The introduction of parenteral nutrition support has given patients with short bowel syndrome the time they need to achieve maximal intestinal rehabilitation and has allowed these patients to survive. The pioneering work of Drs. Byrnes and Wilmore in the 1990s focused on novel techniques to enhance intestinal adaptation and absorption, including mo

A complex disease entity, intestinal failure (IF) has only recently become accepted as a distinct clinical syndrome. Improvements across a wide range of disciplines-including critical care and organ transplantation as well as surgical, medical, and nutritional therapies-have led to a steady rise in survival and quality of life for patients with IF.

This book provides readers with a succinct but comprehensive overview of current concepts relating to intestinal failure, including its treatment, with a particular focus on recent advancements. The opening chapters address basic aspects of intestinal failure, including etiology, clinical pathophysiology, physiology of intestinal adaptation, and intestinal microbiota. The complications of intestinal failure, such as bacterial overgrowth and intestinal failure-associated liver disease, are then discussed. A series of chapters specifically address important strategies in the nutritional, pharmacological, and surgical treatment of intestinal failure as well as the concept of intestinal rehabilitation. Finally, two significant emerging developments are considered: regenerative medicine and distraction enterogenesis. The authors are internationally recognized experts from Europe and North America who are ideally placed to describe current knowledge and progress in the field.

A complex disease entity, intestinal failure (IF) has only recently become accepted as a distinct clinical syndrome. Improvements across a wide range of disciplines—including critical care and organ transplantation as well as surgical, medical, and nutritional therapies—have led to a steady rise in survival and quality of life for patients with IF. Taking a current, multidisciplinary approach to their care, Clinical Management of Intestinal Failure offers intensive discussion of medical and nutritional issues in adults and children with intestinal failure. It addresses all facets of IF, including epidemiology, clinical presentation, intestinal rehabilitation, and transplantation. Topics covered include: Etiology and epidemiology Pathophysiology and clinical assessment Medical and surgical management Prevention and treatment of complications Nursing management Emerging diagnostic and therapeutic methods Long-term care Reflecting the diverse nature of IF clinical care and research, this book is written by a group of expert clinician scientists that includes gastroenterologists, surgeons, nurses, pharmacists, dietitians, social workers, and patients. They show how a multidisciplinary approach to patient care is instrumental in achieving optimal patient outcomes through more efficient lines of communication, improved monitoring of medications and their effects, detailed evaluation of growth parameters, and facilitation of the creative process that can lead to research breakthroughs. Advancing the discipline of IF, this book summarizes the current state of the art of patient management as well as new developments in the science of tissue engineering, medical and surgical therapy, and transplantation.

Adult Short Bowel Syndrome: Nutritional, Medical, and Surgical Management serves as a practical guide to the medical, surgical and nutritional care of complex patients with Short Bowel Syndrome (SBS), providing information on SBS with the most up-to-date, evidence-based data available. Additionally, the book presents global perspectives and highlights emerging areas of research that are influencing the care of patients with SBS. Intended for nutritionists, dieticians, physicians (specifically, general practitioners, gastroenterologists, and surgeons), nurse practitioners, pharmacists, students and researchers, this book serves as a quick reference on the medical, surgical and nutritional care of complex patients with short bowel syndrome. Presents emerging areas of research related to Short Bowel Syndrome (gut microbiome, pre/probiotics), as well as current applications in clinical practice Compiles an overview, classification and complications of the Short Bowel Syndrome disease state Contains effective dietary concepts (including rationale and use of oral rehydration solutions) for managing malabsorption caused by Short Bowel Syndrome Includes medical and pharmaceutical management techniques to compliment nutrition interventions Discusses surgical options for consideration in patients with Short Bowel Syndrome Highlights international perspectives on treatment and care

The objective of this thesis was to evaluate the effect of implementation of a multidisciplinary intestinal rehabilitation program (IRP) on clinical outcomes of pediatric intestinal failure (IF). This was attained by two comprehensive reviews and three related research projects that contribute both clinical and methodological knowledge. Pediatric IF is a complex medical condition. Advances have been made clinically in recent years, but research in the field has suffered from methodological challenges and poor quality. Many of these were outlined and solutions suggested in this thesis. The first project compared clinical outcomes of three eras of pediatric IF-management using univariate categorical and time-to-event analysis. While IRP-introduction led to an increased transplantation rate and improved clinical outcomes, further progress was made and the natural course of the disease changed with IRP-maturation and adoption of novel treatment strategies. The second project quantified the continuous change over time of pediatric IF over a 15-year time period and tested systematically introduced treatments using novel methods. Multivariate time series analysis was applied to assess the relationship between new treatment options and change in clinical outcomes. The study showed that IRP-introduction and omega-3 lipid emulsions independently decreased disease-specific mortality from liver failure and sepsis when adjusted for disease severity, while serial transverse enteroplasty and ethanol locks did not impact mortality significantly. With improved mortality of pediatric IF, assessment of morbidity became imperative. After having identified a severe lack in methodology to measure neonatal and infant health-related quality of life (NIHRQOL) in a systematic literature review, the conceptual meaning of NIHRQL was explored in the final project. It concluded that NIHRQOL is a multidimensional, multilayered and interconnected concept, in which the childâ s needs are fundamental factors, and the caregiverâ s and societyâ s ability to meet those needs characterize the interdependence between the child and its caregiving environment. In summary, the complexity of pediatric IF and related methodological challenges were identified. Methodological solutions were described and illustrated. Clinical advancements of pediatric IF were quantified, and IRP-introduction and omega-3 lipid emulsions recognized as strongest contributors. Finally, the meaning of NIHRQOL was explored and organized in a conceptual framework in this thesis.

Intestinal failure is a challenging, emerging field that has beenthe subject of much research and debate in recent years and hasonly recently become widely accepted as a distinct clinicalsyndrome. This comprehensive book provides an in-depth review ofscientific theory and clinical practice relating to intestinalfailure with specific emphasis on assessment and management as partof a multidisciplinary team. Compiled by an internationallyrecognised editorial team, the book provides a practical how-toguide to the management of adult and pediatric patients withintestinal failure, focusing on quality-of-life issues that are atthe heart of patient care. World experts from centers of excellence share their clinicalexperience and expertise, offering the first ever authoritativeresource on intestinal failure All aspects of patient management are covered, from diagnosisand medical and surgical management (including transplantation) tonutritional consideration and psychosocial aspects of care Numerous illustrations, flow diagrams and summary boxescomplement the text and emphasize important concepts, providing anaccessible approach to this complex field This landmark book is essential reading for anygastroenterologists, surgeons, transplant teams or clinicalnutritionists involved in the care of patients with intestinalfailure.