals is the same. The most frequent complication remains catheter-related infection but its incidence has decreased from previous years, presenting the lowest rate since the creation of the record. Differences in participation in the registry observed in the Autonomous Communities causes the development of implementation strategies. There is a gradual increase in day length of HPN over the years, which suggests the chronic treatments of some patients and obliges to study the existence of a possible confounding factor, in case there is an oversight of closing an episode. Therefore, it is necessary to update the registry with warning systems that facilitate periodic review of the patients and optimize the validity of registration. [ABSTRACT FROM AUTHOR]

Background: Parenteral nutrition (PN) is used to control the nutritional state after severe intestinal resections. Whenever possible, enteral nutrition (EN) is used to promote intestinal rehabilitation and reduce PN dependency. Our aim is to verify whether EN + oral intake (OI) in severe short bowel syndrome (SBS) surgical adult patients can maintain adequate nutritional status in the long term. Methods: This longitudinal retrospective study included 10 patients followed for 7 post-operative years. Body mass index (BMI), percentage of involuntary loss of usual body weight (UWL), free fat mass (FFM), and fat mass (FM) composition assessed by bioelectric impedance, and laboratory tests were evaluated at 6,12,24,36,48,60,72, and 84 months after surgery. Energy and protein offered in HPN and at long term by HEN+ oral intake (OI), was evaluated at the same periods. The statistical model of generalized estimating equations with p < 0,05 was used. Results: With long term EN + OI there was a progressive increase in the UWL, a decrease in BMI, FFM, and FM (p < 0,05). PN weaning was possible in eight patients. Infection due to central venous catheter (CVC) contamination was the most common complication (1.2 episodes CVC/patient/year). There was an increase in energy and protein intake supply provided by HEN+OI (p < 0.05). All patients survived for at least 2 years, seven for 5 years and six for 7 years of follow-up. Conclusions: In the long term SBS surgical adult patients fed with HEN+OI couldn't maintain adequate nutritional status with loss of FM and FFM. [ABSTRACT FROM AUTHOR]

Background & Aims: Short Bowel syndrome is a serious intestinal insufficiency. The most common etiology in adults nowadays is intestinal ischemia and inflammatory disease, while in children the most common are congenital anomalies, volvolus and necrotizing entero-colitis, which makes the TPN obligatory. However the intestine is intimately related to the liver through the entero-hepatic circulation and different endocrinological entero-hepatic systems. Massive intestinal resections and TPN would alter this relationship, and could change the hepatic tissue composition and its histomorphology. The aim of this work is to know these changes in more detail. Materials and methods: We used 3 experimental groups: Group A (10 guinea pigs), which was given anesthetic and a simple laparotomy and fed for 10 days with NPT. Group A (10 guinea pigs), underwent total thin intestine resection and were fed for 10 days with NTP. The control group (6 guinea pigs) underwent anesthetic and a simple sham laparotomy and were fed orally. After this period blood and hepatic tissue samples were taken in order to study the liver fat (total fat, proportion of neutral and polar lipids, proportion of phospholipids and fatty acids). Liver biopsies were taken and studied under an optical microscope. Results: The animals from group A and B, underwent NPT, showed a significant increase in glycémie and serum triglycerides, decreasing the cholesterol in GB. There was a significant decrease in weight and in the proportion of fat per g of the liver tissue, at a maximum level in GB, and an even higher decrease in the LP/LN ratio in GA and GB. There was also a change in the proportion of phospholipids, decreasing the Phosphatidili-nositol and increasing the Phosphatidiletanolamine. There was also a decrease in the AG w6/w3 ratio. Histologically appear a steatohepatitys, with a striking decrease in the mitochondrial density, being more intensive in GB. Conclusions: NPT alters the composition of the hepatic fat and the hystomorphology of the liver. The short bowel syndrome have more lesional mechanisms, favouring the hepatic damage caused by NPT. [ABSTRACT FROM AUTHOR]

The most recent outcomes on bowel transplantation (BT), with a survival rate immediately after transplant higher than 80% and a great rate of survivors achieving complete digestive autonomy and able to carry out activities according to their age allow for considering BT as the first choice therapy in patients with irreversible intestinal failure in whom poor prognosis with parenteral nutrition is foreseen. Parenteral nutrition-associated liver damage is the most frequent indication for BT, especially in children that are more susceptible than adults to develop this complication. Other accepted indications for BT are irreversible intestinal failure in association with loss of deep venous accesses, life-threatening severe infections associated with the use of central catheters, and those cases of intestinal failure usually leading to early death, such as ultra-short bowel syndromes, refractory diarrheas, and intestinal failure associated to high morbidity and poor quality of life. BT is performed in human clinical practice under three technical modalities: isolated bowel transplant, combined liver-bowel transplant, and multi-visceral transplantation. Currently, refinements of original techniques including reduction of liver and/or intestinal grafts, grafts from living donors, etc., allow for overcoming the different needs as well as increasing the likelihood of having access to transplantation, which is a desirable goal specially in very young or very low-weighted children candidate to liver-bowel transplant. One of the most interesting issues in BT programs is having given access to the Intestinal Rehabilitation Units, which comprise the three therapeutic modalities by means of a multidisciplinary team: nutritional support, pharmacotherapy, and surgery. These Units optimize the outcomes, minimize costs, and allow for offering a management adapted to individual needs. [ABSTRACT FROM AUTHOR]

Severe forms of intestinal failure represent one of the most complex pathologies to manage, in both children and adults. In adults, the most common causes are chronic intestinal pseudo-obstruction and severe short bowel syndrome following large intestinal resections, particularly due to massive mesenteric ischemic, within the context of cardiopathies occurring with atrial fibrillation. The essential management after stabilizing the patient consists in nutritional support, either by parenteral or enteral routes, with tolerance to oral diet being the final goal of intestinal adaptation in these pathologies. Surgery may be indicated in some cases to increase the absorptive surface area. Parenteral nutrition is an essential support measure that sometimes has to be maintained for long time, even forever, except for technique-related complications or unfavorable clinical course that would lead to extreme surgical alternatives such as intestinal transplantation. Hormonal therapy with trophism-stimulating factors opens new alternatives that are already being tried in humans. [ABSTRACT FROM AUTHOR]

The human intestine is a complex and variable in lenght organ, oscillating between 3 and 8 metres, depending on the individual characteristics and the techniques used to measure it. The main function of the intestine is to get a suitable incorporation of food into the body and this is carried out by menas of the digestion and food absorption processes. When these functions fail, Maldigestion and Malabsorption appear. These have characteristic clinical data and must be studied with the help of specific techniques for every digestive step and every food (fat malabsorption, proteins and carbohydrates tests). [ABSTRACT FROM AUTHOR]