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New Insights and Interventions for Short Bowel Syndrome

  • Surgical (J Karpelowsky, Section Editor)
  • Published:
Current Pediatrics Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review summarizes recent innovations in the treatment of patients with short bowel syndrome.

Recent Findings

The use of surgical procedures, growth factor stimulation, and bioengineering approaches to increase absorptive surface area of the intestine is examined. While the morphology of the intestine is clearly altered by these interventions, it is less clear that the overall function of the intestine is improved.

Summary

Continued innovations will likely bring about new therapeutic options for patients with short bowel syndrome. Careful evaluations of the impact of these interventions await controlled clinical trials.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wales PW, De Silva N, Kim J, Lecce L, To T, Moore A. Neonatal short bowel syndrome: population-based estimates of incidence and mortality rates. J Pediatr Surg. 2004;39:690–5.

    Article  PubMed  Google Scholar 

  2. Spencer AU, Kovacevich D, McKinney-Barnett M, Hair D, Canham J, Maksym C, et al. Pediatric short-bowel syndrome: the cost of comprehensive care. Am J Clin Nutr. 2008;88(6):1552–9.

    Article  CAS  PubMed  Google Scholar 

  3. Fallon EM, Mitchell PD, Nehra D, Potemkin AK, O’Loughlin AA, Gura KM, et al. Neonates with short bowel syndrome. JAMA Surg. 2014;149(7):663.

    Article  PubMed  Google Scholar 

  4. King B, Carlson G, Khalil BA, Morabito A. Intestinal bowel lengthening in children with short bowel syndrome: systematic review of the Bianchi and STEP procedures. World J Surg. 2013;37:694–704.

    Article  PubMed  Google Scholar 

  5. • Oh PS, Fingeret AL, Shah MY, Ventura KA, Brodlie S, Ovchinsky N, et al. Improved tolerance for enteral nutrition after serial transverse enteroplasty (STEP) in infants and children with short bowel syndrome—a seven-year single-center experience. J Pediatr Surg Elsevier Inc. 2014;49(11):1589–92. A single center study examining enteral autonomy and improved enteral tolerance with STEP

    Article  Google Scholar 

  6. •• Fernandes MA, Usatin D, Allen IE, Rhee S, Vu L. Improved enteral tolerance following step procedure: systematic literature review and meta-analysis. Pediatr Surg Int Springer Berlin Heidelberg. 2016;32(10):921–6. Recent meta-analysis of STEP compiling seven different studies

    Article  Google Scholar 

  7. Jones BA, Hull MA, Potanos KM, Zurakowski D, Fitzgibbons SC, Ching YA, et al. Report of 111 consecutive patients enrolled in the international serial transverse enteroplasty (STEP) data registry: a retrospective observational study. J Am Coll Surg American College of Surgeons. 2013;216(3):438–46.

    Article  Google Scholar 

  8. • Garnett GM, Kang KH, Jaksic T, Woo RK, Puapong DP, Kim HB, et al. First STEPs: serial transverse enteroplasty as a primary procedure in neonates with congenital short bowel. J Pediatr Surg. Elsevier Inc. 2014;49(1):104–8. Demonstrates role for primary treatment with STEP in neonates

    Article  Google Scholar 

  9. Madsen KB, Askov-Hansen C, Naimi RM, Brandt CF, Hartmann B, Holst JJ, et al. Acute effects of continuous infusions of glucagon-like peptide (GLP)-1, GLP-2 and the combination (GLP-1 + GLP-2) on intestinal absorption in short bowel syndrome (SBS) patients. A placebo-controlled study. Regul Pept Elsevier BV. 2013;184:30–9.

    Article  CAS  Google Scholar 

  10. Burness CB, McCormack PL. Teduglutide: a review of its use in the treatment of patients with short bowel syndrome. Drugs. 2013;73(9):935–47.

    Article  CAS  PubMed  Google Scholar 

  11. McKeage K. Teduglutide: a guide to its use in short bowel syndrome. Clin Drug Investig. 2015;35(5):335–40.

    Article  CAS  PubMed  Google Scholar 

  12. Jeppesen PB, Gilroy R, Pertkiewicz M, Allard JP, Messing B, O’Keefe SJ. Randomised placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome. Gut. 2011;60(7):902–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Jeppesen PB, Pertkiewicz M, Messing B, Iyer K, Seidner DL, O’Keefe SJD, et al. Teduglutide reduces need for parenteral support among patients with short bowel syndrome with intestinal failure. Gastroenterology. 2012;143(6):1473–1481.e3.

    Article  CAS  PubMed  Google Scholar 

  14. • Schwartz LK, O’Keefe SJD, Fujioka K, Gabe SM, Lamprecht G, Pape U-F, et al. Long-term teduglutide for the treatment of patients with intestinal failure associated with short bowel syndrome. Clin Transl Gastroenterol. 2016;7:e142. Demonstrates sustained wean from parentral nutrition in adults taking teduglutide

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. • Fujioka K, Jeejeebhoy K, Pape U-F, Li B, Youssef NN, Schneider SM. Patients with short bowel on narcotics during 2 randomized trials have abdominal complaints independent of teduglutide. JPEN J Parenter Enteral Nutr. 2016. In adults, adverse abdominal complaints relate more to underlying intestinal dysfunction than to teduglutide

  16. •• Sullins VF, Scott A, Wagner JP, Steinberger D, Lee SL, Wu BM, et al. Intestinal lengthening in an innovative rodent surgical model. J Pediatr Surg. 2014;49(12):1791–4. Development of a novel biodegradable spring for use in distraction enterogenesis, moving away from devices that would require both surgical placement and removal

    Article  PubMed  Google Scholar 

  17. Grant CN, Salvador GM, Sala FG, Hill JR, Levin DE, Speer AL, et al. Human and mouse tissue-engineered small intestine both demonstrate digestive and absorptive function. Am J Physiol Gastrointest Liver Physiol. 2015; doi:10.1152/ajpgi.00111.2014.

    Google Scholar 

  18. Koga H, Sun X, Yang H, Nose K, Somara S, Bitar KN, et al. Distraction-induced intestinal enterogenesis: preservation of intestinal function and lengthening after reimplantation into normal jejunum. Ann Surg. 2012;255(2):302–10.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Stark R, Panduranga M, Carman G, Dunn JCY. Development of an endoluminal intestinal lengthening capsule. J Pediatr Surg. Elsevier Inc. 2012;47(1):136–41.

    Article  Google Scholar 

  20. Okawada M, Mustafa Maria H, Teitelbaum DH. Distraction induced enterogenesis: a unique mouse model using polyethylene glycol. J Surg Res. 2011;170(1):41–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sullins VF, Wagner JP, Suwarnasarn AT, Lee SL, Wu BM, Dunn JCY. A novel biodegradable device for intestinal lengthening. J Pediatr Surg Elsevier Inc. 2014;49(1):109–13. discussion 113

    Article  Google Scholar 

  22. Scott A, Sullins VF, Steinberger D, Rouch JD, Wagner JP, Chiang E, et al. Repeated mechanical lengthening of intestinal segments in a novel model. J Pediatr Surg. 2015;50(6):954–7. doi:10.1016/j.jpedsurg.2015.03.020.

  23. Fisher JG, Sparks EA, Khan FA, Dionigi B, Wu H, Brazzo J, et al. Extraluminal distraction enterogenesis using shape-memory polymer. J Pediatr Surg. 2015;50:938–42.

    Article  PubMed  Google Scholar 

  24. Dionigi B, Brazzo J, Connors JP, Ahmed A, Fisher JG, Zurakowski D, et al. Extraluminal helicoidal stretch (Helixtretch): a novel method of intestinal lengthening. J Pediatr Surg. 2014;49(12):1787–90.

    Article  PubMed  Google Scholar 

  25. Sueyoshi R, Woods Ignatoski KM, Okawada M, Teitelbaum DH. Distraction-induced intestinal growth: the role of mechanotransduction mechanisms in a mouse model of short bowel syndrome. Tissue Eng Part A. 2013;20:131106060201007.

    Article  Google Scholar 

  26. Sueyoshi R, Ralls MW, Teitelbaum DH. Glucagon-like peptide 2 increases efficacy of distraction enterogenesis. J Surg Res. 2013;184(1):365–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Rouch JD, Scott A, Jabaji ZB, Chiang E, Wu BM, Lee SL, et al. Basic fibroblast growth factor eluting microspheres enhance distraction enterogenesis. J Pediatr Surg. 2016;51(6):960–5.

    Article  PubMed  Google Scholar 

  28. Demehri FR, Wong PM, Freeman JJ, Fukatsu Y, Teitelbaum DH. A novel double-balloon catheter device for fully endoluminal intestinal lengthening. Pediatr Surg Int. 2014;30(12):1223–9.

    Article  PubMed  Google Scholar 

  29. Demehri FR, Freeman JJ, Fukatsu Y, Luntz J, Teitelbaum DH. Development of an endoluminal intestinal lengthening device using a geometric intestinal attachment approach. Surgery (United States). 2015;158:802–11.

    Google Scholar 

  30. •• Demehri FR, Utter B, Freeman JJ, Fukatsu Y, Luntz J, Brei D, et al. Development of an endoluminal intestinal attachment for a clinically applicable distraction enterogenesis device. J Pediatr Surg. 2016;51:101–6. One of the first large animal models demonstrating translatability of distraction enterogenesis

    Article  PubMed  Google Scholar 

  31. • Huynh N, Rouch JD, Scott A, Chiang E, Wu BM, Shekherdimian S, et al. Spring-mediated distraction enterogenesis in-continuity. J Pediatr Surg. 2016;51(12):1983–7. Study showing the feasibility of an in-continuity lengthening device in a translatable, large animal model

    Article  PubMed  Google Scholar 

  32. • Rouch JD, Huynh N, Scott A, Chiang E, Wu BM, Shekherdimian S, et al. Scalability of an endoluminal spring for distraction enterogenesis. J Pediatr Surg. 2016;51(12):1988–92. Study providing a scalable factor that could be used for eventual translatability of spring force in distraction enterogenesis

    Article  PubMed  Google Scholar 

  33. Walton KD, Freddo AM, Wang S, Gumucio DL. Generation of intestinal surface: an absorbing tale. Development. 2016;143(13):2261–72.

    Article  CAS  PubMed  Google Scholar 

  34. Cromeens BP, Liu Y, Stathopoulos J, Wang Y, Johnson J, Besner GE. Production of tissue-engineered intestine from expanded enteroids. J Surg Res Elsevier Inc. 2016;204(1):164–75.

    CAS  Google Scholar 

  35. •• Watson CL, Mahe MM, Múnera J, Howell JC, Sundaram N, Poling HM, et al. An in vivo model of human small intestine using pluripotent stem cells. Nat Med. 2014;20(11):1310–4. Landmark study demonstrating that tissue-engineered intestine from induced pluripotent stem cells has morphologically similarities and is functionally competent

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Liu Y, Nelson T, Cromeens B, Rager T, Lannutti J, Johnson J, et al. HB-EGF embedded in PGA/PLLA scaffolds via subcritical CO2 augments the production of tissue engineered intestine. Biomaterials Elsevier Ltd. 2016;103:150–9.

    Article  CAS  Google Scholar 

  37. Zachos NC, Kovbasnjuk O, Foulke-Abel J, In J, Blutt SE, De Jonge HR, et al. Human enteroids/colonoids and intestinal organoids functionally recapitulate normal intestinal physiology and pathophysiology. J Biol Chem. 2016;291(8):3759–66.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA

    Joshua D. Rouch

  2. Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive Always M116, MC 5733, Stanford, CA, 94305, USA

    James C. Y. Dunn

Authors
  1. Joshua D. Rouch
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Corresponding author

Correspondence to James C. Y. Dunn.

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Conflict of Interest

Joshua D. Rouch and James C.Y. Dunn declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Surgical

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Rouch, J.D., Dunn, J.C.Y. New Insights and Interventions for Short Bowel Syndrome. Curr Pediatr Rep 5, 1–5 (2017). https://doi.org/10.1007/s40124-017-0119-6

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  • DOI: https://doi.org/10.1007/s40124-017-0119-6

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