Intestinal rehabilitation: What is intestinal rehab? - Episode 1

Until recently, there was no standardized definition for intestinal failure.

Intestinal failure is when gut function is insufficient to absorb enough nutrients, fluids, and calories to support survival and, in children, growth.

Earlier recognition and taking advantage of the gut's biology to adapt are time dependent.

An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and other associated needs, as defined in recent ASPEN guidelines.

The intestinal rehabilitation approach streamlines care and improves communication with families and between care providers.

Intestinal rehabilitation depends on nutrition in the gut, nutrition in the body, and healing.

Pattern recognition from multiple experienced clinicians observing patients over time is essential in intestinal rehabilitation.

Causes of intestinal failure divide into three categories: short bowel syndrome, motility disorders, and congenital enteropathies.

Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients.

Causes of short bowel syndrome include congenital anomalies (intestinal atresia, malrotation, volvulus, gastroschisis, long segment Hirschsprung disease) and acquired neonatal diseases (necrotizing enterocolitis).

Motility disorders occur when abnormalities of intestinal muscle or the nerves controlling that muscle prevent coordinated propulsion of food and stool.

Congenital enteropathies are conditions where patients have all their bowel but the mucosal lining does not digest or absorb properly.

Some patients have elements of two or all three categories of intestinal failure in their presentation.

Most intestinal failure patients are infants or babies, but some older pediatric patients develop intestinal failure from inflammatory bowel disease, Crohn disease complications, trauma, malignancy, or vascular thrombosis.

Three time points exist for diagnosis and referral to intestinal rehab: prenatal diagnosis (atresia with cystic fibrosis, gastroschisis), postnatal acquired problems (volvulus, NEC), and later presentations after discharge when patients fail to progress.

Innovation in intestinal rehabilitation comes from multiple approaches to problems and different visions, with more expertise leading to better outcomes.

Transitioning older children with intestinal failure into their late teen years and beyond is a major obstacle currently not being adequately addressed.

The intestinal rehabilitation team includes dietitians (for nutritional needs), social workers, nurse practitioners, pharmacy, interventional radiology, pathology, endocrinology, and nephrology.

Long-term survivors now develop chronic comorbidities not previously seen to the same extent because patients did not live long enough, including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life problems.