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Published on: December 1, 2012
Comparison of short bowel syndrome acquired early in life and during adolescence
Matias Bruzoni1, Debra L Sudan, Robert A Cusick
1Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. mbruzoni@unmc.edu
Insights
Adults who developed short bowel syndrome (SBS) in childhood have similar long-term outcomes to those who developed SBS in adolescence. Despite differing causes and anatomy, both groups require similar treatments like parenteral nutrition and intestinal transplant.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Transplant Surgery
Background:
- Short bowel syndrome (SBS) survival has improved with parenteral nutrition and intestinal transplantation.
- Hypothesized differences exist between adult SBS patients who developed the condition in childhood versus adolescence.
Purpose of the Study:
- To investigate potential differences in etiology, intestinal anatomy, and long-term outcomes between adult patients with SBS originating in childhood versus adolescence.
Main Methods:
- Studied 67 patients aged 16–40 years.
- Divided into a pediatric group (PG; n=30, SBS onset <12 years) and an adolescent group (AG; n=37, SBS onset 13–25 years).
Main Results:
- Pediatric group (PG) causes: midgut volvulus, gastroschisis, intestinal atresia. Adolescent group (AG) causes: trauma, tumors, postoperative complications.
- PG had more colon remnants (97% vs. 71%) and fewer ostomies (7% vs. 47%) than AG.
- Both groups had similar rates of short intestinal remnants (<60 cm), need for parenteral nutrition, and intestinal transplant; PG had worse height z-scores.
Conclusions:
- Pediatric patients developing SBS early in life show similar long-term outcomes to adolescent-onset SBS patients.
- Differences in SBS origin and intestinal anatomy do not appear to significantly alter long-term outcomes.
- Acknowledges inherent biases in group definitions.
Background:
Prolonged survival in pediatric patients with short bowel syndrome (SBS) is now possible because of parenteral nutrition and small bowel transplantation. We hypothesized that there may be important differences between adult patients who developed SBS during early childhood and those who develop this as adolescents.
Methods:
Sixty-seven patients between the ages of 16 and 40 years were studied. Thirty patients developing SBS younger than 12 years comprised the pediatric group (PG), 37 developing SBS at age 13 to 25 constituted the adolescent group (AG).
Results:
Midgut volvulus (n=11) was the most common cause in the PG followed by gastroschisis (n=5), intestinal atresia (n=5), and necrotizing enterocolitis (n=4). The most common cause of SBS in the AG was trauma (n=13), followed by tumors (n=7) and postoperative complications (n=5). A similar portion in each group had intestinal remnants less than 60 cm (69% vs. 58%), however, the PG was more likely to have a colon remnant (97% vs. 71%, P<0.05), and less likely to have an ostomy (7% vs. 47%, P<0.05). Patients in PG were followed significantly longer than AG (246+/-67 vs. 90+/-58 months, P<0.05). A similar portion of the patients require long-term parenteral nutrition (86% vs. 84%) or have undergone intestinal transplant (28% vs. 23%). Significantly more pediatric patients had negative height z scores when compared with the adolescents.
Conclusions:
Acknowledging the inherent biases created in defining the two groups, pediatric patients developing SBS early in life seem to be similar to those who develop SBS as adolescents with regards to long-term outcome, despite differences in origin and intestinal anatomy.
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