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Medical management of pediatric intestinal failure

Samuel A Kocoshis1

  • 1University of Cincinnati College of Medicine, Nutrition and Intestinal Transplantation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. Samuel.kocoshis@cchmc.org

Seminars in Pediatric Surgery
|February 4, 2010
PubMed

Insights

Outcomes for children with congenital enteropathies and short bowel syndrome have improved due to advances in understanding and treatment. New strategies, including nutritional support and therapies, enhance intestinal adaptation and reduce reliance on parenteral nutrition.

Area of Science:

  • Pediatric Gastroenterology
  • Intestinal Adaptation
  • Congenital Enteropathies

Background:

  • Significant improvements in outcomes for pediatric congenital enteropathies and short bowel syndrome over 20 years.
  • Enhanced understanding of intractable diarrhea pathophysiology and genetic mutations.
  • Advances in parenteral nutrition (TPN) and enteral alimentation strategies.

Purpose of the Study:

  • To review advancements in managing congenital enteropathies and surgical short bowel syndrome.
  • To highlight strategies promoting intestinal adaptation and independence from TPN.
  • To discuss future therapeutic targets for improved outcomes.

Main Methods:

  • Literature review of recent advancements in pediatric intestinal failure.
  • Analysis of therapeutic strategies for congenital enteropathies and short bowel syndrome.
  • Synthesis of current knowledge on intestinal adaptation mechanisms.

Main Results:

  • Improved outcomes due to better understanding of disease mechanisms and targeted treatments.
  • Enhanced nutritional support strategies (TPN and enteral) improve outcomes for short bowel syndrome.
  • Ancillary therapies (acid suppression, antibiotics, prokinetics, fiber) accelerate adaptation.

Conclusions:

  • Pediatric intestinal failure management has advanced significantly.
  • Intestinal adaptation is key to improving outcomes and enabling emancipation from TPN.
  • Future therapies including trophic hormones (EGF, GLP-2) hold promise for further improving outcomes.

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