Welcome to the N&G 2023 Meeting Calendar

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Displaying One Session

Session Type
Parallel Session
Date
03/30/2023
Session Time
03:00 PM - 04:00 PM
Room
Platinum Suite Room 1+2

Growth in Short Bowel Syndrome (SBS)

Session Type
Parallel Session
Date
03/30/2023
Session Time
03:00 PM - 04:00 PM
Room
Platinum Suite Room 1+2
Lecture Time
03:00 PM - 03:18 PM

Abstract

Abstract Body

Although the care of children with SBS-IF has improved significantly in recent years, their nutritional status is frequently affected by the limited absorption of nutrients. About 50% of the children may have short stature for age, and one-third of them may have low bone mineral density. Children with inflammatory conditions might be at greatest risk of growth failure and inflammation might be a predictor of short stature in the long term. Optimal growth in SBS children needs to cover energy requirements including energy for basal metabolic rate or resting energy expenditure (REE), physical activity, growth and the metabolic response to feeding. In children with SBS-IF faecal energy losses are greater compared to healthy children. Furthermore, energy losses vary between patients according to the anatomy while having a remnant colon represents a potential for energy salvage. REE may be measured by indirect calorimetry or by using predictive equation such as Schofield formula. The PN dependency index (PNDI) is the ratio between non-protein-energy intake (NPEI), provided by PN for achieving normal or catch-up body weight gain, and REE) (PNDI = NPEI/REE). Protein (nitrogen) intake is established according to recommendations and adapted to the Nitrogen/Energy ratio (1gr Nitrogen for 200-250kcal). Given the intestinal malabsorption that characterizes the SBS, it is inappropriate to consider that the sum of enteral and parenteral nutritional intakes corresponding to RDAs can be optimal. We have observed in weaned off PN SBS pediatric patients, a syndrome we call the “overloaded gut syndrome” (abdominal distension, digestive dyscomfort and failure to thrive) resulting from forced tube feeding in insufficiently adapted remaining intestine. This requires to resume PN for a while and discuss non-transplant surgery and/or GLP-2 analog treatment. Serum citrulline is though as a helpful marker of intestinal absorption, however effective cut off levels cannot be extrapolated. Changes in serum citrulline levels along the process of adaptation is correlated with the PNDI reflecting the changes in intestinal mucosa growth and may be used as a reliable predictive factor of PN weaning. Beside inappropriate protein-energy intake, other factors may cause failure to thrive such as sodium deficiency from high stool output, small intestinal bacterial overgrowth, chronic metabolic acidosis (e.g. D-Lactic), IFALD, and repeated catheter related blood-stream infections.
Nutritional status should be monitored to adapt the nutritional support. It includes body weight and length gain velocity as well as BMI. Height curves should always be weighted upon genetic target size. Body composition is helpful and may be easily assessed by using dual X-Ray Absorptiometry (DXA) that measures also bone mineral density. Data on final adult height are scarce while it is greatly influenced by the long term management and follow up of SBS pediatric patients. One of the objectives of an optimal management is to reach or even exceed the genetic target size.
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Oral Aversion and Hyperphagia: Two Faces of the Same Coin

Session Type
Parallel Session
Date
03/30/2023
Session Time
03:00 PM - 04:00 PM
Room
Platinum Suite Room 1+2
Lecture Time
03:18 PM - 03:36 PM

New Frontiers to Improve Absorption and Prevent Complications

Session Type
Parallel Session
Date
03/30/2023
Session Time
03:00 PM - 04:00 PM
Room
Platinum Suite Room 1+2
Lecture Time
03:36 PM - 03:54 PM

Abstract

Abstract Body

Short bowel syndrome (SBS) is the leading cause of intestinal failure (IF) in children. The mainstay of treatment for IF is parenteral nutrition (PN).

SBS-IF may be reversible or irreversible, depending on several factors such as the underlying cause of SBS, the length of the remaining intestine and treatment used to develop or restore intestinal autonomy.

Numerous factors determine SBS prognosis and duration of PN dependency: the underlying diagnosis, the type and condition of intestinal segments preserved, the presence/absence of the ileo-cecal valve (ICV) and/or colon, a long-term enterostomy versus a primary anastomosis, any associated motility disorders, especially in intestinal atresia and gastroschisis, the number of surgical procedures, as well as the age of the patient at the time of surgery.

Long term follow of SBS-IF may be affected by multiple complication which are linked or not to long term home-PN. Even if impressive progress has been made in the latest decade in dealing with home-PN, some of those complication may be evolutive and irreversible and expose to risk of nutritional failure which may require intestinal transplantation.

The aim of the long-term treatment of SBS-IF should, thus, be multiple: on one hand, aiming to improve intestinal absorption to facilitate PN weaning; on the other hand, aiming to prevent from the very beginning the onset of complications which would highly impact on SBS-IF prognosis.

The aim of the current lecture will be to analyze all recent advancement in medical care which allowed to improve intestinal absorption rate and to avoid as much as possible complications in children with SBS-IF.

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Q&A

Session Type
Parallel Session
Date
03/30/2023
Session Time
03:00 PM - 04:00 PM
Room
Platinum Suite Room 1+2
Lecture Time
03:54 PM - 04:00 PM