Our Summary

This research paper discusses a condition called Pediatric Intestinal Failure (IF), which is a severe decrease in the intestinal mass or function in children, hindering their normal growth. The most common cause of this condition is Short-Bowel Syndrome (SBS), which results from the removal of a part of the intestine.

The primary focus of managing this condition is to achieve a state where the child can digest and absorb food normally without the need for supplementary nutrition given through injections (parenteral nutrition). The ultimate goal is to stimulate the remaining parts of the intestine to adapt and function optimally while ensuring the child’s normal growth and development.

However, the treatment options vary greatly and there is a lack of sufficient evidence to establish a standard care plan for such patients. The paper presents some basic principles of enteral nutrition (nutrition provided through the digestive tract) and offers practical advice on improving the diet of children with SBS.

The paper also examines new trends in managing this condition, including the growing interest in blended diets and their impact on SBS. It also discusses the role of the microbiome (the community of microorganisms living in our bodies) on the ability to tolerate enteral nutrition and the problem of excessive bacterial growth in the small intestine.

FAQs

  1. What is pediatric intestinal failure and what causes it?
  2. What are the goals of nutrition management in children with short-bowel syndrome (SBS)?
  3. What is the role of the microbiome in enteral tolerance and small bowel bacterial overgrowth in pediatric SBS?

Doctor’s Tip

A helpful tip a doctor might tell a patient about intestinal resection is to follow a strict dietary plan to support intestinal adaptation and prevent complications such as bacterial overgrowth. It is important to work closely with a dietitian to ensure proper nutrition and monitor for any signs of malabsorption or nutrient deficiencies. Additionally, staying hydrated and taking any prescribed medications as directed can help support overall gut health and function. Regular follow-up appointments with healthcare providers are essential to monitor progress and make any necessary adjustments to the treatment plan.

Suitable For

Patients who are typically recommended for intestinal resection include those with short-bowel syndrome, intestinal failure, and other conditions that require the removal of a portion of the intestine. These patients may have difficulty absorbing nutrients and require specialized nutrition management to support growth and development. Intestinal resection may be recommended in cases where conservative treatments have not been effective in managing the underlying condition. The goal of intestinal resection is to improve the patient’s quality of life and overall health by addressing the underlying cause of intestinal dysfunction.

Timeline

  • Before intestinal resection: The patient may experience symptoms such as chronic diarrhea, malabsorption, weight loss, and nutritional deficiencies. Diagnostic tests such as imaging studies and endoscopy may be performed to determine the extent of the intestinal damage.

  • Intestinal resection surgery: The damaged portion of the intestine is surgically removed, and the remaining healthy sections are reconnected. The length of the remaining intestine will determine the severity of the short bowel syndrome.

  • Post-operative recovery: The patient will likely require a period of hospitalization for monitoring and intravenous nutrition support. Gradual transition to enteral nutrition will begin once the intestines start functioning properly.

  • Enteral nutrition management: The goal is to achieve enteral autonomy, where the patient can be nourished solely through oral or tube feeding and no longer require intravenous nutrition. This may involve a gradual advancement of the diet, monitoring of nutrient absorption, and managing complications such as small bowel bacterial overgrowth.

  • Long-term care: Patients with short bowel syndrome may require ongoing monitoring and management of their nutritional needs. Regular follow-up appointments with a multidisciplinary team, including dietitians, gastroenterologists, and surgeons, may be necessary to ensure optimal growth and development.

What to Ask Your Doctor

  1. What is the reason for the intestinal resection and how much of my intestine was removed?
  2. What are the potential complications or risks associated with intestinal resection surgery?
  3. How will my digestion and absorption of nutrients be affected after the surgery?
  4. Will I require parenteral nutrition or enteral nutrition after the surgery, and for how long?
  5. What is the likelihood of achieving enteral autonomy and being able to resume a normal diet?
  6. What are the signs and symptoms of complications such as small bowel bacterial overgrowth that I should watch out for?
  7. Are there any dietary restrictions or special considerations I should be aware of post-surgery?
  8. How often will I need follow-up appointments to monitor my progress and adjust my treatment plan if needed?
  9. Are there any support groups or resources available for individuals with short-bowel syndrome or intestinal resection?
  10. What are the long-term implications of having intestinal resection and how can I best manage my condition to maintain proper growth and development?

Reference

Authors: Channabasappa N, Girouard S, Nguyen V, Piper H. Journal: Nutr Clin Pract. 2020 Oct;35(5):848-854. doi: 10.1002/ncp.10565. Epub 2020 Aug 19. PMID: 32815247