title: Medical management of motility disorders in patients with intestinal failure: a focus on necrotizing enterocolitis, gastroschisis, and intestinal atresia.
abstract: BACKGROUND
  Intestinal failure (IF) is the dependence upon parenteral nutrition to maintain minimal energy requirements for growth and development. It may occur secondary to a loss of bowel length, disorders of motility, or both. Short bowel syndrome (SBS) is a malabsorptive state resulting from surgical resection, congenital defect, or diseases associated with loss of absorptive surface area. A particularly vexing problem is associated with whole bowel and/or segmental intestinal dysmotility. Motility disorders within the context of SBS and IF may relate to rapid intestinal transit secondary to loss of intestinal length, dysmotility associated with loss or poor antegrade peristalsis, or gastroparesis. Therapy may be classified into medical (prokinetic and antidiarrheal agents) and surgical to deal with the overdistended poorly motile bowel.
  
  
  METHODS
  We performed a systematic review of the literature pertaining to IF, SBS, and dysmotility in the pediatric population with gastroschisis, necrotizing enterocolitis, and intestinal atresia. In addition to the available treatment options, we have provided a review of the literature and a summary of the available evidence.
  
  
  CONCLUSIONS
  Despite relatively poor level of evidence regarding the application of promotility and antidiarrheal medications in patients with SBS and IF, these agents continue to be used. Herein, we provide a review of the physiology and pathophysiology of intestinal motility/dysmotility and available strategies for the use of promotility and antidiarrheal agents in patients with IF/SBS.
authors.affiliation: Division of Pediatric Surgery, Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada. bdicken@ualberta.ca
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Dicken
authors.forename: Consolato
authors.initials: C
authors.lastname: Sergi
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Rescorla
authors.forename: Francine
authors.initials: F
authors.lastname: Breckler
authors.forename: David
authors.initials: D
authors.lastname: Sigalet
mesh_terms: D000930:Antidiarrheals / Q000627:therapeutic use; D020345:Enterocolitis, Necrotizing / Q000150:complications* / Q000503:physiopathology; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005769:Gastrointestinal Motility / Q000502:physiology*; D020139:Gastroschisis / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007409:Intestinal Atresia / Q000150:complications* / Q000503:physiopathology; D007410:Intestinal Diseases / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008286:Malabsorption Syndromes / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D012778:Short Bowel Syndrome / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
chemical_list: D000930:Antidiarrheals; D005765:Gastrointestinal Agents