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Nutritional and Surgical Management of Pediatric Intestinal Motility Disorders

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Diet and Nutrition in Critical Care

Abstract

Intestinal motility disorders are increasingly recognized conditions characterized by impaired propulsion of enteric contents in the absence of mechanical bowel occlusion. Clinical presentation ranges from mild symptoms to rare disabling and life-threatening disorders. A significant proportion of patients require long-term parenteral nutrition (PN) to survive. Chronic intestinal pseudo-obstruction (CIPO) and Hirschsprung disease (HD) are among the most common reasons for pediatric intestinal failure (IF) with high mortality. CIPO involves variable defects of the intestinal neuromuscular apparatus. Besides extended aganglionosis, HD may result in IF due to persistent generalized dysmotility of the remaining ganglionic intestine. The management of severe intestinal motility disorders is challenging, the main goals being improvement of intestinal passage while maintaining of adequate nutrition and growth. These goals are best achieved by multidisciplinary approach. Because effectiveness of prokinetic medication alone is often poor, the mainstay of treatment is nutritional support. Every effort should be made to avoid life-threatening complications of long-term PN, such as IF-associated liver disease (IFALD), frequent septicemia, and loss of venous access sites when intestinal transplantation (IT) serves as a salvage therapy. With critical patient selection, also non-transplant surgery can effectively relieve intestinal obstruction, facilitate enteral tolerance, aid to avoid development of IFALD, and provide prerequisite for weaning off PN.

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Abbreviations

CIPO:

Chronic intestinal pseudo-obstruction

HD:

Hirschsprung disease

IF:

Intestinal failure

IT:

Intestinal transplantation

PN:

Parenteral nutrition

SBS:

Short bowel syndrome

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Authors and Affiliations

  1. Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children’s Hospital, Helsinki University Central Hospital, University of Helsinki, Stenbackinkatu 11, Box 281, FIN-00029 HUS, Helsinki, Finland

    Mikko P. Pakarinen & Annika Mutanen

  2. Section of Pediatric Gastroenterology, Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

    Laura Merras-Salmio

Authors
  1. Mikko P. Pakarinen
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  2. Laura Merras-Salmio
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  3. Annika Mutanen
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Corresponding author

Correspondence to Mikko P. Pakarinen .

Editor information

Editors and Affiliations

  1. Royal Free London Hospitals, Barnet General Hospital, London, UK

    Rajkumar Rajendram

  2. Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Rajkumar Rajendram

  3. King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

    Rajkumar Rajendram

  4. Department of Nutrition and Dietetics, Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Victor R. Preedy

  5. Department of Biomedical Sciences, Faculty of Science & Technology, University of Westminster, London, UK

    Vinood B. Patel

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Pakarinen, M.P., Merras-Salmio, L., Mutanen, A. (2015). Nutritional and Surgical Management of Pediatric Intestinal Motility Disorders. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7836-2_94

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  • DOI: https://doi.org/10.1007/978-1-4614-7836-2_94

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7837-9

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