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Role of an intestinal rehabilitation program in the treatment of advanced intestinal failure.

Publication ,  Journal Article
Torres, C; Sudan, D; Vanderhoof, J; Grant, W; Botha, J; Raynor, S; Langnas, A
Published in: J Pediatr Gastroenterol Nutr
August 2007

OBJECTIVE: To analyze outcomes in children with intestinal failure treated by our Intestinal Rehabilitation Program (IRP) in a 4-year period. PATIENTS AND METHODS: A total of 51 parenteral nutrition (PN)-dependent patients (20 male) were enrolled in the IRP. Median age was 1.7 years, with the primary diagnoses being gastroschisis, necrotizing enterocolitis, volvulus, and congenital atresia. Median small bowel intestinal length was 35 cm, with the majority of patients having only jejunum as remaining bowel anatomy. Thirty-six of the 51 patients had liver disease characterized by cirrhosis, advance bridging fibrosis, and portal and periportal fibrosis. Height, weight z score, platelet count, albumin, and bilirubin levels were measured at the beginning and end of the study. RESULTS: Of the 51 patients, 29 had 46 different surgical intestinal repairs. Twenty-nine of the 36 patients with hyperbilirubinemia had normalized serum bilirubin with treatment. Ten patients required transplantation. Five patients died of sepsis, influenza, or complications after intestinal transplantation. Of the remaining 37 patients in the IRP, 31 were weaned from parenteral nutrition (5 with cirrhosis); 6 patients are in the process of weaning. Survival rate of the patients in the IRP was 90%. Growth has continued along the same curve, and some patients have exhibited significant catch-up. CONCLUSIONS: With an aggressive medical/surgical approach, even patients with intestinal failure and advanced liver disease can avoid transplantation. Patients in the IRP showed improved liver function and nutritional parameters with the ability to discontinue PN while maintaining growth. Early referral of these patients to specialized centers before the development of advanced liver disease is recommended.

Duke Scholars

Published In

J Pediatr Gastroenterol Nutr

DOI

EISSN

1536-4801

Publication Date

August 2007

Volume

45

Issue

2

Start / End Page

204 / 212

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Short Bowel Syndrome
  • Postoperative Complications
  • Parenteral Nutrition
  • Male
  • Liver Diseases
  • Intestines
  • Intestinal Diseases
  • Infant
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Torres, C., Sudan, D., Vanderhoof, J., Grant, W., Botha, J., Raynor, S., & Langnas, A. (2007). Role of an intestinal rehabilitation program in the treatment of advanced intestinal failure. J Pediatr Gastroenterol Nutr, 45(2), 204–212. https://doi.org/10.1097/MPG.0b013e31805905f9
Torres, Clarivet, Debra Sudan, Jon Vanderhoof, Wendy Grant, Jean Botha, Stephen Raynor, and Alan Langnas. “Role of an intestinal rehabilitation program in the treatment of advanced intestinal failure.J Pediatr Gastroenterol Nutr 45, no. 2 (August 2007): 204–12. https://doi.org/10.1097/MPG.0b013e31805905f9.
Torres C, Sudan D, Vanderhoof J, Grant W, Botha J, Raynor S, et al. Role of an intestinal rehabilitation program in the treatment of advanced intestinal failure. J Pediatr Gastroenterol Nutr. 2007 Aug;45(2):204–12.
Torres, Clarivet, et al. “Role of an intestinal rehabilitation program in the treatment of advanced intestinal failure.J Pediatr Gastroenterol Nutr, vol. 45, no. 2, Aug. 2007, pp. 204–12. Pubmed, doi:10.1097/MPG.0b013e31805905f9.
Torres C, Sudan D, Vanderhoof J, Grant W, Botha J, Raynor S, Langnas A. Role of an intestinal rehabilitation program in the treatment of advanced intestinal failure. J Pediatr Gastroenterol Nutr. 2007 Aug;45(2):204–212.

Published In

J Pediatr Gastroenterol Nutr

DOI

EISSN

1536-4801

Publication Date

August 2007

Volume

45

Issue

2

Start / End Page

204 / 212

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Short Bowel Syndrome
  • Postoperative Complications
  • Parenteral Nutrition
  • Male
  • Liver Diseases
  • Intestines
  • Intestinal Diseases
  • Infant