P3B.14: Glucocorticoid treatment improves enteral feeding tolerance in pediatric short bowel syndrome patients with chronic intestinal inflammatory changes

Abstract

Introduction: Studies suggest that chronic local and systemic inflammation are related to short bowel syndrome (SBS). We believe that glucocorticoids may reduce inflammation and improve enteral tolerance in pediatric SBS patients. A group of patients from our intestinal rehabilitation program developed chronic intestinal inflammation under biopsy while struggling weaning off parenteral nutrition (PN). We treated them with oral prednisolone taper, maintenance budesonide and sulfasalazine. We will describe the treatment outcome. Method: Our study included 15 patients whose lab values, pathology results and clinic notes were reviewed, and excluded patients who took steroids for post-transplant immunosuppression or severe food allergy to maintain the homogenous of our patient cohort. Results: The most common reason for SBS was gastroschisis. The small bowel length range was 20–108 cm. Thirteen patients had more than ½ colon remaining. The median age of starting steroid therapy was 3.3 years. Twelve patients had decreased PN calorie count or normalized follow-up histology. Six patients were able to wean off PN completely with median treatment duration of 5 months, five of which remained on maintenance budesonide for significant period of time (median: 7.5 months), the other one had steroids stopped 5 months before being off PN due to clinical improvement and concern for medication noncompliance. Six out of fifteen children had significant eosinophils in their initial biopsy, five were able to wean off PN while one had significant symptom improvement (GI bleeding stopped). Two patients were not on steroids continuously, as they resumed steroids months later due to histological recurrence of the chronic inflammatory process. Three patients were still not able to be cut down PN calorie. Two patients’ intestinal biopsies findings were still consistent with chronic inflammatory process. Conclusion: For SBS children with histologically confirmed chronic intestinal inflammatory changes, steroid therapy may help to promote enteral feeding tolerance and wean off PN. Patients may respond better if their initial histology has chronic intestinal inflammation with significant eosinophilic infiltrate. Patients may need to remain on maintenance steroids for a period of time even if they were able to wean off PN or significantly reduce PN calories as they may experience regression on enteral tolerance or evidence of GI bleeding as weaning off steroids is attempted.