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Outcomes of intestinal failure--a comparison between children with short bowel and dysmotile intestine

Mikko P Pakarinen1, Antti I Koivusalo, Risto J Rintala

  • 1Section of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Box 281, FIN-00029 HUS Helsinki, Finland. mikko.pakarinen@hus.fi

Journal of Pediatric Surgery
|December 1, 2009
PubMed

Insights

Children with short bowel (SB) are more likely to stop parenteral nutrition (PN) but face a higher risk of cholestatic liver disease compared to those with bowel dysmotility (DM). This study highlights key differences in outcomes for intestinal failure patients.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Intestinal Failure Research

Background:

  • Investigating differences in mortality, intestinal adaptation, and liver function in pediatric patients with intestinal failure (IF).
  • Comparing outcomes between patients with short bowel (SB) and bowel dysmotility (DM) as causes of IF.

Purpose of the Study:

  • To determine if mortality, intestinal adaptation, and liver function vary between children with SB and DM causing IF.
  • To identify predictors for weaning off parenteral nutrition (PN) and developing cholestasis.

Main Methods:

  • Retrospective assessment of 26 consecutive pediatric patients with IF (20 SB, 6 DM) treated between 2000-2007.
  • Defining IF as <25% age-adjusted small intestinal length or dependence on PN >6 months.
  • Analyzing survival rates, intestinal length, colon proportion, serum bilirubin, and cholestasis incidence.

Main Results:

  • SB patients had shorter intestinal length (17% vs 45%) and higher colon proportion (86% vs 0%) than DM patients (P < .05).
  • SB group showed higher peak serum bilirubin (80 vs 25 micromol/L) and cholestasis rates (11/20 vs 0/6) (P < .05).
  • SB etiology predicted weaning off PN (RR, 39.3; P < .01) and cholestasis (RR, 18.3; P < .05). Three SB children developed liver failure, two died; none in the DM group.

Conclusions:

  • Children with SB are more likely to be weaned off PN compared to those with DM.
  • SB is associated with a significantly higher risk of developing cholestatic liver disease.
  • SB and DM present distinct prognoses and complications in pediatric intestinal failure.
Abstract

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