Irreversible intestinal failure
Child; Humans; Parenteral Nutrition; Adaptation; infant; Physiological; Gastrointestinal Motility; Intestinal Absorption; Digestive Physiology; Hirschsprung Disease/complications; Intestinal Pseudo-Obstruction/complications/surgery; Intestines/transplantation; Liver Diseases/prevention & control; Malabsorption Syndromes/etiology/therapy; Short Bowel Syndrome/complications/surgery
Intestinal failure (IF) can be defined as the reduction of functional gut mass below the minimal amount necessary for digestion and absorption adequate to satisfy the nutrient and fluid requirements for maintenance in adults or growth in children. In developed countries, IF mainly includes individuals with the congenital or early onset of conditions requiring protracted or indefinite parenteral nutrition (PN). Short bowel syndrome was the first commonly recognized cause of protracted IF. The normal physiologic process of intestinal adaptation after extensive resection usually allows for recovery of sufficient intestinal function within weeks to months. During this time, patients can be sustained on parenteral nutrition. Only a few children have permanent intestinal insufficiency and life-long dependency on PN. Non-transplant surgery including small bowel tapering and lengthening may allow weaning from PN in some cases. Hormonal therapy with recombinant human growth hormone has produced poor results while therapy with glucagon-like peptide-2 holds promise. Congenital diseases of enterocyte development such as microvillus inclusion disease or intestinal epithelial dysplasia cause permanent IF for which no curative medical treatment is currently available. Severe and extensive motility disorders such as total or subtotal intestinal aganglionosis (long segment Hirschsprung disease) or chronic intestinal pseudo-obstruction syndrome may also cause permanent IF. PN and home-PN remain are the mainstays of therapy regardless of the cause of IF. Some patients develop complications while receiving long-term PN for IF especially catheter related complications (thrombosis, sepsis) and liver disease. These patients may be candidates for intestinal transplantation. This review discusses the causes of irreversible IF and emphasizes the specific medico-surgical strategies for prevention and treatment of these conditions at several stages of IF.
2004
Goulet O; Ruemmele F; Lacaille F; Colomb V
Journal Of Pediatric Gastroenterology And Nutrition
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00005176-200403000-00006" target="_blank" rel="noreferrer">10.1097/00005176-200403000-00006</a>
Fundamentals of neurogastroenterology: basic science
Humans; Animals; Brain/physiology; Signal Transduction; Gastrointestinal Motility; Neurons; Adenosine Triphosphate/physiology; Afferent/physiology; Corticotropin-Releasing Hormone/physiology; Enteric Nervous System/physiology; Excitatory Postsynaptic Potentials; Gastroenterology; Gastrointestinal Diseases/physiopathology; Neuroeffector Junction/physiology; Spinal Cord/physiology; Vagus Nerve/physiology
The focus of neurogastroenterology in Rome II was the enteric nervous system (ENS). To avoid duplication with Rome II, only advances in ENS neurobiology after Rome II are reviewed together with stronger emphasis on interactions of the brain, spinal cord, and the gut in terms of relevance for abdominal pain and disordered gastrointestinal function. A committee with expertise in selective aspects of neurogastroenterology was invited to evaluate the literature and provide a consensus overview of the Fundamentals of Neurogastroenterology textbook as they relate to functional gastrointestinal disorders (FGIDs). This review is an abbreviated version of a fuller account that appears in the forthcoming book, Rome III. This report reviews current basic science understanding of visceral sensation and its modulation by inflammation and stress and advances in the neurophysiology of the ENS. Many of the concepts are derived from animal studies in which the physiologic mechanisms underlying visceral sensitivity and neural control of motility, secretion, and blood flow are examined. Impact of inflammation and stress in experimental models relative to FGIDs is reviewed as is human brain imaging, which provides a means for translating basic science to understanding FGID symptoms. Investigative evidence and emerging concepts implicate dysfunction in the nervous system as a significant factor underlying patient symptoms in FGIDs. Continued focus on neurogastroenterologic factors that underlie the development of symptoms will lead to mechanistic understanding that is expected to directly benefit the large contingent of patients and care-givers who deal with FGIDs.
2006
Grundy D; Al-Chaer ED; Aziz Q; Collins SM; Ke M; Tache Y; Wood JD
Gastroenterology
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1053/j.gastro.2005.11.060" target="_blank" rel="noreferrer">10.1053/j.gastro.2005.11.060</a>
Motility disorders in childhood: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition
Child; Humans; Gastroesophageal Reflux; Vomiting; Research; Medical; Practice Guidelines; Gastrointestinal Motility; Gastroenterology; Gastrointestinal Diseases/physiopathology; Societies; Esophageal Motility Disorders/physiopathology; Child Nutrition Physiology; Constipation/physiopathology; Diarrhea/physiopathology; Intestinal Obstruction
2002
Milla P; Cucchiara S; Di Lorenzo C; Rivera NM; Rudolph C; Tomomasa T
Journal Of Pediatric Gastroenterology And Nutrition
2002
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00005176-200208002-00017" target="_blank" rel="noreferrer">10.1097/00005176-200208002-00017</a>
Gastrointestinal problems in the neurologically impaired child
Child; Humans; Preschool; Q3 Literature Search; Enteral Nutrition/methods; Cerebral Palsy/complications; Gastrostomy/adverse effects; Constipation/etiology; Gastroesophageal Reflux/etiology/physiopathology/surgery; Gastrointestinal Diseases/etiology/physiopathology; Gastrointestinal Motility; Nervous System Diseases/complications/physiopathology; Nutrition Physiology
Damage to the developing central nervous system may result in significant dysfunction in the gastrointestinal tract and is reflected in impairment in oral-motor function, rumination, gastro-oesophageal reflux, with or without aspiration, delayed gastric emptying and constipation. These problems can all potentially contribute to feeding difficulty in disabled children. Early recognition of an infant with neurological impairment that is compromising the normal feeding process is crucial. Detailed assessment of the nature of the feeding difficulties will help to predict the anticipated future nutritional needs and will allow decisions to be made about the appropriateness of input from different professionals (speech therapy, dietitians, gastroenterologists). Only when such information has been carefully assembled will rational and directed medical and surgical therapy be possible. Nutritional rehabilitation of disabled children can be associated with increased mortality and morbidity secondary to gastro-oesophageal reflux, retching, dumping syndrome or aspiration. It may also entail an increased work for care givers and increase costs of care. It is therefore necessary to document the impact of such rehabilitation on growth and quality of life for both patient and care giver.
1997
Sullivan P
Bailliere's Clinical Gastroenterology
1997
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0950-3528(97)90030-0" target="_blank" rel="noreferrer">10.1016/s0950-3528(97)90030-0</a>