Intestinal Failure Research Articles

Nutrition management of intestinal failure: From neonates to the elderly

Double enterostomies (DES) and necrotising enterocolitis (NEC) are prevalent in neonatal intensive care units (NICU), commonly resulting from surgical removal of diseased intestine. Sarcopenia prevalence is >40% in community dwelling elderly >65 yrs and is associated with poor nutritional status before/after abdominal surgery, with intestinal failure (IF) and high output stoma losses. Parenteral Nutrition (PN) is the standard of care for Type 2 IF patients with DES or enteroatmospheric fistulas (EAF), but risks catheter-related complications, infection, gut and hepatobiliary dysfunction. Chyme reinfusion therapy (CRT) is a recommended distal feeding technique that may minimise these risks.

Important practical aspects in the management of patients with shot bowel syndrome and intestinal failure

Short bowel syndrome is a gastrointestinal disorder resulting from massive resection of the small intestine. The most common causes of resection are acute mesenteric ischemia, Crohn’s disease, abdominal trauma, adhesive intestinal obstruction, intestinal malignancies, and radiation enteritis. Short bowel syndrome with intestinal failure is characterized by severe malabsorption-m aldigestion accompanied by abdominal pain, diarrhea, dehydration, and progression of protein-energy malnutrition. Many patients with SBS develop long-term clinical complications over time due to altered bowel anatomy and physiology or various therapeutic interventions such as parenteral nutrition and central venous catheterization. This review focuses on the most important aspects of diagnosis, treatment, and prevention of several complications that can occur in this patient population, including macronutrient and micronutrient imbalances, diarrhea, fluid and electrolyte imbalances, metabolic bone disease, biliary disorders, bacterial overgrowth in the small intestine, and complications related to venous access. The main therapeutic strategies for SBS with intestinal failure are: special diet, enteral nutritional support with semi-elemental mixtures, parenteral nutrition, oral rehydration, antimicrobal and antidiarrheal drugs, enzymes. Administration of glucagon-like peptide 2 analog, teduglutide, is clinically effective in reducing dependence on parenteral nutrition and improving quality of life. Management of patients with SBS with intestinal failure is a complex long-term process which requires dynamic clinical and laboratory monitoring.

Prevention of Infectious Complications in Acute Pancreatitis

AIM OF STUDY. The study was aimed to evaluate the effectiveness of treating acute pancreatitis by early enteral nutrition and selective introduction of nutritional mixtures directly into the initial sections of the jejunum, bypassing the duodenum.MATERIAL AND METHODS. A comprehensive treatment method for acute pancreatitis was developed based on the use of a pancreatoduodenal catheter. The method focuses on preventing intestinal failure syndrome by isolating the duodenum and preventing any liquid from entering it while ensuring the selective introduction of glucose-saline solutions and/or enteral nutritional mixtures directly into the initial sections of the jejunum. Several Russian clinics are currently conducting the research approved by local ethics committees. This article presents preliminary results from the data analysis. The study included moderate to severe forms (according to the 2012 Atlanta classification) of acute biliary pancreatitis without indications for endoscopic retrograde cholangiopancreatography, as well as alimentary-alcoholic pancreatitis. The first group of patients received standard therapy according to the 2020 clinical guidelines of the Russian Society of Surgeons. The second group received standard therapy combined with the new selective enteral nutrition method. The observation period lasted until the end of the hospital treatment, including five mandatory visits and a final visit to the physician. A follow-up survey was conducted three months or more after discharge to identify delayed episodes of acute pancreatitis complications, focusing on the incidence of infectious complications and surgical interventions.RESULTS. A total of 148 patients were treated. Patients were evenly distributed by etiology, gender, age, and body mass index. The analysis revealed that the number of patients with infectious complications decreased from 19.3% in the comparison group to 6.67% in the study group (p=0.041). The number of patients requiring surgical interventions was 5.0% in the study group compared to 19.3% in the comparison group (p=0.017).CONCLUSIONS. The study demonstrated that the use of the new method in the comprehensive treatment of acute pancreatitis, including early enteral feeding at the onset of the disease, may improve the course of the disease by reducing the incidence of infectious complications and the number of necessary surgical interventions.

Commentary: When control becomes a matter of life: a phenomenological exploration of intestinal failure patients’ lived experience receiving assistance from home care nurses in home parenteral nutrition management

Commentary: When control becomes a matter of life: a phenomenological exploration of intestinal failure patients’ lived experience receiving assistance from home care nurses in home parenteral nutrition management

When control becomes a matter of life: a phenomenological exploration of intestinal failure patients’ lived experience receiving assistance from home care nurses in home parenteral nutrition management

Background: Parenteral nutrition (PN) provides the body with essential nourishment through intravenous infusion. Home parenteral nutrition (HPN) has a significant impact on the lives of its users; however, very few studies explore the phenomenon of homecare nurse provided assistance for the management and administration of HPN. Method: The phenomenological approach, Reflective Lifeworld Research, was utilised. Data were collected through semi-structured interviews with five patients with intestinal failure. The analysis was performed according to the instructions of Reflective Lifeworld Research. Results: Four constituents were identified: (1) balanced nursing experience, (2) correct handling of procedures, (3) reversed expert roles and (4) the homecare nurse as a lifeline. Control was found to be the essence of the phenomenon, multi-faceted and characterised by the participants’ ambivalent feelings. Conclusion: The participants were ambivalent about receiving assistance from the homecare nurses. HPN is a complex treatment in which demands are placed on the homecare nurses’ competencies to deliver a high quality of care. The patients live with a constant fear of complications and hospitalisations. The participants felt compelled to perform control, monitoring the homecare nurses’ work, to ensure that errors did not occur. As more assistance was received from homecare nurses, the participants experienced a loss of control. However, the assistance did also give a sense of security, whereby the homecare nurse was perceived as a lifeline. From a sociological perspective, the need for control can be a result of the constant development of society, where greater demands were placed on citizens’ commitment and responsibility for their own treatment, prompting a larger need for individual control.

Comparison of mortality in crohn’s disease patients complicated by intestinal failure with background population and with Crohn’s disease patients without intestinal failure

Comparison of mortality in crohn’s disease patients complicated by intestinal failure with background population and with Crohn’s disease patients without intestinal failure

Efficacy and safety of apraglutide in short bowel syndrome with intestinal failure and colon–in–continuity: A multicenter, open-label, metabolic balance study

BackgroundApraglutide is a novel long-acting GLP-2 analog in development for short bowel syndrome with intestinal failure (SBS-IF). This multicenter, open-label, phase 2 study in SBS-IF and colon-in-continuity (CiC) investigates the safety and efficacy of apraglutide. MethodsThis was a 52-week phase 2 metabolic balance study (MBS) in 9 adult patients with SBS-IF-CiC receiving once-weekly subcutaneous apraglutide injections. Safety was the primary endpoint. Secondary endpoints included changes in absorption parameters (MBS at baseline, after 4 weeks with stable parenteral support (PS), and 48 weeks), PS needs (48-week PS adjustment period based on monthly 48-hour fluid balances) and intestinal morphology and motility (static and cine MRI at baseline and 4, 24 and 48 weeks). ResultsPS volume decreased by -4702mL/week (-52%; p<0.001) at week 52. Seven patients (78%) achieved ≥1 day off PS at week 52. At 4 weeks, fecal output was reduced by 253 g/day (p=0.013). At 48 weeks, increases in wet weight absorption by 316 g/day (p=0.039), energy absorption by 1134 kJ/day (p=0.041) and carbohydrate absorption by 56.1 g/day (p= 0.024) were observed. Moreover, small bowel length increased from 29.7 to 40.7 cm (p=0.012), duodenal wall thickness increased by 0.8 mm (p=0.02) and motility in the proximal colon was reduced (p=0.031). A total of 127 adverse events was reported, which were mostly mild to moderate. ConclusionApraglutide had an acceptable safety profile and was associated with significant reductions in PS needs and days off PS, improvements in intestinal absorption, and structural and functional intestinal changes in patients with SBS-IF-CiC.ClinicalTrials.gov, Number NCT04964986

When parenteral nutrition is the answer: The case of pediatric intestinal rehabilitation.

In pediatric patients with intestinal failure, parenteral nutrition is lifesaving but also has several associated risks. The goals of intestinal rehabilitation include promoting growth, minimizing complications associated with intestinal failure, and reaching enteral autonomy, if possible. Pediatric intestinal rehabilitation programs are interdisciplinary teams that strive to provide optimal care for children dependent on parenteral nutrition. The provision of parenteral nutrition requires close monitoring of patients' growth, nutrition concerns, clinical status, and laboratory parameters. Recent advances in the field of intestinal rehabilitation include new lipid emulsions, considerations regarding enteral feeding, advances in micronutrient provision, and central venous catheter preservation techniques. Challenges in the field remain, including improving overall quality of life with home parenteral nutrition administration and preventing recently recognized complications such as chronic intestinal inflammation.

Characteristics of patients with intestinal failure with parenteral nutrition and/or outpatient parenteral fluids without social security.

Characteristics of patients with intestinal failure with parenteral nutrition and/or outpatient parenteral fluids without social security.

Secondary sarcopenia in patients with intestinal failure: Associated risk factors and infection incidence

Secondary sarcopenia in patients with intestinal failure: Associated risk factors and infection incidence

Increased oral intake and improved energy and carbohydrate absorption at 48 weeks with apraglutide in short bowel syndrome with intestinal failure (SBS-IF) and colon-in-continuity (CIC)

Increased oral intake and improved energy and carbohydrate absorption at 48 weeks with apraglutide in short bowel syndrome with intestinal failure (SBS-IF) and colon-in-continuity (CIC)

Assessment of liver stiffness and steatosis in patients with intestinal failure: A cross-sectional study

Assessment of liver stiffness and steatosis in patients with intestinal failure: A cross-sectional study

Changes in motility and bowel morphology assessed by magnetic resonance imaging (MRI) in short bowel syndrome with intestinal failure (SBS-IF) and colon-in-continuity (CIC) treated with apraglutide

Changes in motility and bowel morphology assessed by magnetic resonance imaging (MRI) in short bowel syndrome with intestinal failure (SBS-IF) and colon-in-continuity (CIC) treated with apraglutide

Efficacy and safety of apraglutide once-weekly in patients with Short Bowel Syndrome and Intestinal Failure (SBS-IF): results from the stars study - a global phase 3 double-blind, randomized, placebo-controlled trial

Efficacy and safety of apraglutide once-weekly in patients with Short Bowel Syndrome and Intestinal Failure (SBS-IF): results from the stars study - a global phase 3 double-blind, randomized, placebo-controlled trial

S2211 Phase 3, Double-Blind, Randomized STARS Trial of Apraglutide Once-Weekly in Patients with Short Bowel Syndrome and Intestinal Failure (SBS-IF): Subgroup Analyses by Baseline Demographics and SBS Disease Characteristics

S2211 Phase 3, Double-Blind, Randomized STARS Trial of Apraglutide Once-Weekly in Patients with Short Bowel Syndrome and Intestinal Failure (SBS-IF): Subgroup Analyses by Baseline Demographics and SBS Disease Characteristics

Evaluating poly-prescribing in patients with intestinal failure

Evaluating poly-prescribing in patients with intestinal failure

Nutritional status of patients with intestinal failure (IF) and intestinal insufficiency (II)

Nutritional status of patients with intestinal failure (IF) and intestinal insufficiency (II)

Apraglutide results in reduced Parenteral Support (PS) needs and improved patient reported outcomes in Short Bowel Syndrome with Intestinal Failure (SBS-IF) and Colon-in-Continuity (CiC)

Apraglutide results in reduced Parenteral Support (PS) needs and improved patient reported outcomes in Short Bowel Syndrome with Intestinal Failure (SBS-IF) and Colon-in-Continuity (CiC)

Durable Mixed Chimerism May Permit Subsequent Immunosuppression-Free Intestinal Transplantation – a Proof-of-Principle Study

Intestinal transplantation (ITx) is the definitive treatment for intestinal failure but has the highest rejection rate among solid organ transplants, requiring high doses of immunosuppression with high rates of infection, graft-versus-host disease, and malignancy. Transplant tolerance would overcome the need for long-term immunosuppression. Using non-myeloablative conditioning, our laboratory has developed a novel swine model of hematopoietic stem cell transplantation (HSCT) that produces durable mixed chimerism (MC) and immune tolerance without toxicity. We investigated whether durable MC would promote tolerance of subsequently transplanted donor-matched intestinal allografts without immunosuppression. Using miniature swine with defined MHC, we performed HSCT across an MHC-Class-I haplotype mismatch. Immunosuppression was stopped by day 45. MC was evaluated by flow cytometry, and mixed lymphocyte reaction (MLR) assays were used to evaluate cellular responses. Subsequently, orthotopic ITx was performed without immunosuppression using a donor that was MHC-matched to the HSCT donor. Recipients were observed for four weeks and euthanized for tissue collection and mechanistic assays. After HSCT, the recipients developed durable multilineage MC and apparent deletional tolerance. After ITx, recipients showed no clinical or histological signs of rejection, and chimerism was unchanged. These results demonstrate the potential value of generating durable MC to achieve transplant tolerance.

The impact of home parenteral support on phase angle and functional mass change in palliative cancer patients with chronic intestinal failure (TYPE 3)

The impact of home parenteral support on phase angle and functional mass change in palliative cancer patients with chronic intestinal failure (TYPE 3)