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Shariatzadeh S, Sazi AT, Dunn JCY. Distraction Enterogenesis Induces Desert Hedgehog in the Lengthened Murine Colon. J Pediatr Surg 2024; 59:161960. [PMID: 39349347 DOI: 10.1016/j.jpedsurg.2024.161960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 09/06/2024] [Accepted: 09/17/2024] [Indexed: 10/02/2024]
Abstract
BACKGROUND Distraction enterogenesis lengthens the intestine through applied mechanical stress. The Hedgehog pathway (Hh) is responsible for intestinal tract development and directing the multi-layer patterning of the intestinal lumen. This study investigates the alteration in the principal components of this pathway in spring-mediated colonic lengthening. METHODS Samples from the murine cecal lengthening model were used to study Hh alteration during the cecal lengthening process. Primary components of this pathway were analyzed using RT-qPCR and immunostaining after 7 and 14 days of force application. The spring-mediated lengthened segments were compared to untreated control segments within each animal. RESULTS The spring-treated segments showed a 50% increase in length. There was a significant increase in the expression of the Desert Hedgehog ligand as opposed to the Sonic Hedgehog and Indian Hedgehog ligands. Additionally, the downstream targets of the pathway, Gli1, Gli2, and Gli3, were significantly overexpressed. The highest alterations in these components occurred at the earlier time point, after 7 days. CONCLUSIONS These findings highlight the contribution of the conserved Hedgehog developmental pathway during mechanical force-induced cecal lengthening, primarily through the Desert Hedgehog ligand. These data suggest that the Desert Hedgehog pathway may serve as therapeutic targets for intestinal regeneration.
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Affiliation(s)
| | | | - James C Y Dunn
- Department of Surgery, Stanford University, Stanford, CA, United States; Division of Bioengineering, Stanford University, Stanford, CA, United States.
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Mlaver E, Smith SR, Matar AJ, Zhao VM, Leong R, Sharma J, Srinivasan JK, Galloway JR. Serial transverse enteroplasty in adults with parenteral nutrition dependence: A case series. JPEN J Parenter Enteral Nutr 2024; 48:965-973. [PMID: 39221785 DOI: 10.1002/jpen.2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/07/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Serial transverse enteroplasty is used to treat patients with chronic intestinal failure owing to short bowel syndrome. Current literature lacks discussion of its role for other etiologies of intestinal failure and its impact on adult patients' nutrition support needs and quality of life. METHODS We performed a case series on adults with parenteral nutrition (PN) dependence who underwent serial transverse enteroplasty at Emory University Hospital, a quaternary referral center between 2011 and 2022. Data collected included demographics, operative technique, and preoperative and postoperative PN requirements. A phone survey was administered to evaluate the impact of PN and the operation on quality of life. RESULTS Ten patients underwent the procedure of interest during the study period. Indications included short bowel syndrome following multiple abdominal operations or intra-abdominal catastrophe and chronic partial bowel obstruction with dysmotility. Bowel length increased by a median of 83%. All patients were discharged home after a median hospital stay of 21 days. At 1-year follow-up, survival was 100%, two (20%) patients fully weaned from PN, three others (30%) reduced PN frequency, and six (60%) decreased their daily parenteral energy requirement. Two additional patients fully weaned from PN by 18 months postoperatively. CONCLUSION This represents one of the largest case series of serial transverse enteroplasty in adults. Small intestinal length nearly doubled, and PN dependence was reduced in most patients. Given the low morbidity and good quality of life observed in this series, this procedure should be more widely investigated for patients with chronic intestinal failure.
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Affiliation(s)
- Eli Mlaver
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Savannah R Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Abraham J Matar
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vivian M Zhao
- Department of Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Rachel Leong
- Department of Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Jyotirmay Sharma
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jahnavi K Srinivasan
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John R Galloway
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
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He QN, Chen L, Hu HY, Yang Z, Huang JY, Miao SL, Chen FF. Role of spleen density in predicting postoperative complications in patients with acute mesenteric ischemia. Vascular 2024; 32:1026-1035. [PMID: 36946194 DOI: 10.1177/17085381231164663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is a life-threatening surgical emergency with a poor prognosis. This study assessed the association of diffuse reduction of spleen density (DROSD) with postoperative complications and identified risk factors for adverse outcomes in AMI patients after surgery. METHODS Patients who were diagnosed with AMI and underwent surgical operations between April 2006 and July 2021 were enrolled. Spleen density was assessed using preoperative non-enhanced computed tomography. The lowest quartile of spleen density in all patients was regarded as the cutoff value for DROSD. Univariate and multivariate analyses were performed to determine the risk factors related to postoperative outcomes after surgery. RESULTS According to the diagnostic cutoff, patients with a spleen density ≤49.07 HU were defined as DROSD. In a cohort of 97 patients, 34.0% developed complications within 30 days of surgery. The multivariate analysis illustrated that DROSD was an independent risk factor for prognostic outcomes in AMI patients after surgery. CONCLUSION Patients with low spleen density were prone to postoperative complications. As an imaging method, preoperative assessment of spleen density is a novel predictor that can be used clinically to identify high-risk AMI patients with poor prognosis.
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Affiliation(s)
- Qi-Na He
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, China
| | - Lang Chen
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, China
| | - Han-Yu Hu
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, China
| | - Zhe Yang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing-Yong Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shou-Liang Miao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fan-Feng Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Ramírez-Ochoa S, Zepeda-Gutiérrez LA, Ambriz-Alarcón MA, Vicente-Hernández B, Cervantes-Guevara G, Castro Campos KD, Valencia-López K, Cervantes-Pérez G, Ruiz-León M, Hernández-Mora FJ, Cervantes-Nápoles TE, Flores-Villavicencio ME, Sánchez-Sánchez SO, Cervantes-Pérez E. A Multidisciplinary Approach to the Classification and Management of Intestinal Failure: Knowledge in Progress. Diagnostics (Basel) 2024; 14:2114. [PMID: 39410518 PMCID: PMC11475224 DOI: 10.3390/diagnostics14192114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 09/06/2024] [Accepted: 09/20/2024] [Indexed: 10/20/2024] Open
Abstract
Intestinal failure (IF) is a debilitating condition characterized by the insufficient function of the gastrointestinal tract to absorb nutrients and fluids essential for life. This review consolidates recent advancements and challenges in managing IF among adult and pediatric populations, highlighting differences in etiology, management, and outcomes. Over the recent years, significant strides have been made in the nutritional and medical management of IF, significantly reducing mortality rates and improving the quality of life for patients. Key advancements include the development and availability of glucagon-like peptide-2 (GLP-2) analogs, improved formulations of parenteral nutrition, and the establishment of specialized interdisciplinary centers. Short bowel syndrome (SBS) remains the predominant cause of IF globally. The pediatric segment is increasingly surviving into adulthood, presenting unique long-term management challenges that differ from adult-onset IF. These include the need for tailored nutritional support, management of IF-associated liver disease, and addressing growth and neurodevelopmental outcomes. The therapeutic landscape for IF continues to evolve with the development of new treatment modalities and better understanding of the condition's pathophysiology. However, disparities in treatment outcomes between children and adults suggest the need for age-specific management strategies. This review underscores the importance of a nuanced approach to IF, incorporating advancements in medical science with a deep understanding of the distinct needs.
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Affiliation(s)
- Sol Ramírez-Ochoa
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico; (S.R.-O.); (L.A.Z.-G.); (B.V.-H.); (K.D.C.C.); (K.V.-L.); (G.C.-P.); (M.R.-L.); (S.O.S.-S.)
| | - Luis Asdrúval Zepeda-Gutiérrez
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico; (S.R.-O.); (L.A.Z.-G.); (B.V.-H.); (K.D.C.C.); (K.V.-L.); (G.C.-P.); (M.R.-L.); (S.O.S.-S.)
| | | | - Berenice Vicente-Hernández
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico; (S.R.-O.); (L.A.Z.-G.); (B.V.-H.); (K.D.C.C.); (K.V.-L.); (G.C.-P.); (M.R.-L.); (S.O.S.-S.)
| | - Gabino Cervantes-Guevara
- Department of Gastroenterology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara 44280, Jalisco, Mexico;
- Department of Welfare and Sustainable Development, Centro Universitario del Norte, Universidad de Guadalajara, Colotlán 46200, Jalisco, Mexico
| | - Karla D. Castro Campos
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico; (S.R.-O.); (L.A.Z.-G.); (B.V.-H.); (K.D.C.C.); (K.V.-L.); (G.C.-P.); (M.R.-L.); (S.O.S.-S.)
| | - Karla Valencia-López
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico; (S.R.-O.); (L.A.Z.-G.); (B.V.-H.); (K.D.C.C.); (K.V.-L.); (G.C.-P.); (M.R.-L.); (S.O.S.-S.)
| | - Gabino Cervantes-Pérez
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico; (S.R.-O.); (L.A.Z.-G.); (B.V.-H.); (K.D.C.C.); (K.V.-L.); (G.C.-P.); (M.R.-L.); (S.O.S.-S.)
| | - Mariana Ruiz-León
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico; (S.R.-O.); (L.A.Z.-G.); (B.V.-H.); (K.D.C.C.); (K.V.-L.); (G.C.-P.); (M.R.-L.); (S.O.S.-S.)
| | - Francisco Javier Hernández-Mora
- Department of Human Reproduction, Growth and Child Development, Health Sciences University Center, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico;
| | - Tania Elizabeth Cervantes-Nápoles
- Department of Philosophical, Methodological and Instrumental Disciplines, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico;
| | - María Elena Flores-Villavicencio
- Departament of Social Sciences, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico;
| | - Sandra O. Sánchez-Sánchez
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico; (S.R.-O.); (L.A.Z.-G.); (B.V.-H.); (K.D.C.C.); (K.V.-L.); (G.C.-P.); (M.R.-L.); (S.O.S.-S.)
| | - Enrique Cervantes-Pérez
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico; (S.R.-O.); (L.A.Z.-G.); (B.V.-H.); (K.D.C.C.); (K.V.-L.); (G.C.-P.); (M.R.-L.); (S.O.S.-S.)
- Department of Philosophical, Methodological and Instrumental Disciplines, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico;
- Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Zúñiga 45641, Jalisco, Mexico
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Wang X, Chen H, Han S, Li L, Chen H, Yang B. The real-world analysis of adverse events with teduglutide: a pharmacovigilance study based on the FAERS database. Front Pharmacol 2024; 15:1404658. [PMID: 39329127 PMCID: PMC11424547 DOI: 10.3389/fphar.2024.1404658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/20/2024] [Indexed: 09/28/2024] Open
Abstract
Background Teduglutide, the first glucagon-like peptide 2 analogue, has been demonstrated to facilitate the absorption of gut nutrient and lessen the need for parenteral assistance in patients with Short Bowel Syndrome (SBS). However, its adverse drug events (AEs) are primarily documented in clinical trials, with a deficit in real-world data. This study evaluates the AEs profile of teduglutide based on Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) data. Method A disproportionality analysis of FAERS data from Quarter 1 (Q1) 2013 to Quarter 3 (Q3) 2023 was conducted to examine the association between teduglutide and adverse events, employing Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM) methods. Results Out of 13,809,302 reports in the FAERS database, 10,114 reports identified teduglutide as the "primary suspect" in AEs identification. During the dosing observation period, the median occurrence of adverse events was 393 days (interquartile range [IQR] 97-996 days). Teduglutide-associated AEs occurred in 27 System Organ Classes (SOC), of which renal and urinary disorders is not mentioned in the specification. Based on the four algorithms, a total of 260 major disproportionality preferred terms (PTs) were filtered out, including previously unreported AEs including weight decreased (n = 805), vascular device infection (n = 683), dehydration (n = 596) and nephrolithiasis (n = 146). Conclusion Our findings corroborate the AEs listed in the teduglutide prescribing information and additionally unveil new adverse reaction signals such as nephrolithiasis. These discoveries could aid in clinical monitoring and risk identification for teduglutide.
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Affiliation(s)
- Xiaogan Wang
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hao Chen
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shuangshuang Han
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Lingbo Li
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hongjin Chen
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Bolin Yang
- Inflammatory Bowel Disease Center/Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Siddiqui MT, Coughlin KL, Koenen B, Al-Yaman W, Bestgen A, Regueiro M, Kirby DF. Association between tunneled catheter placement and catheter-associated deep venous thrombosis in adults with inflammatory bowel disease receiving home parenteral nutrition: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:562-570. [PMID: 38949827 DOI: 10.1002/jpen.2647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at increased risk of thrombosis. They often need parenteral nutrition (PN) requiring intravenous access for prolonged periods. We assessed the risk of deep vein thrombosis (DVT) associated with peripherally inserted central catheters (PICCs) and tunneled catheters for patients with IBD receiving home PN (HPN). METHODS Using the Cleveland Clinic HPN Registry, we retrospectively studied a cohort of adults with IBD who received HPN between June 30, 2019 and January 1, 2023. We collected demographics, catheter type, and catheter-associated DVT (CADVT) data. We performed descriptive statistics and Poisson tests to compare CADVT rates among parameters of interest. We generated Kaplan-Meier graphs to illustrate longevity of CADVT-free survival and a Cox proportional hazard model to calculate the hazard ratio associated with CADVT. RESULTS We collected data on 407 patients, of which, 276 (68%) received tunneled catheters and 131 (32%) received PICCs as their initial catheter. There were 17 CADVTs with an overall rate of 0.08 per 1000 catheter days, whereas individual rates of DVT for PICCs and tunneled catheters were 0.16 and 0.05 per 1000 catheter days, respectively (P = 0.03). After adjusting for age, sex, and comorbidity, CADVT risk was significantly higher for PICCs compared with tunneled catheters, with an adjusted hazard ratio of 2.962 (95% CI=1.140-7.698; P = 0.025) and adjusted incidence rate ratio of 3.66 (95% CI=2.637-4.696; P = 0.013). CONCLUSION Our study shows that CADVT risk is nearly three times higher with PICCs compared with tunneled catheters. We recommend tunneled catheter placement for patients with IBD who require HPN infusion greater than 30 days.
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Affiliation(s)
- Mohamed Tausif Siddiqui
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kathleen L Coughlin
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Koenen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Wael Al-Yaman
- Department of Gastroenterology and Hepatology, St. Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | - Ashley Bestgen
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald F Kirby
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Iyer KR. Indications for Intestinal Transplantation. Gastroenterol Clin North Am 2024; 53:233-244. [PMID: 38719375 DOI: 10.1016/j.gtc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Outcomes for patients with chronic intestinal failure have improved with organization of experts into multidisciplinary teams delivering care in intestinal rehabilitation programs. There have been improvements in understanding of intestinal failure complications as well as development of newer therapies that have amplified the improvements in survival. In spite of this encouraging trend, patients who fail PN are often referred too late for intestinal transplantation. The author proposes a more rational framework that might allow earlier identification of intestinal failure patients at risk for PN-failure, who could appropriately be considered earlier for intestinal transplantation with improvements in overall outcomes.
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Affiliation(s)
- Kishore R Iyer
- Intestinal Rehabilitation & Transplant Program, Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, One Gustave Levy Place, Box 1104, New York 10029, USA.
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Ricci L, Joly F, Coly A, Guillemin F, Quilliot D. Important issues in proposing autonomy training in home parenteral nutrition for short bowel syndrome patients: a qualitative insight from the patients' perspectives. Eur J Clin Nutr 2024; 78:436-441. [PMID: 38424159 DOI: 10.1038/s41430-024-01415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES The standard treatment for short bowel syndrome is home parenteral nutrition. Patients' strict adherence to protocols is essential to decrease the risk of complications such as infection or catheter thrombosis. Patient training can even result in complete autonomy in daily care. However, some patients cannot or do not want too much responsibility. However, doctors often encourage them to acquire these skills. Based on qualitative investigations with patients, we wanted to document issues of importance concerning perceptions of autonomy in daily care. METHODS Semistructured interviews were conducted with 13 adult patients treated by home parenteral nutrition using a maximum variation sampling strategy. We proceeded to a thematic analysis following an inductive approach. RESULTS After achieving clinical management of symptoms, a good quality of life is within the realm of possibility for short bowel syndrome patients with home parenteral nutrition. In this context, achieving autonomy in home parenteral nutrition could be a lever to sustain patients' quality of life by providing better life control. However, counterintuitively, not all patients aim at reducing constraints by reaching autonomy in home parenteral nutrition. First, they appreciate the social contact with the nurses, which is particularly true among patients who live alone. Second, they can feel safer with the nurse's visits. Regaining freedom was the main motivation for patients in the training program and the main benefit for those who were already autonomous. CONCLUSIONS Medical teams should consider patients' health locus of control (internal or external) for disease management to support them concerning the choice of autonomy in daily care for parenteral nutrition.
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Affiliation(s)
- Laetitia Ricci
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000, Nancy, France.
- Université de Lorraine, Inserm, INSPIIRE, F-54000, Nancy, France.
| | - Francisca Joly
- Department of Gastroenterology and Nutritional Support, Center for Intestinal Failure, Reference Centre of Rare Disease MarDI, AP-HP Beaujon Hospital, University of Paris Inserm UMR, 1149, Paris, France
| | - Alfa Coly
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000, Nancy, France
| | - Francis Guillemin
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, F-54000, Nancy, France
- Université de Lorraine, Inserm, INSPIIRE, F-54000, Nancy, France
| | - Didier Quilliot
- Department of Diabetology-Endocrinology-Nutrition, Brabois Hospital, Nancy University Hospital, 54511, Vandoeuvre-lès-Nancy, France
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9
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Dahiya DS, Wachala J, Solanki S, Solanki D, Kichloo A, Holcomb S, Mansuri U, Haq KS, Ali H, Gangwani MK, Shah YR, Varghese T, Khan HMA, Horslen SP, Schiano TD, Jafri SM. Sepsis during short bowel syndrome hospitalizations: Identifying trends, disparities, and clinical outcomes in the United States. World J Gastrointest Pathophysiol 2024; 15:92085. [PMID: 38682025 PMCID: PMC11045357 DOI: 10.4291/wjgp.v15.i1.92085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/10/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Short bowel syndrome (SBS) hospitalizations are often complicated with sepsis. There is a significant paucity of data on adult SBS hospitalizations in the United States and across the globe. AIM To assess trends and outcomes of SBS hospitalizations complicated by sepsis in the United States. METHODS The National Inpatient Sample was utilized to identify all adult SBS hospitalizations between 2005-2014. The study cohort was further divided based on the presence or absence of sepsis. Trends were identified, and hospitalization characteristics and clinical outcomes were compared. Predictors of mortality for SBS hospitalizations complicated with sepsis were assessed. RESULTS Of 247097 SBS hospitalizations, 21.7% were complicated by sepsis. Septic SBS hospitalizations had a rising trend of hospitalizations from 20.8% in 2005 to 23.5% in 2014 (P trend < 0.0001). Compared to non-septic SBS hospitalizations, septic SBS hospitalizations had a higher proportion of males (32.8% vs 29.3%, P < 0.0001), patients in the 35-49 (45.9% vs 42.5%, P < 0.0001) and 50-64 (32.1% vs 31.1%, P < 0.0001) age groups, and ethnic minorities, i.e., Blacks (12.4% vs 11.3%, P < 0.0001) and Hispanics (6.7% vs 5.5%, P < 0.0001). Furthermore, septic SBS hospitalizations had a higher proportion of patients with intestinal transplantation (0.33% vs 0.22%, P < 0.0001), inpatient mortality (8.5% vs 1.4%, P < 0.0001), and mean length of stay (16.1 d vs 7.7 d, P < 0.0001) compared to the non-sepsis cohort. A younger age, female gender, White race, and presence of comorbidities such as anemia and depression were identified to be independent predictors of inpatient mortality for septic SBS hospitalizations. CONCLUSION Septic SBS hospitalizations had a rising trend between 2005-2014 and were associated with higher inpatient mortality compared to non-septic SBS hospitalizations.
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Affiliation(s)
- Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States
| | - Jennifer Wachala
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
| | - Shantanu Solanki
- Division of Gastroenterology Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Dhanshree Solanki
- Department of Medicine, Institute for Foreign Medical Graduate Education, Houston, TX 77030, United States
| | - Asim Kichloo
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
| | - Samantha Holcomb
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
| | - Uvesh Mansuri
- Department of Internal Medicine, MedStar Harbor Hospital, Baltimore, MD 21225, United States
| | - Khwaja Saad Haq
- Department of Internal Medicine, WellStar Spalding Regional Hospital, Griffin, GA 30224, United States
| | - Hassam Ali
- Division of Gastroenterology, Hepatology and Nutrition, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States
| | - Manesh Kumar Gangwani
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Yash R Shah
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States
| | - Teresa Varghese
- Department of Internal Medicine, WellStar Spalding Regional Hospital, Griffin, GA 30224, United States
| | - Hafiz Muzaffar Akbar Khan
- Division of Gastroenterology and Hepatology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
| | - Simon Peter Horslen
- Department of Pediatrics, School of Medicine and UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15219, United States
| | - Thomas D Schiano
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Syed-Mohammed Jafri
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, MI 48202, United States
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10
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Hirsch TI, Wang SZ, Fligor SC, Quigley M, Gura KM, Puder M, Tsikis ST. Fat malabsorption in short bowel syndrome: A review of pathophysiology and management. Nutr Clin Pract 2024; 39 Suppl 1:S17-S28. [PMID: 38429962 PMCID: PMC10914324 DOI: 10.1002/ncp.11119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/13/2023] [Accepted: 12/28/2023] [Indexed: 03/03/2024] Open
Abstract
Fat malabsorption is central to the pathophysiology of short bowel syndrome (SBS). It occurs in patients with insufficient intestinal surface area and/or function to maintain metabolic and growth demands. Rapid intestinal transit and impaired bile acid recycling further contribute to fat malabsorption. A significant portion of patients require parenteral nutrition (PN) for their survival but may develop sepsis and liver dysfunction as a result. Despite advancements in the treatment of SBS, fat malabsorption remains a chronic issue for this vulnerable patient population. Peer-reviewed literature was assessed on the topic of fat malabsorption in SBS. Current management of patients with SBS involves dietary considerations, PN management, antidiarrheals, glucagon-like peptide 2 agonists, and multidisciplinary teams. Clinical trials have focused on improving intestinal fat absorption by facilitating fat digestion with pancreatic enzymes. Targeting fat malabsorption in SBS is a potential pathway to improving lifestyle and reducing morbidity and mortality in this rare disease.
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Affiliation(s)
- Thomas I. Hirsch
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Z. Wang
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott C. Fligor
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Mikayla Quigley
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathleen M. Gura
- Department of Pharmacy and the Division of Gastroenterology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Puder
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Savas T. Tsikis
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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11
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Ukkola-Vuoti L, Tuominen S, Pohju A, Kovac B, Lassenius MI, Merras-Salmio L, Pakarinen MP, Sallinen V, Pikkarainen S. Expenditure and survival of adult patients with intestinal failure due to short bowel syndrome: real-world evidence from Southern Finland. Scand J Gastroenterol 2024; 59:401-410. [PMID: 38217349 DOI: 10.1080/00365521.2024.2303063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Comprehensive follow-up data from the largest hospital district in Finland was used to assess hospital-based healthcare resource utilization (HCRU) and expenses, incidence and prevalence, survival, and effect of comorbidities/complications on survival of adult patients with intestinal failure due to short bowel syndrome (SBS-IF). METHODS This study utilized electronic healthcare data covering all ≥18-year-old patients with SBS-IF at the Hospital District of Helsinki and Uusimaa in Finland between 2010 and 2019. Patients were followed from SBS-IF onset until the end of 2020 or death and compared to birth year and sex-matched control patients without SBS-IF. RESULTS The study included 77 patients with SBS-IF (cases) and 363 controls. Cases had high HCRU; the cumulative expenses were about tenfold compared to the controls, at the end of the study (€123,000 vs. €14,000 per patient). The expenses were highest during the first year after SBS-IF onset (€53,000 per patient). Of the cases with a median age 62.5 years, 51.9% died during study time. The median survival was 4.4 years from SBS-IF onset and cases died 13.5 times more likely during the follow-up compared to controls. Mortality risk was lower in female cases (hazard ratio (HR) 0.46; 95% confidence intervals (CI) 0.24, 0.9) and higher with presence of comorbidities (Charlson comorbidity index HR 1.55; 95% CI 1.2, 2.0) and mesenteric infarction (HR 4.5; 95% CI 1.95, 10.36). The incidence of adult SBS-IF was 0.6 per 100,000 adults. CONCLUSION Our study demonstrates a high demand for healthcare support and elevated mortality in adult SBS-IF-patients. Our results suggest that the presence of comorbidities is a key driver for mortality.
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Affiliation(s)
| | | | - Anne Pohju
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland
| | - Bianca Kovac
- Gastroenterolgy Department, Takeda Oy, Helsinki, Finland
| | | | - Laura Merras-Salmio
- Helsinki University Hospital, Pediatric Gastroenterology Unit, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko P Pakarinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Women's Health, Karolinska Institute, Solna, Sweden
| | - Ville Sallinen
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sampsa Pikkarainen
- Abdomen Center, Gastroenterology Unit, Helsinki University Hospital, Helsinki, Finland
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12
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Švagždys S, Smolskaitė I, Vindžigalskytė R. Parenteral nutrition: a life-saving intervention for 4 months in short bowel syndrome-a case report and review of the literature. J Med Case Rep 2024; 18:122. [PMID: 38509559 PMCID: PMC10956210 DOI: 10.1186/s13256-024-04442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Short bowel syndrome (SBS) in adults is defined as having less than 180 to 200 cm of remaining small bowel. Many literature sources do not provide precise epidemiological data, and challenges in estimating the prevalence of SBS include its multifactorial etiology and varying definitions. The most common pathologies leading to SBS include Crohn disease, mesenteric ischemia, radiation enteritis, post-surgical adhesions, and post-operative complications. CASE PRESENTATION This article presents a clinical case of a 76-year-old Lithuanian patient who underwent parenteral nutrition for four months due to SBS. Before the following diagnosis, the patient had undergone two surgeries. During the hospitalization, life-threatening conditions such as stercoral peritonitis, septic shock, and acute respiratory failure, were observed and treated. As a result of SBS, hypoproteinemia and hypoalbuminemia developed, leading to the prescription of full parenteral nutrition. After correcting the malnutrition, a third surgery was performed, resulting in the discontinuation of parenteral nutrition and the resumption of a regular diet. CONCLUSIONS Parenteral nutrition is the sole effective method for preserving the lives of patients with a short segment of the intestine. While on parenteral nutrition, patients can be prepared for reconstructive surgery.
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Affiliation(s)
- Saulius Švagždys
- Department of Abdominal Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Ieva Smolskaitė
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rūta Vindžigalskytė
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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13
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Endo R, Sugimoto S, Shirosaki K, Kato H, Wada M, Kanai T, Sato T. Clinical challenges of short bowel syndrome and the path forward for organoid-based regenerative medicine. Regen Ther 2023; 24:64-73. [PMID: 37868721 PMCID: PMC10584670 DOI: 10.1016/j.reth.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 10/24/2023] Open
Abstract
Short bowel syndrome (SBS) is a rare condition, the main symptom of which is malabsorption following extensive resection of the small intestine. Treatment for SBS is mainly supportive, consisting of supplementation, prevention and treatment of complications, and promotion of intestinal adaptation. While development of parenteral nutrition and drugs promoting intestinal adaptation has improved clinical outcomes, the prognosis of patients with SBS remains poor. Intestinal transplantation is the only curative therapy but its outcome is unsatisfactory. In the absence of definitive therapy, novel treatment is urgently needed. With the advent of intestinal organoids, research on the intestine has developed remarkably in recent years. Concepts such as the "tissue-engineered small intestine" and "small intestinalized colon," which create a functional small intestine by combining organoids with other technologies, are potentially novel regenerative therapeutic approaches for SBS. Although they are still under development and there are substantial issues to be resolved, the problems that have prevented establishment of the complex function and structure of the small intestine are gradually being overcome. This review discusses the current treatments for SBS, the fundamentals of the intestine and organoids, the current status of these new technologies, and future perspectives.
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Affiliation(s)
- Ryoma Endo
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Shinya Sugimoto
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Koji Shirosaki
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hirochika Kato
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Motoshi Wada
- Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Toshiro Sato
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
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14
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Katz D, Jelen N, Xavier de Almeida A, Cruz A, Chatani B, Fifi A. Early Central Venous Catheter Replacement After Candida in Pediatric Intestinal Failure Patients. JPGN REPORTS 2023; 4:e358. [PMID: 38034446 PMCID: PMC10684224 DOI: 10.1097/pg9.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/20/2023] [Indexed: 12/02/2023]
Abstract
Background Deferred central venous catheter (CVC) replacement places children with intestinal failure (IF) at risk of complications. We hypothesized that early CVC replacement after uncomplicated candidemia is safe and beneficial. Methods We performed a retrospective review of children with IF. Patients were divided into early (<7 days after their first negative culture), and late (≥7 days after their first negative culture) CVC replacement following uncomplicated candidemia. We calculated the median time to CVC removal, clearance of infection, CVC replacement or exchange, and duration of the initial hospitalization. The proportion of patients readmitted within 30 days was also calculated, taking note of the number of candida reinfections. Results Early replacement occurred in 18 encounters and late replacement in 21 encounters. The median time in both groups to CVC removal was 3 days (P = 0.949), and clearance of infection was 4 days (P = 0.466). The median time to CVC replacement or exchange in the early group was 4 days, compared to 10 days in the late group (P < 0.001). The median duration of the hospitalization in the early group was 12 days compared to 21 days in the late group (P = 0.011). In total 39% of patients from the early group were readmitted within 30 days compared to 57% from the late group (P = 0.359). None of the patients were reinfected with candida within 30 days. Conclusion Early CVC replacement after uncomplicated candidemia in children with IF decreases hospital stay without increased risk of readmission or reinfection.
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Affiliation(s)
- Daphna Katz
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Miami, Miami, FL
- Department of Pediatrics, Holtz Children’s Hospital, Jackson Health System, Miami, FL
| | - Natalia Jelen
- Department of Pediatrics, Holtz Children’s Hospital, Jackson Health System, Miami, FL
| | | | - Alberto Cruz
- Division of Biostatistics, Department of Public Health Sciences, Biostatistics Collaboration & Consulting Core, University of Miami, Miami, FL
| | - Brandon Chatani
- Pediatric Infectious Disease Subspecialty, Department of Pediatrics, Advent Health for Children, Orlando, FL
| | - Amanda Fifi
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Miami, Miami, FL
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15
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Pironi L, Cuerda C, Jeppesen PB, Joly F, Jonkers C, Krznarić Ž, Lal S, Lamprecht G, Lichota M, Mundi MS, Schneider SM, Szczepanek K, Van Gossum A, Wanten G, Wheatley C, Weimann A. ESPEN guideline on chronic intestinal failure in adults - Update 2023. Clin Nutr 2023; 42:1940-2021. [PMID: 37639741 DOI: 10.1016/j.clnu.2023.07.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND & AIMS In 2016, ESPEN published the guideline for Chronic Intestinal Failure (CIF) in adults. An updated version of ESPEN guidelines on CIF due to benign disease in adults was devised in order to incorporate new evidence since the publication of the previous ESPEN guidelines. METHODS The grading system of the Scottish Intercollegiate Guidelines Network (SIGN) was used to grade the literature. Recommendations were graded according to the levels of evidence available as A (strong), B (conditional), 0 (weak) and Good practice points (GPP). The recommendations of the 2016 guideline (graded using the GRADE system) which were still valid, because no studies supporting an update were retrieved, were reworded and re-graded accordingly. RESULTS The recommendations of the 2016 guideline were reviewed, particularly focusing on definitions, and new chapters were included to devise recommendations on IF centers, chronic enterocutaneous fistulas, costs of IF, caring for CIF patients during pregnancy, transition of patients from pediatric to adult centers. The new guideline consist of 149 recommendations and 16 statements which were voted for consensus by ESPEN members, online in July 2022 and at conference during the annual Congress in September 2022. The Grade of recommendation is GPP for 96 (64.4%) of the recommendations, 0 for 29 (19.5%), B for 19 (12.7%), and A for only five (3.4%). The grade of consensus is "strong consensus" for 148 (99.3%) and "consensus" for one (0.7%) recommendation. The grade of consensus for the statements is "strong consensus" for 14 (87.5%) and "consensus" for two (12.5%). CONCLUSIONS It is confirmed that CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for the underlying gastrointestinal disease and to provide HPN support. Most of the recommendations were graded as GPP, but almost all received a strong consensus.
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Affiliation(s)
- Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Center for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Francisca Joly
- Center for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Cora Jonkers
- Nutrition Support Team, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Željko Krznarić
- Center of Clinical Nutrition, Department of Medicine, University Hospital Center, Zagreb, Croatia
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, United Kingdom
| | | | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), United Kingdom
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany
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16
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Lakananurak N, Wall E, Catron H, Delgado A, Greif S, Herlitz J, Moccia L, Mercer D, Vanuytsel T, Kumpf V, Berner-Hansen M, Gramlich L. Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey. Nutrients 2023; 15:2763. [PMID: 37375667 DOI: 10.3390/nu15122763] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND International practice guidelines for high-stool-output (HSO) management in short bowel syndrome (SBS) are available, but data on implementation are lacking. This study describes the approach used to manage HSO in SBS patients across different global regions. METHODS This is an international multicenter study evaluating medical management of HSO in SBS patients using a questionnaire survey. Thirty-three intestinal-failure centers were invited to complete the survey as one multidisciplinary team. RESULTS Survey response rate was 91%. Dietary recommendations varied based on anatomy and geographic region. For patients without colon-in-continuity (CiC), clinical practices were generally consistent with ESPEN guidelines, including separation of fluid from solid food (90%), a high-sodium diet (90%), and a low-simple-sugar diet (75%). For CiC patients, practices less closely followed guidelines, such as a low-fat diet (35%) or a high-sodium diet (50%). First-line antimotility and antisecretory medications were loperamide and proton-pump inhibitors. Other therapeutic agents (e.g., pancreatic enzymes and bile acid binders) were utilized in real-world practices, and usage varied based on intestinal anatomy. CONCLUSION Expert centers largely followed published HSO-management guidelines for SBS patients without CiC, but clinical practices deviated substantially for CiC patients. Determining the reasons for this discrepancy might inform future development of practice guidelines.
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Affiliation(s)
- Narisorn Lakananurak
- Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Elizabeth Wall
- Clinical Nutrition, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Hilary Catron
- College of Allied Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Adela Delgado
- Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB T5H 3V9, Canada
| | - Sophie Greif
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, 10117 Berlin, Germany
| | - Jean Herlitz
- Clinical Nutrition, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Lisa Moccia
- Center for Human Nutrition, Cleveland Clinic, Cleveland, OH 44195, USA
| | - David Mercer
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Tim Vanuytsel
- Gastroenterology and Hepatology, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Vanessa Kumpf
- Center for Human Nutrition, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Mark Berner-Hansen
- Digestive Disease Center K, Bispebjerg University Hospital of Copenhagen, 2400 Copenhagen, Denmark
- Zealand Pharma, 2860 Soeborg, Denmark
| | - Leah Gramlich
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T5B 4E4, Canada
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17
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Bannert K, Karbe C, Förster RH, Sautter LF, Meyer F, Valentini L, Wiese ML, Ehlers L, Berlin P, Jaster R, Aghdassi AA, Lerch MM, Lamprecht G. Orally compensated short bowel patients are thin, potentially malnourished but rarely sarcopenic. Clin Nutr 2023:S0261-5614(23)00160-7. [PMID: 37311685 DOI: 10.1016/j.clnu.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM In short bowel syndrome, insufficient absorptive capacity of the remnant bowel may lead to metabolic and nutritional consequences including electrolyte disturbances, severe diarrhea and malnutrition. While intestinal failure requires parenteral nutrition, short bowel patients with intestinal insufficiency (SB/II) have achieved oral autonomy. The aim of this exploratory study was to assess the nutritional, muscular and functional status of orally compensated SB/II patients. METHODS 28 orally compensated SB/II patients with a mean of 46 months after termination of parenteral nutrition and 56 age- and sex-matched healthy controls (HC) were compared regarding anthropometric parameters, body composition using bioelectrical impedance analysis, handgrip strength and gait speed, blood parameters as well as nutritional intake and physical activity using validated questionnaires. Malnutrition and sarcopenia were diagnosed according to the criteria of the GLIM or EWGSOP2. RESULTS SB/II patients had lower body mass index (BMI) and anthropometric parameters than HC but were within the normal weight range. The GLIM algorithm operationally diagnosed malnutrition in 39% (n = 11) of SB/II patients. Reduced skeletal muscle mass index and phase angle were rarely accompanied by a reduction of handgrip strength below cut-off values and the subsequent diagnosis of sarcopenia in SB/II patients (15%, n = 4). Compared to 11% of HC, 37% of SB/II patients had low physical activity level. Female SB/II patients had higher caloric and macronutrient intake. Caloric intake negatively correlated with body weight indicating compensatory hyperphagia in patients with lower body weight. Some of the SB/II patients showed signs of dehydration. CONCLUSIONS Orally compensated SB/II patients are thinner than HC but have mostly normal BMI. Malnutrition is frequently diagnosed but may be overestimated due to the underlying malabsorption and its interplay with hyperphagia. Muscle mass is often reduced but is rarely accompanied by functional impairment leading to sarcopenia diagnosis. Thus, SB/II patients long term after termination of parenteral support may be malnourished but usually do not develop sarcopenia.
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Affiliation(s)
- Karen Bannert
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Cathleen Karbe
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Robert H Förster
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Lea F Sautter
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Fatuma Meyer
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Germany
| | - Luzia Valentini
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Germany
| | - Mats L Wiese
- University Medicine Greifswald, Department and Polyclinic of Internal Medicine A, Germany
| | - Luise Ehlers
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Peggy Berlin
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Robert Jaster
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Ali A Aghdassi
- University Medicine Greifswald, Department and Polyclinic of Internal Medicine A, Germany
| | - Markus M Lerch
- LMU University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Georg Lamprecht
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany.
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18
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Winkler M, Tappenden K. Epidemiology, survival, costs, and quality of life in adults with short bowel syndrome. Nutr Clin Pract 2023; 38 Suppl 1:S17-S26. [PMID: 37115027 DOI: 10.1002/ncp.10964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 04/29/2023] Open
Abstract
Short bowel syndrome (SBS) is a rare disorder with known physical, psychosocial, and economic burdens and significant morbidity and mortality. Many individuals with SBS require long-term home parenteral nutrition (HPN). The incidence and prevalence of SBS is difficult to determine because it is often based on HPN usage and may not account for those who receive intravenous fluids or achieve enteral autonomy. The most common etiologies associated with SBS are Crohn's disease and mesenteric ischemia. Intestinal anatomy and remnant bowel length are prognostic for HPN dependency, and enteral autonomy confers a survival advantage. Health economic data confirm that PN-related costs are higher for hospitalizations than at home; yet significant healthcare resource utilization is necessary for successful HPN, and patients and families report substantial financial distress that impacts quality of life (QOL). An important advancement in QOL measurement is the validation of HPN- and SBS-specific QOL questionnaires. In addition to the known factors negatively impacting QOL, such as diarrhea, pain, nocturia, fatigue, depression, and narcotic dependency, research has shown that the volume and number of PN infusions per week is associated with QOL. Although traditional QOL measurements describe how underlying disease and therapy influence life, they do not assess how symptoms and functional limitations affect the QOL of patients and caregivers. Patient-centered measures and conversation focused on psychosocial issues helps patients with SBS and HPN dependency better cope with their disease and treatment. This article presents a brief overview of SBS, including epidemiology, survival, costs, and QOL.
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Affiliation(s)
- Marion Winkler
- Department of Surgery/Nutrition Support, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kelly Tappenden
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
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19
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Wang W, Wang Y, Lu Y, Tian X, Chen S, Wu B, Du J, Xiao Y, Cai W. Inositol hexaphosphate promotes intestinal adaptation in short bowel syndrome via an HDAC3-mediated epigenetic pathway. Food Nutr Res 2023; 67:8694. [PMID: 36794012 PMCID: PMC9899046 DOI: 10.29219/fnr.v67.8694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/29/2022] [Accepted: 11/07/2022] [Indexed: 02/05/2023] Open
Abstract
Background Short bowel syndrome (SBS) has high morbidity and mortality rates, and promoting intestinal adaptation of the residual intestine is a critical treatment. Dietary inositol hexaphosphate (IP6) plays an important role in maintaining intestinal homeostasis, but its effect on SBS remains unclear. This study aimed at investigating the effect of IP6 on SBS and clarified its underlying mechanism. Methods Forty male Sprague-Dawley rats (3-week-old) were randomly assigned into four groups (Sham, Sham + IP6, SBS, and SBS + IP6 groups). Rats were fed standard pelleted rat chow and underwent resection of 75% of the small intestine after 1 week of acclimation. They received 1 mL IP6 treatment (2 mg/g) or sterile water daily for 13 days by gavage. Intestinal length, levels of inositol 1,4,5-trisphosphate (IP3), histone deacetylase 3 (HDAC3) activity, and proliferation of intestinal epithelial cell-6 (IEC-6) were detected. Results IP6 treatment increased the length of the residual intestine in rats with SBS. Furthermore, IP6 treatment caused an increase in body weight, intestinal mucosal weight, and IEC proliferation, and a decrease in intestinal permeability. IP6 treatment led to higher levels of IP3 in feces and serum, and higher HDAC3 activity of the intestine. Interestingly, HDAC3 activity was positively correlated with the levels of IP3 in feces (r = 0.49, P = 0.01) and serum (r = 0.44, P = 0.03). Consistently, IP3 treatment promoted the proliferation of IEC-6 cells by increasing HDAC3 activity in vitro. IP3 regulated the Forkhead box O3 (FOXO3)/Cyclin D1 (CCND1) signaling pathway. Conclusion IP6 treatment promotes intestinal adaptation in rats with SBS. IP6 is metabolized to IP3 to increase HDAC3 activity to regulate the FOXO3/CCND1 signaling pathway and may represent a potential therapeutic approach for patients with SBS.
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Affiliation(s)
- Weipeng Wang
- Department of Pediatric Surgery, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wang
- Department of Pediatric Surgery, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Shanghai Institu of Pediatric Research, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Ying Lu
- Shanghai Institu of Pediatric Research, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Xinbei Tian
- Department of Pediatric Surgery, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shanshan Chen
- Department of Pediatric Surgery, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Wu
- Department of Pediatric Surgery, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Du
- Shanghai Institu of Pediatric Research, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Yongtao Xiao
- Department of Pediatric Surgery, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Shanghai Institu of Pediatric Research, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China,Yongtao Xiao Division of Pediatric Gastroenterology and Nutrition, Xin Hua Hospital, Shanghai Jiao Tong University, No. 1665, Kong Jiang Road, Shanghai, China.
| | - Wei Cai
- Department of Pediatric Surgery, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Shanghai Institu of Pediatric Research, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China,Wei Cai Department of Pediatric Surgery, Xin Hua Hospital, Shanghai Jiao Tong University, No. 1665, Kong Jiang Road, 200092 Shanghai, China.
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20
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Bannert K, Sautter LF, Wiese ML, Meyer F, Ehlers L, Fromhold-Treu S, Karbe C, Gärtner S, Lerch MM, Aghdassi AA, Jaster R, Valentini L, Lamprecht G. Analysis of ESPEN and GLIM algorithms reveals specific drivers for the diagnosis of malnutrition in patients with chronic gastrointestinal diseases. Nutrition 2023; 106:111887. [PMID: 36473417 DOI: 10.1016/j.nut.2022.111887] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/09/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Disease-related malnutrition (MN) is common in patients with liver cirrhosis (LC), short bowel syndrome (SBS), and chronic pancreatitis (CP). Different MN risk screening tools and diagnostic criteria of the European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM) algorithms were analyzed for their diagnostic accuracy and role as specific drivers to diagnose MN in patients with LC, SBS, and CP. METHODS A total of 187 patients with LC, SBS, and CP, as well as control patients were prospectively recruited in a multicenter cross-sectional study. MN risk was screened using Nutritional Risk Screening 2002 (NRS-2002), the Malnutrition Universal Screening Tool (MUST), and the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), and diagnosed using the ESPEN, GLIM, and GLIMCRP+ (GLIM incorporating C-reactive protein [CRP] >5 mg/L) algorithms. For each of the individual diagnostic criteria, relative frequency, sensitivity, specificity, as well as positive and negative predictive values were calculated. RESULTS NRS-2002 was only sensitive in conjunction with ESPEN, while MUST was sensitive additionally with the GLIM algorithm. RFH-NPT worked the best for LC. GLIM and GLIMCRP+ diagnosed MN more frequently than the ESPEN algorithm. Diagnostic criteria were detected at remarkably different relative frequencies starting with reduced food intake/malabsorption and chronic disease/inflammation, followed by weight loss, reduced fat-free mass index, low body mass index, and body mass index <18.5 kg/m². Relative frequencies differed between LC, SBS, and CP. Weight loss in LC and CP and reduced fat-free mass index and food intake in SBS had good diagnostic accuracy, suggesting that these criteria act as specific drivers for MN. CONCLUSIONS RFH-NPT and MUST performed better in conjunction with the GLIM algorithm than NRS-2002. MN was diagnosed more frequently by GLIM than the ESPEN algorithm in LC, SBS, and CP. Individual criteria acted as specific drivers in MN in chronic gastrointestinal diseases.
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Affiliation(s)
- Karen Bannert
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Lea Franziska Sautter
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Mats Lukas Wiese
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Fatuma Meyer
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Neubrandenburg, Germany
| | - Luise Ehlers
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Sophie Fromhold-Treu
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Cathleen Karbe
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Simone Gärtner
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Robert Jaster
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Luzia Valentini
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Neubrandenburg, Germany
| | - Georg Lamprecht
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany.
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21
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Lakkasani S, Seth D, Khokhar I, Touza M, Dacosta TJ. Concise review on short bowel syndrome: Etiology, pathophysiology, and management. World J Clin Cases 2022; 10:11273-11282. [PMID: 36387822 PMCID: PMC9649563 DOI: 10.12998/wjcc.v10.i31.11273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/12/2022] [Accepted: 09/20/2022] [Indexed: 02/05/2023] Open
Abstract
Adults have approximately 20 feet of small intestine, which is the primary site for absorbing essential nutrients and water. Resection of the intestine for any medical reason may result in short bowel syndrome (SBS), leading to loss of major absorptive surface area and resulting in various malabsorption and motility disorders. The mainstay of treatment is personalized close dietary management. Here we present SBS with its pathophysiology and different nutritional management options available. The central perspective of this paper is to provide a concise review of SBS and the treatment options available, along with how proper nutrition can solve major dietary issues in SBS and help patients recover faster.
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Affiliation(s)
- Saraswathi Lakkasani
- Gastroenterology and Hepatology, Saint Michael’s Medical Center in Affiliation with New York Medical College, Newark, NJ 07102, United States
| | - Deeksha Seth
- Gastroenterology, Chandan Institute of Liver and Biliary Sciences, Lucknow 226001, India
| | - Imran Khokhar
- Medicine, Suburban Medical Center, Norristown, PA 19401, United States
| | - Masara Touza
- Medicine, Saint Michael’s Medical Center in Affiliation with New York Medical College, Newark, NJ 07102, United States
| | - Theodore Jr Dacosta
- Gastroenterology and Hepatology, Saint Michael’s Medical Center in Affiliation with New York Medical College, Newark, NJ 07102, United States
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22
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Hoch M, Ehlers L, Bannert K, Stanke C, Brauer D, Caton V, Lamprecht G, Wolkenhauer O, Jaster R, Wolfien M. In silico investigation of molecular networks linking gastrointestinal diseases, malnutrition, and sarcopenia. Front Nutr 2022; 9:989453. [DOI: 10.3389/fnut.2022.989453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Malnutrition (MN) is a common primary or secondary complication in gastrointestinal diseases. The patient’s nutritional status also influences muscle mass and function, which can be impaired up to the degree of sarcopenia. The molecular interactions in diseases leading to sarcopenia are complex and multifaceted, affecting muscle physiology, the intestine (nutrition), and the liver at different levels. Although extensive knowledge of individual molecular factors is available, their regulatory interplay is not yet fully understood. A comprehensive overall picture of pathological mechanisms and resulting phenotypes is lacking. In silico approaches that convert existing knowledge into computationally readable formats can help unravel mechanisms, underlying such complex molecular processes. From public literature, we manually compiled experimental evidence for molecular interactions involved in the development of sarcopenia into a knowledge base, referred to as the Sarcopenia Map. We integrated two diseases, namely liver cirrhosis (LC), and intestinal dysfunction, by considering their effects on nutrition and blood secretome. We demonstrate the performance of our model by successfully simulating the impact of changing dietary frequency, glycogen storage capacity, and disease severity on the carbohydrate and muscle systems. We present the Sarcopenia Map as a publicly available, open-source, and interactive online resource, that links gastrointestinal diseases, MN, and sarcopenia. The map provides tools that allow users to explore the information on the map and perform in silico simulations.
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23
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Belcher E, Mercer D, Raphael BP, Salinas GD, Stacy S, Tappenden KA. Management of short-bowel syndrome: A survey of unmet educational needs among healthcare providers. JPEN J Parenter Enteral Nutr 2022; 46:1839-1846. [PMID: 35511707 PMCID: PMC9790246 DOI: 10.1002/jpen.2388] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/12/2022] [Accepted: 04/23/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Management of short-bowel syndrome with intestinal failure (SBS-IF) is complex and requires a multidisciplinary approach. Because of the rarity of SBS-IF, healthcare professionals (HCPs) often lack clinical experience with the disease and may benefit from education regarding SBS-IF and its management. This study identified unmet educational needs related to the management of patients with SBS-IF. METHODS This was a prospective, web-based survey (December 2019-January 2020) in which a series of clinical questions were posed to US HCPs after presenting three standardized SBS-IF cases to assess current practice patterns. HCPs were then asked a series of questions to identify potential knowledge gaps and unmet educational needs relating to SBS-IF management. RESULTS Overall, 558 HCPs completed the survey, with 12%-38% having a formal SBS-IF multidisciplinary team currently available to make treatment decisions within their institution. Clinicians involved in care included gastroenterologists (93%), registered dietitians (79%), gastroenterology nurse practitioners and physician assistants (37%), registered nurses (43%), social workers (45%), and psychologists/psychiatrists (27%). There was underuse of published guidelines and limited understanding of the course of intestinal adaptation. Responses to the clinical scenarios highlighted disparities in SBS-IF care delivery, including diagnosis, management goals, medications prescribed, and nutrition practices. CONCLUSIONS Future SBS-IF educational interventions for HCPs should aim to improve awareness and understanding of the disease, facilitate timely diagnosis, and standardize management practices to ensure patients receive optimal interdisciplinary care as widely as possible.
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Affiliation(s)
| | - David Mercer
- Department of Surgery, Division of TransplantationUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | | | | | | | - Kelly A. Tappenden
- Department of Kinesiology and NutritionUniversity of Illinois ChicagoChicagoIllinoisUSA
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24
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Iyer KR, Winkler M, Zubizarreta N, Nisenholtz M, Lucero K, Lubarda J. Knowledge of chronic intestinal failure among US gastroenterologists: Cause for concern and learning opportunity. JPEN J Parenter Enteral Nutr 2021; 46:730-733. [PMID: 34713914 DOI: 10.1002/jpen.2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chronic intestinal failure (CIF) is an ultrarare disease, with an estimated national prevalence of ∼25,000 cases. There is a suspicion of widespread lack of expertise in CIF care, but no formal assessment tool or data exist. We developed and validated a knowledge test in CIF and now report our preliminary results from testing CIF knowledge in a cohort of US gastroenterologists. METHOD We developed a 20-question knowledge test in CIF, covering four key components of IF. After internal testing, refinement, and revision, we administered the test to a convenience sample of experts and nonexperts in IF. We then deployed the validated test to a cohort of 100 US gastroenterologists. RESULTS The test had a Cronbach alpha of 0.74, suggesting a reliable test, with a threshold score to discriminate experts and nonexperts of 13.4 (maximum 20) and with a sensitivity of 81.3% and specificity of 86.4%. The overall mean score of 8.2 for the 100 US gastroenterologists was at the level of nonexperts in our convenience sample. CONCLUSION The preliminary results of our validated knowledge test in IF among a broad group of US gastroenterologists demonstrate lack of knowledge in IF.
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Affiliation(s)
- Kishore R Iyer
- Intestinal Rehabilitation & Transplant Program, Icahn School of Medicine at Mount Sinai/Mount Sinai Hospital, New York, New York, USA
| | - Marion Winkler
- Department of Surgery/Nutrition Support, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Nicole Zubizarreta
- Intestinal Rehabilitation & Transplant Program, Icahn School of Medicine at Mount Sinai/Mount Sinai Hospital, New York, New York, USA
| | - Marjorie Nisenholtz
- Intestinal Rehabilitation & Transplant Program, Icahn School of Medicine at Mount Sinai/Mount Sinai Hospital, New York, New York, USA
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25
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Winkler MF, Tappenden KA, Spangenburg M, Iyer K. Learn Intestinal Failure Tele-ECHO Project: An innovative online telementoring and case-based learning clinic. Nutr Clin Pract 2021; 36:785-792. [PMID: 34159643 DOI: 10.1002/ncp.10743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Intestinal failure (IF) is a rare chronic disease requiring intravenous (IV) fluids or parenteral nutrition (PN) dependency for optimal patient health and sustenance. The complex care is best managed by specialized multidisciplinary teams. Patients who have limited access to intestinal rehabilitation centers often receive IV/PN care from clinicians lacking specialty expertise. An innovative videoconferencing project was launched in May 2019 to provide online telementoring and case-based learning in IF. The Extension for Community Healthcare Outcomes (ECHO) model was adopted to provide education and virtual support via the Learn Intestinal Failure Tele-ECHO (LIFT-ECHO) project. Online clinics include patient case presentations, moderated discussion, best-practice recommendations, and didactic continuing education lectures on IF- and PN-related topics. Participation is interprofessional and international. Via knowledge dissemination and specialty mentorship, LIFT-ECHO is expected to improve healthcare for patients with IF and transform care delivery by overcoming the limitations in access to expertise.
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Affiliation(s)
- Marion F Winkler
- Department of Surgery/Nutritional Support Service, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kelly A Tappenden
- Department of Kinesiology and Nutrition, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Michelle Spangenburg
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Kishore Iyer
- Adult and Pediatric Intestinal Rehabilitation and Transplantation, Mount Sinai School of Medicine, New York, USA
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