Adverse effects of liver dysfunction and portal hypertension on intestinal adaptation in short bowel syndrome in children.
BACKGROUND
The effects of liver dysfunction and portal hypertension on intestinal adaptation in short bowel syndrome are generally unknown. The presence of these disorders may adversely affect the ability to wean these patients from parenteral nutrition.


METHODS
Forty-two infants with short bowel syndrome were placed in one of three Child's classifications, depending on serum bilirubin, prothrombin time, ascites, albumin, and liver biopsy, and compared for time to diet tolerance, time required for parenteral nutrition, and survival. A subgroup of these patients also underwent portal pressure measurement, which was combined with liver biopsy results to compare three groups for the same parameters.


RESULTS
Survival was Child's class A 100%, B 84%, C 61%, while time to feeding tolerance was A 16.3 days, B 20.0 days, C 28 days, and total parenteral nutrition time was A 80.0 days, B 98.0 days, C 100.0 days. In the groups that underwent portal pressure measurement, the survival was group I (normal biopsy and pressure) 100%, group II (abnormal biopsy and normal pressure) 90%, group III (abnormal biopsy and pressure) 66%, while time to feeding tolerance was I 15.0 days, II 18.0 days, III 24.0 days, and total parenteral nutrition time was I 72.0 days, II 94.0 days, III 184.0 days.


CONCLUSIONS
Cholestatic liver disease, especially associated with portal hypertension adversely affects bowel adaptation in short bowel syndrome.
Weber
Thomas R
TR
Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, 1465 South Grand Blvd., MO 63104, USA. Weberm2@slu.edu
Keller
Martin S
MS
D002780:Cholestasis, Intrahepatic / Q000209:etiology / Q000503:physiopathology*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D020345:Enterocolitis, Necrotizing / Q000601:surgery; D005248:Feeding Methods; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology*; D007231:Infant, Newborn; D007422:Intestines / Q000503:physiopathology*; D012720:Severity of Illness Index; D012778:Short Bowel Syndrome / Q000209:etiology / Q000503:physiopathology*; D016896:Treatment Outcome