Motility disorders in children with intestinal failure: a national tertiary referral center experience
Audelia Eshel Fuhrer1,2, Stephanie Sukhotnik3, Hadar Moran-Lev4,5,6
1Department of Pediatric Surgery, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. odly86@gmail.com.
Insights
Intestinal dysmotility (ID) is a frequent complication in pediatric intestinal failure (IF) and short bowel syndrome (SBS). Tapering enteroplasty (STEP) effectively treated ID in these patients, improving outcomes.
Area of Science:
- Pediatric Gastroenterology
- Intestinal Failure Research
- Surgical Innovation
Background:
- Intestinal dysmotility (ID) frequently complicates pediatric intestinal failure (IF) and short bowel syndrome (SBS).
- ID contributes to significant morbidity and hinders enteral nutrition (EN) advancement in affected children.
- Understanding ID's clinical features and complications is crucial for managing IF and SBS.
Purpose of the Study:
- To investigate the clinical characteristics and complications of intestinal dysmotility (ID) in children with IF and short bowel syndrome (SBS).
- To identify risk factors and clinical manifestations associated with ID in pediatric IF and SBS patients.
- To evaluate the effectiveness of surgical interventions for ID in this population.
Main Methods:
- Retrospective chart review of 42 children with IF/SBS treated between 2003-2022.
- Patients categorized into SBS and non-SBS groups, with SBS further divided into those with and without ID.
- ID identification based on clinical, radiological, and functional assessments; analysis of demographics, anatomy, complications, and outcomes.
Main Results:
- ID was the primary cause of IF in 80% of non-SBS patients and occurred in 56% of SBS patients.
- SBS patients with ID exhibited specific characteristics, including shorter residual small bowel length and absence of the ileocecal valve (ICV).
- Common ID symptoms included food intolerance, distension, vomiting, malabsorption, and constipation; complications included failure to thrive (FTT) and bacterial overgrowth.
Conclusions:
- Intestinal dysmotility is the leading complication in SBS and a major cause of IF in non-SBS pediatric patients.
- ID presents with diverse clinical manifestations and high morbidity, significantly impacting patient outcomes.
- Tapering enteroplasty (STEP) demonstrated significant success in treating ID, leading to improved intestinal function and TPN weaning.
Purpose:
Intestinal dysmotility (ID) problems are common in patients with pediatric-onset intestinal failure (IF) and short bowel syndrome (SBS), leading to significant morbidity and delays in the advancement of enteral nutrition (EN). We aimed to investigate the clinical features and complications of ID in children with IF and SBS.
Methods:
Retrospective chart review of all children with IF and/or SBS who required parenteral nutrition (PN) > 6 weeks or small-intestinal resection ≥ 50%. Patients were divided into SBS and non-SBS groups. SBS group was divided into two subgroups: with and without ID. Patients with ID were identified (clinically, radiologically and functionally) and analyzed with regard to demographics, intestinal anatomy, complications and outcomes (short and long term).
Results:
A total of 42 children with IF were treated in our institution during 2003-2022. In non-SBS group (n = 10), ID was the most common cause of IF (80%). SBS-group included 32 children; 18 children (56%) developed ID. The clinical profile of SBS-ID patients (vs SBS) was: female gender (56%), remaining small bowel length ≤ 55 cm, estimated residual small bowel ≤ 28% (p = 0.045) and absence of ICV (56%). Common symptoms of the SBS-ID group were: food intolerance (61%), abdominal distension (50%), vomiting (44%), malabsorption and severe constipation. Complications included FTT (67%) (p = 0.003), bacterial overgrowth with subsequent bloodstream infection (33%) (p = 0.75), and lactic acidosis (11%). Lengthening procedure (STEP) was performed in 11 SBS-ID patients (61%) (p = 0.002). In all patients, STEP operation "rescued" their dysfunctional intestine. Eight of these patients (73%) were weaned from TPN. Survival rate was 100%; however, one SBS-ID patient is a candidate for combined intestinal and liver transplantation.
Conclusions:
ID is the most common complication of SBS and is the most common cause of IF in non-SBS patients. ID has a high morbidity rate and various clinical manifestations. Successful treatment of these infants may be achieved with the use of tapering enteroplasty.
Related Concept Videos
01:20Gastrointestinal Motility Disorders
01:26Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
01:18Drugs Affecting GI Tract Motility: Antimicrobials as Antidiarrheal Agents
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:23Drugs Affecting GI Tract Motility: Serotonin Receptor Agonists
01:28Drugs Affecting GI Tract Motility: Dopamine Receptor Antagonists