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Tissue Engineering of the Intestine in a Murine Model
Published on: December 1, 2012
Current concepts in the medical management of pediatric intestinal failure
Jeffrey A Rudolph1, Robert Squires
1Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15224, USA. jeffrey.rudolph@chp.edu
Insights
Medical intestinal rehabilitation aims to improve outcomes for children with intestinal failure by enhancing gut adaptation. This approach focuses on achieving enteral autonomy, potentially reducing the need for intestinal transplantation.
Area of Science:
- Pediatric Gastroenterology
- Intestinal Rehabilitation
- Surgical Innovation
Background:
- Medical management of pediatric intestinal failure is increasingly important, with small bowel transplantation as a growing option.
- Achieving enteral autonomy through intestinal adaptation is crucial for determining transplant eligibility.
- This review focuses on advances in intestinal rehabilitation and insights into intestinal failure morbidity.
Purpose of the Study:
- To review key advances in intestinal rehabilitation for children with intestinal failure.
- To highlight strategies for enhancing intestinal adaptation and achieving enteral autonomy.
- To discuss recent findings on the morbidity associated with intestinal failure.
Main Methods:
- Review of current medical and therapeutic strategies in intestinal rehabilitation.
- Focus on identifying prognostic factors and therapies to increase functional gut mass.
- Emphasis on balancing enteral feeding with nutritional goals.
Main Results:
- Intestinal rehabilitation has evolved into a multidisciplinary field.
- Therapeutic efforts concentrate on objective prognostication and methods to augment gut mass.
- Enteral nutrition remains central to adaptive therapy, alongside management of parenteral nutrition complications.
Conclusions:
- Medical intestinal rehabilitation has advanced beyond mere caloric provision to promoting enteral autonomy via adaptation.
- Evolving strategies aim to enhance adaptation and minimize morbidity.
- Improved understanding will clarify the optimal choice between rehabilitation and transplantation.
Purpose Of Review:
Medical management of children with intestinal failure has gained increased relevance in recent years, in part owing to the growth of small bowel transplantation as a therapeutic option. The capacity of a patient to attain enteral autonomy through intestinal adaptation is critical in the decision process of whether or not transplantation is beneficial. This article reviews several important advances in the field of intestinal rehabilitation, focusing on enhancing adaptation and briefly mentioning recent insights into the morbidity of intestinal failure.
Recent Findings:
The field of intestinal rehabilitation has developed into a multidisciplinary venture with many facets. From a medical standpoint, intestinal adaptation efforts have come to focus upon identifying objective prognostic factors and therapies geared to increase functional gut mass. However, the stalwart of adaptive therapy remains the provision of enteral feeds, which must be balanced with nutritional goals. Although the common complications of parenteral nutrition therapy continue to affect outcomes, new therapies offer promise with regard to prevention of morbidity in this population.
Summary:
Medical intestinal rehabilitative therapy has progressed from the solitary concept of providing sufficient calories for growth to the promotion of enteral autonomy via intestinal adaptation. As strategies evolve with enhancing adaptation and minimizing morbidity, a clearer perspective will be gained regarding the difficult choice of rehabilitation versus transplantation as optimal therapy.
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