Update on the management of intestinal failure.
Intestinal failure is a serious complication of conditions such as inflammatory bowel disease, mesenteric ischemia, and radiation enteritis--and of extensive bowel resection performed because of these diseases. Imbalances of fluids and electrolytes and poor nutritional status manifest as chronic diarrhea or increased ostomy output. Prompt referral to a center specializing in intestinal rehabilitation is key to achieving nutritional homeostasis and, in some cases, can help the patient return to oral food intake. We review the intestinal sequelae of bowel resection and provide an update on intestinal rehabilitation with dietary modification, drug therapy, and parenteral nutrition. We also review current experience with intestinal transplant, a potentially lifesaving option in select patients when intestinal rehabilitation fails or parenteral nutrition causes severe complications.
Department of Gastroenterology/Hepatology, McMaster University, Hamilton, ON, Canada.
Shishira
S
Bharadwaj
Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
Parul
P
Tandon
Department of Gastroenterology and Hepatology, Cleveland Clinic, Weston, FL, USA.
John M
JM
Rivas
Center for Human Nutrition, Cleveland Clinic, Cleveland, OH, USA.
Anne
A
Furman
Center for Human Nutrition, Cleveland Clinic, Cleveland, OH, USA.
Lisa
L
Moccia
Center for Human Nutrition, Cleveland Clinic, Cleveland, OH, USA.
Ashley
A
Ratliff
Center for Human Nutrition, Cleveland Clinic, Cleveland, OH, USA.
Abdullah
A
Shatnawei
Center for Human Nutrition, Cleveland Clinic, Cleveland, OH, USA.
Ezra
E
Steiger
Director, Center for Human Nutrition, Cleveland Clinic, Cleveland, OH, USA.|Medical Director, Intestinal Transplant Program, Cleveland Clinic, Cleveland, OH, USA. E-mail: kirbyd@ccf.org.
Donald F
DF
Kirby
D004035:Diet Therapy / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000534:rehabilitation*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D063305:Organ Dysfunction Scores; D010288:Parenteral Nutrition / Q000379:methods*; D020127:Recovery of Function; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000628:therapy
D005765:Gastrointestinal Agents