Treatment Of Intestinal Failure Research Articles

The role of intestinal failure in the pathogenesis of severe acute pancreatitis

Severe acute pancreatitis can induce systemic and local complications, with infectious pancreatic necrosis and sepsis leading to the second death peak. Enterogenous infection caused by intestinal failure is considered to be an important mechanism of secondary infection of pancreatic or peripancreatic necrosis. Therefore, the prevention and treatment of intestinal failure is the key point in the treatment of severe acute pancreatitis and has an important influence on the course and prognosis of the disease. Individualized treatment should be selected according to the advantages of treatment centers and the characteristics of patients.

Glucagon-like peptide 2 analogues in the treatment of intestinal failure: A qualitative exploration of the views of patients and their families in decision making.

Patients with short bowel syndrome and type 3 intestinal failure (SBS-IF) are dependent on parenteral nutrition (PN), a lifesaving treatment but inconvenient and with risks. Glucagon-like peptide 2 analogue (teduglutide) can reduce patients' need for PN. However, it comes with the risk of a number of side effects. This qualitative study investigated patients' decision making process to start teduglutide and how family members contributed to the decision. In-depth semi-structured interviews were conducted with nine participants, six patients with SBS-IF and three family members about the decision to take teduglutide. Interviews were transcribed verbatim and analysed using framework analysis. The prominent motivation for taking teduglutide (Revestive® Takeda Pharmaceuticals Limited) was reducing or stopping PN. Other motivations were to help others by assisting in developing the knowledge base around teduglutide, patients felt that they had nothing to lose by trying the drug and the support of relatives. The reasons patients considered not taking the drug were that they had accepted being on PN, the potential side effects of teduglutide and undergoing extra monitoring. However, the monitoring programme also acted as a motivator providing reassurance that patients would be observed and supported with side effects. Family members were happy to support patients' decision to try teduglutide, although they had more reservations, indicating a higher risk threshold. Patients considered potential benefits of teduglutide outweighed any disadvantages. Relatives, although supportive, had more reservations.

OPTN/SRTR 2019 Annual Data Report: Intestine

Intestine transplant can be life-saving and can improve quality of life for patients with intestinal failure. Medical and surgical advances in treatment of intestinal failure over the past 10 to 15 years have resulted in fewer patients being added to the waiting list for intestine transplant alone or for intestine transplant in combination with liver transplant (and sometimes other organs). Consequently, fewer transplants are being performed. The numbers of listings and transplants fell to new lows in 2019. The number of programs performing transplants in at least one patient in 2019 was the lowest in the last decade, equal to 2014, at 15. Graft failure plateaued over the past decade, but early graft loss has increased in the past 2 years, notably in recipients of a combined liver and intestine allograft. Five-year patient survival for transplants in 2012-2014 varied little by graft type.

New insights into the indications for intestinal transplantation.

To discuss the new guidelines on the indications for intestinal transplantation (ITx) devised in 2019 by the Intestinal Rehabilitation and Transplant Association. Early referral of patients with intestinal failure to expert intestinal rehabilitation/transplant centre is strongly recommended. Listing for a life-saving transplantation is recommended for intestinal failure-associated liver disease (IFALD) evolving to liver failure, invasive intra-abdominal desmoids, acute diffuse intestinal infarction with hepatic failure, re-transplant, and children with loss of at least three of the four upper central venous access sites or with high morbidity intestinal failure. Developments in ITx made the probability of posttransplant survival equal to that on home parenteral nutrition (HPN) and the QoL after successful ITx better than on HPN. However, for patients who have not an actual increased risk of death on HPN, the matter of preemptive listing for ITx is still controversial. For these patients, a careful case-by-case decision is recommended. The new guidelines on ITx confirm the straight referral for ITx only for patients at actual risk of death on HPN. Improvements in ITx practice and results, advances in the severity classification of intestinal failure, monitoring of the evolution of IFALD, and measuring patients' QoL are required for an immediate progression in the treatment of intestinal failure.

OPTN/SRTR 2018 Annual Data Report: Intestine.

Despite medical and surgical advances in treatment of intestinal failure, intestine transplant still plays an important role. However, the number of new patients added to the intestine transplant waiting list has decreased over the past decade, reaching a low of 135 in 2018. The number of intestine donors also decreased, reaching a low of 106 in 2018, and the number of intestine transplants performed declined to its lowest level, 104, of which 59% were intestine-liver transplants. Graft failure has plateaued over the past decade. Patient survival for transplants in 2011-2013 varied by age and transplant type. Patient survival was lowest for adult intestine-liver recipients (1-and 5-year survival 66.7% and 49.1%, respectively) and highest for pediatric intestine recipients (1-and 5-year survival 89.1% and 76.4%, respectively).

Establishment and development of Department of Burns and Plastic Surgery of the Affiliated Hospital of Nankai University (Tianjin No.4 Hospital)

Tianjin No.4 Hospital is a general hospital featured in burns, and the Department of Burns and Plastic Surgery has six secondary clinical departments with 110 hospital beds. After hard working by several generations, the department has successively developed into a key discipline in Tianjin and Tianjin Burn Emergency Center. Tianjin Burn Research Institute was established in 1992, and then the department became master's granting unit of Tianjin Medical University. In scientific research aspect, many researches have been completed and obtained important results, such as the mechanism and effect of integrated traditional Chinese and Western medicine in prevention and treatment of intestinal failure, early diagnosis and local treatment with fiberoptic bronchoscope, energy metabolism regularity of burn patients, and the development of irradiated biological dressings. In clinic aspect, tens of thousands of complex wounds and chronic refractory wounds were repaired by various kinds of flaps and advanced methods, and the cure rate of patients with large burn area reached 94.1%. In 2016, Tianjin No.4 Hospital became the Affiliated Hospital of Nankai University. Hereafter, a number of research intentions have collaborated between the department and the State Key Laboratory of Academy of Life Sciences of Nankai University. In the future, our department will focus on improving the treatment level of patients with large burn area, carrying out researches on comprehensive anti-shock in the early stage, inhalation injury treatment, infection treatment, comprehensive treatment of multiple organ failure, wound repair, scar treatment, rehabilitation, and the clinical application.

OPTN/SRTR 2015 Annual Data Report: Intestine

Intestine and intestine-liver transplant remains important in the treatment of intestinal failure, despite decreased morbidity associated with parenteral nutrition. In 2015, 196 new patients were added to the intestine transplant waiting list, with equal numbers waiting for intestine and intestine-liver transplant. Among prevalent patients on the list at the end of 2015, 63.3% were waiting for an intestine transplant and 36.7% were waiting for an intestine-liver transplant. The pretransplant mortality rate decreased dramatically over time for all age groups. Pretransplant mortality was notably higher for intestine-liver than for intestine transplant candidates (respectively, 19.9 vs. 2.8 deaths per 100 waitlist years in 2014–2015). By age, pretransplant mortality was highest for adult candidates, at 19.6 per 100 waitlist years, and lowest for children aged younger than 6 years, at 3.6 per 100 waitlist years. Pretransplant mortality by etiology was highest for candidates with non-congenital types of short-gut syndrome. Numbers of intestine transplants without a liver increased from a low of 51 in 2013 to 70 in 2015. Intestine-liver transplants increased from a low of 44 in 2012 to 71 in 2015. Short-gut syndrome (congenital and non-congenital) was the main cause of disease leading to intestine and to intestine-liver transplant. Patient survival was lowest for adult intestine-liver recipients and highest for pediatric intestine recipients.

Improving awareness on the management and treatment of intestinal failure

Management of intestinal failure (IF) is complex and challenging, requiring a multidisciplinary team approach. It was observed that there was an apparent lack of awareness among nursing and medical staff about the management of patients with IF admitted to a regional university hospital in the Republic of Ireland, despite the availability of a hospital-based guideline on IF. A lack of awareness is understandable, given the limited number of patients diagnosed with IF, and specialised centres are limited. The aim of this project was to explore awareness of IF among hospital staff, and to provide more information on its management and treatment. Developments that arose as a result of this project included an algorithm, an alert on medical records and a patient information leaflet.

Intestine.

Intestine and intestine-liver transplant plays an important role in the treatment of intestinal failure, despite decreased morbidity associated with parenteral nutrition. In 2014, 210 new patients were added to the intestine transplant waiting list. Among prevalent patients on the list at the end of 2014, 65% were waiting for an intestine transplant and 35% were waiting for an intestine-liver transplant. The pretransplant mortality rate decreased dramatically over time for all age groups. Pretransplant mortality was highest for adult candidates, at 22.1 per 100 waitlist years compared with less than 3 per 100 waitlist years for pediatric candidates, and notably higher for candidates for intestine-liver transplant than for candidates for intestine transplant without a liver. Numbers of intestine transplants without a liver increased from a low of 51 in 2013 to 67 in 2014. Intestine-liver transplants increased from a low of 44 in 2012 to 72 in 2014. Short-gut syndrome (congenital and other) was the main cause of disease leading to both intestine and intestine-liver transplant. Graft survival improved over the past decade. Patient survival was lowest for adult intestine-liver recipients and highest for pediatric intestine recipients.

PP101-MON: Long-Term Safety and Efficacy of Teduglutide Treatment for Intestinal Failure Associated with Short Bowel Syndrome (SBS–IF): Final Results of a 2-Year, Multicenter, Open-Label, Clinical Trial

PP101-MON: Long-Term Safety and Efficacy of Teduglutide Treatment for Intestinal Failure Associated with Short Bowel Syndrome (SBS–IF): Final Results of a 2-Year, Multicenter, Open-Label, Clinical Trial

Living Related Small Bowel Transplantation

Multivisceral transplantation has brought new opportunities in the treatment of organ failure, offering better outcomes and quality of life to patients. Standardized surgical technique was developed in 1997. Currently, living donor (LD) intestinal transplant has been perfected relative to technical details, leading results comparable with those performed with deceased donors (DDs). Additional advantages such as elimination of waiting time, better human leukocyte antigen (HLA) matching, short ischemia time, and being scheduled as an elective surgery are achieved with this type of procedure. Regenerative medicine constitutes a pathway of innovate techniques in the treatment of intestinal failure; however, further research needs to be performed to fully translate regenerative medicine into the clinical field.

Endoscopic Experience with Small Bowel Transplant Surveillance

Purpose: Small bowel transplantation is increasingly used as a treatment for intestinal failure and parenteral nutrition failure. The diagnosis of post transplant acute rejection is best made by routine surveillance ileoscopy with biopsies. We therefore performed this study with this specific aim: To review a single institution's experience with post-transplant ileoscopy and biopsies, specifically evaluating the efficacy and safety of random biopsy. Methods: We retrospectively examined the records of all patients who underwent small bowel transplantation at our center and then underwent ileoscopy with biopsies between November 2003 and October 2008. We reviewed all endoscopy and pathology records. Variables examined included: indication, endoscopic findings, anesthetic medications and/or sedatives, complications, and histologic findings. Results: A total of 43 patients were identified, of whom 58% were male. Among these patients, a total of 832 ileoscopies with biopsies were performed for post-operative surveillance of acute rejection. The only complication reported was bleeding, which occurred in 9 of 832 (1.1%) ileoscopies with biopsies. Each of these exhibited endoscopic evidence of hemorrhage, including: blood clot, oozing, and active bleeding associated with ulceration at a previous biopsy site. Rejection was diagnosed histologically in 119 (14%) biopsies performed; rejection was found in 13 (30%) patients overall. In 26 (22%) of these cases of rejection, endoscopic findings were described as normal. Therefore, 93 (78%) had endoscopic evidence of rejection, including: inflammation, erythema, edema, ulceration, erosion, and mucosal friability. Propofol and/or general anesthesia was used in 295 (35%) procedures. Conscious sedation was used in 283 (34%) procedures. No sedation was given in 254 (31%) procedures. Conclusion: In our institution, ileoscopy for post operative surveillance of acute rejection is a safe diagnostic modality. Random biopsies of normal appearing allograft may increase the diagnostic yield of ileoscopy, but in general histologic rejection is suggested by endoscopic findings. With the relatively high correlation, we found no need to employ zoom endoscopy. Hemorrhage was the only complication seen and was best managed with early repeat endoscopic intervention. Additionally, ileoscopy can safely be performed with little or no sedation. Continued analysis and data sharing should be performed as we try to improve and standardize post-small bowel transplant patient care.

O020 ENTERAL FEEDING WITH A LACTOSE- COMPARED TO A POLYCOSE-BASED FORMULA IMPROVES NUTRIENT ABSORPTION AND COLITIS RESISTANCE IN PRETERM PIGS

unclear. Osmotic renal charge, amino-acids, aminoside treatment may impair renal function. The aim of this study was to compare retrospectively renal biopsies (RB) in children on LTPN to search similarities suggesting a PN toxicity. Methods: Eleven patients on LTPN for more than 1 year were studied. Median age at RB was 8 years (1 24). Median PN duration was 6.5 years (1 14). Indication for PN was congenital diarrhoea (5 cases), short bowel syndrome (4), Hirschsprung disease (2). Indications for RB were: measured glomerular filtration rate <80ml/min/1.73m2 and tubular impairment (7 cases), proteinuria (2), evaluation before intestinal transplantation (ITx) (2). Lesions observed on RB were classified into: acute and chronic tubulo-interstitial lesions, vascular lesions and glomerular sclerosis with immuno-fluorescence evaluation. Renal ultrasonography (US) at RB was evaluated. Results: Histological anomalies were observed in 6 patients (1 RB before ITx and 5 for renal impairment). One patient presented with acute tubular necrosis after an episode of dehydration. One patient with congenital diarrhoea presented a membranous glomerulonephritis. In the last 4 patients ischemic lesions were observed (arteriolar myocyte vacuolization); 3 of these showed also calcifications and osmotic lesions (tubular microvacuolisation), with interstitial fibrosis in 2. Patients with histological lesions had a greater number of CVC and nephrotoxic treatment. Three of 6 patients with histological lesions showed US anomalies: hyperechogenicity, reduced size and reduced corticomedullary differentiation. No lesions were found in patients with Hirschsprung disease. Conclusion: Tubular microvacuolisation might be of osmotic origin (intravenous immunoglobulins, CT contrast). Hyperosmolar solutions, like PN, could cause such lesion which is not observed in all our patients. No specific lesions were found. Histological lesions are probably of multifactorial origin and they can occur without biological disorders. ITx, the alternative treatment of intestinal failure, shows a high risk of renal side effects. Therefore, a systematic renal histological evaluation in children on LTPN is mandatory, especially at the time of evaluation before ITx, for a correct interpretation of possible lesions after ITx.

Treatment of intestinal failure: home parenteral nutrition

Intestinal failure can result from surgical resection, obstruction, dysmotility, congenital deficiencies or disease-associated loss of absorption. Before the development of intravenous feeding in the late 1960s, the condition was fatal, but by the 1990s approximately 40,000 patients were being successfully managed on long-term home parenteral nutrition (HPN) annually in the US. Survival on HPN depends on the nature of the underlying medical condition: over 80% of Crohn's disease patients survive for 5 years, but only 20% of cancer patients survive for 1 year. Although a patient's nutritional status is easy to maintain, there are serious long-term complications that arise from bypassing the gut and infusing nutrients directly into the systemic circulation. Catheter sepsis occurs about once per year (range 0-12 times). Abnormalities in liver function tests are common, but end-stage liver disease is rare. Central venous thrombosis develops in nearly all patients after 5 years. Although approximately 80% of patients on HPN are completely rehabilitated at home, their quality of life is impaired by the perpetual dependence on nocturnal intravenous infusions (every 8-12 h). In conclusion, HPN has allowed patients with previously fatal intestinal failure to survive and lead relatively normal lives at home, but their quality of life remains impaired by the dependence on intravenous infusions and complications that progress with time.

Role of living donor bowel transplantation in the treatment of intestinal failure in adults

Role of living donor bowel transplantation in the treatment of intestinal failure in adults

Liver disease associated with intestinal failure in the small bowel syndrome

The introduction of the Total Parenteral Nutrition (TPN) has given rise to a new hope in the treatment of intestinal failure (LF) associated with the Short Bowel Syndrome (SBS). However, together with the TPN and the increase of survival of these patients, new problems and questions have emerged, as well as new therapeutical procedures. Taking into consideration this emerging reality, this paper has the purpose to undertake a review of current concepts and available treatments for patients with IF associated-liver disease. Although TPN provides an increase of survival of patients with intestinal failure, it is a potential source of complication such as: septicemia, hyperglycemia, venous thrombosis and liver disease. There are several hypothesis conceived to explain the liver disease associated to intestinal failure, however the only definite treatment as a potential to reverse the non-cirrhotic liver disease is the small intestine transplantation. Despite indications for intestine transplantation are not entirely defined in literature, the trend is its early indication in high-risk patients, preserving the liver integrity and preventing the eventual need of both liver and intestine transplantations altogether.

A Multidisciplinary Approach to the Treatment of Intestinal Failure

A Multidisciplinary Approach to the Treatment of Intestinal Failure

Alternativas terapéuticas en el fracaso intestinal

Long-term parenteral nutrition is effective in the treatment of intestinal failure. Equally, the results of intestinal transplantation (IT) are promising. The choice of one or other form of treatment depends on the balance between the advantages and disadvantages of each. Based on these premises, we analyzed the outcome of home parenteral nutrition (HPN) for intestinal failure in our patients. Intestinal failure was considered when parenteral nutrition was required for more than 5 months. In the 14 patients included in the HPN program since 1993, we reviewed the indication of HPN as well as their suitability for IT. Five of the 14 patients received HPN for causes other than intestinal failure. Of the remaining nine patients, four had severe motility disorder, three had short bowel syndrome, and two had protracted diarrhea of infancy. All these patients would be potential candidates for IT. Five patients were weaned off HPN because of intestinal adaptation between 2.5 and 13 months after starting HPN. One patient died because of lack of venous access. Three patients currently continue on HPN. Intestinal rehabilitation constitutes the best option for patients with intestinal failure. HPN offers the best interim treatment while waiting for adaptation. IT should be reserved for those patients with severe complications due to HPN. Nevertheless, it may become a real option for those with indefinite HPN. HPN and IT should be considered as complementary treatments.

Isolated intestinal transplantation: A viable option for the treatment of intestinal failure

Isolated intestinal transplantation: A viable option for the treatment of intestinal failure

Isolated intestinal transplantation: A viable option for the treatment of intestinal failure

Isolated intestinal transplantation: A viable option for the treatment of intestinal failure