Search

Short-bowel syndrome (SBS) is defined as a state of malabsorption after resection or loss of a major portion of the bowel due to congenital or acquired factors. This article presents an overview on the recent management of pediatric SBS. The pediatric SBS population is very heterogeneous. The incidence of SBS is estimated to be 24.5 per 100,000 live births. The nutritional, medical, and surgical therapies available require a comprehensive evaluation. Thus, multidisciplinary intestinal rehabilitation programs (IRPs) are necessary for the management of these complex patients. The key points of focus in IRP management are hepato-protective strategies to minimize intestinal failure-associated liver disease; the aggressive prevention of catheter-related bloodstream infections; strategic nutritional supply to optimize the absorption of enteral calories; and the management and prevention of small bowel bacterial overgrowth, nephrocalcinosis, and metabolic bone disease. As the survival rate of children with SBS currently exceeds 90%, the application of small bowel transplantation has been evolving. The introduction of innovative treatments, such as combined therapy of intestinotrophic hormones, including glucagon-like peptide-2, may lead to further improvements in patients' quality of life. [ABSTRACT FROM AUTHOR]

Chronic gastrointestinal diseases such as inflammatory bowel disease, malabsorption syndromes (e.g., intestinal lymphangiectasia, celiac disease, congenital chloride diarrhea, cystic fibrosis), and postsubtotal gastrectomy state or short-bowel syndrome after extensive bowel resection are related to poor bone health in pediatric patients due to increased risks of low bone mineral density, osteoporosis, and fractures. The pathophysiology of abnormal bone health in pediatric gastrointestinal diseases may present from inflammation to malabsorption. In children with chronic gastrointestinal diseases at high risk of poor bone health, routine evaluation using dual-energy X-ray absorptiometry and appropriate prevention or treatment strategies are needed. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric patients with intestinal failure need long-term parenteral nutrition (PN), but this nutritional support causes liver dysfunction, such as intestinal failure-associated liver disease (IFALD). Several studies have shown that the lipid emulsion produced by soybean oil (SO) is associated with the occurrence of IFALD. In this study, we evaluated the effect of SO and fish oil (FO) lipid emulsion on hepatic steatosis.Methods: Sprague-Dawley rats underwent jugular vein catheterization and were divided into three groups: sham operation with normal chow (Sham group), 80% small bowel resection (80% SBR) + TPN with SO lipid emulsion (SO group), and 80% SBR + TPN with FO lipid emulsion (FO group). All rats were euthanized and the serum biochemistry and hepatic histology analyzed.Results: No significant differences in the serum liver or biliary enzymes were noted between the SO and FO groups. The pathological findings and NAFLD score in the FO group did not show steatosis and were significantly lower than in the SO group. An analysis of the fatty acids profile in the both the SO and FO groups did not indicate essential fatty acid deficiency (EFAD).Conclusion: FO lipid emulsion may have a protective role against steatosis of IFALD without EFAD. [ABSTRACT FROM AUTHOR]

Purpose: Short-bowel syndrome (SBS) is associated with high morbidity and mortality. We conducted this study to establish the predictors of survival and weaning off parenteral nutrition (PN). Methods: We reviewed the medical records of 16 SBS infants treated at our institution within a 30-year period. SBS was defined as a residual small-bowel length (RSBL) of <75 cm. Loss of the ileocecal valve (ICV), cholestasis (D-Bil >2.0 mg/dl), enterostomy, and RSBL were all evaluated. Kaplan-Meier analysis was used to analyze the predictors. Results: The mean RSBL was 34.9 ± 22.9 cm. Six patients died (37.5%) and nine patients were weaned off PN (56.3%). Significant differences were observed in cholestasis ( p < 0.03), enterostomy ( p < 0.01), an absolute RSBL of <30 cm ( p < 0.04), and a percentage of expected RSBL of <10% ( p < 0.04) as survival predictors. Significant differences were also observed for cholestasis ( p < 0.01), loss of the ICV ( p < 0.04), an absolute RSBL of <20 cm ( p < 0.01), and a percentage of expected RSBL of <10% ( p < 0.03) as predictors of weaning off PN. Conclusion: These predictors may help us select the optimal treatments for pediatric patients with SBS. [ABSTRACT FROM AUTHOR]

Aim of the study:Insufficient data are available to determine the most suitable extent of intestinal resection required to induce short-bowel syndrome (SBS) in pigs. This study aimed to compare the three main SBS-models published.Methods:A 75%, 90%, or 100% mid-intestinal resection was performed in groups ofn= 5 pigs each. Clinical (body weight, stool consistency) and biochemical (serum eletrolytes, citrulline, albumin, prealbumin, and transferrin) parameters were determined daily, functional (D-xylose resorption) and histological (intestinal villus length) parameters were determined after 2 weeks. At-test and ANOVA were used for statistical analysis.Results:Only in the 100% group, we observed a persistent weight loss (13.6 ± 3.8%) and diarrhea, as well as a decrease in prealbumin-levels (41%) and transferrin levels (33%). Serum electrolytes remained stable in all groups during the observation period. Citrulline stabilized at different levels (100% group 13.9 ± 1.0 μmol/L; 90% group 18.8 ± 1.0 μmol/L; 75% group 26.3 ± 1.4 μmol/L; allp< .05). D-xylose resorption was lowest in the 100%, followed by 90% and 75% group (100% group 32.8 ± 4.9 mg/L; 90% group 50.0 ± 19.6 mg/L; 75% group 57.8 ± 8.8 mg/L;p= .393). Intestinal villus length decreased in all groups (100% group 11.0%; 90% group 14.0%; 75% group 19.1%).Conclusions:75% intestinal resection is less suitable as an SBS model, as animals tend to recover remarkably. The 90% model is suitable for longer-term studies, as animals might survive longer due to partial compensation. Due to severe nutritional, biochemical, and physiological derangements, the 100% model can only be used for acute experiments and those immediately followed by small bowel transplantation. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study was performed to analyze the potential benefits of probiotics on experimental short-bowel syndrome (SBS). Methods: Forty-eight male Wistar-Albino rats were used in the study. The animals were divided into 6 groups as follows: control, rats that received probiotics, rats that underwent intestinal transection and anastomosis, rats that underwent anastomosis and received probiotics, rats that underwent 75% intestinal resection, and rats that underwent 75% intestinal resection plus received probiotics. Body weight monitoring, intestinal bowel diameter, villus length and crypt depth measurements, goblet cell count, mitosis, and immunohistochemical evaluation were used for the assessment of intestinal proliferation ability. Results: Statistical analysis showed a significant difference in villus length, crypt depth, goblet cell count in villus and crypt, mitosis, and immunohistochemical evaluation in the jejunum when the SBS group was compared with the SBS group that received probiotics. There was no significant difference in these parameters in ileum. Conclusions: This trial clearly has shown that probiotics had a positive impact on jejunum in the experimental SBS. [Copyright &y& Elsevier]

Keywords: Crohn's disease; fibrostenosing jejunoileal disease; inflammatory bowel disease; Michelassi's strictureplasty; short-bowel syndrome; side-to-side isoperistaltic strictureplasty; strictureplasty; terminal ileitis EN Crohn's disease fibrostenosing jejunoileal disease inflammatory bowel disease Michelassi's strictureplasty short-bowel syndrome side-to-side isoperistaltic strictureplasty strictureplasty terminal ileitis 2343 2343 1 12/31/20 20201201 NES 201201 Up to 50% of patients with Crohn's disease will have surgery in the 10 years following the diagnosis [1]. Footnotes 1 Accepted Article online 30 July 2020 References 1 Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn's disease: ileocaecal Crohn's disease. Crohn's disease, fibrostenosing jejunoileal disease, inflammatory bowel disease, Michelassi's strictureplasty, short-bowel syndrome, side-to-side isoperistaltic strictureplasty, strictureplasty, terminal ileitis. [Extracted from the article]