Glucocorticoids Improve Enteral Feeding Tolerance in Pediatric Short Bowel Syndrome With Chronic Intestinal Inflammation

Abstract

Objectives: A group of short bowel syndrome (SBS) patients developed chronic intestinal inflammation while struggling weaning off parenteral nutrition (PN). They did not respond to standard management of SBS and food allergy. We treated them with glucocorticoids and described the outcome. Methods: Our study is a retrospective descriptive study. We reviewed records from the intestinal rehabilitation program from 2006 to 2017. We identified 15 patients whose lab values, pathology results, and clinic notes were reviewed. Results: We had more patients (n ¼ 10) with diagnosis of gastroschisis, and more female patients (n ¼ 9). Seven patients weaned off PN with median treatment duration of 5 months, 5 of which remained on budesonide for significant period of time (median: 7.5 months). One of these 7 patients relapsed, as the patient resumed glucocorticoids because of recurrence of chronic intestinal inflammation. Six of 15 children had significant eosinophils in their initial biopsy, 5 of these children weaned off PN whereas 1 child's gastrointestinal (GI) bleeding stopped. Four patients were not able to decrease PN calorie. Two of these patients' GI bleeding stopped, the other 2 had normalized histology. Conclusions: For SBS children with histologically confirmed chronic intestinal inflammation, glucocorticoids may help promote enteral feeding tolerance. Glucocorticoids regimen should be chosen individually. Patients are more likely to respond if initial histology has significant eosinophilic infiltration. Patients may need to remain on glucocorticoids for over 6 months.

Bacterial overgrowth assessment and treatment among pediatric intestinal rehabilitation and nutrition support providers: An international survey of clinical practice patterns

“…Although endoscopic assessments are used, consistent with grade show that anti-inflammatory therapy is especially important in the pathogenesis of SBBO and that there may be overlap with IBD in SBS patients 13,14 . Lastly, the study relied on clinical diagnosis of SBBO, which is not recommended in the adult literature.…”

“…We furthermore did not assess resistant organism formation or prevalence of fungemia with respect to SBBO treatment. Current literature and future studies may show that anti‐inflammatory therapy is especially important in the pathogenesis of SBBO and that there may be overlap with IBD in SBS patients 13,14 . Lastly, the study relied on clinical diagnosis of SBBO, which is not recommended in the adult literature 1 …”

“…An important relationship may exist between motility and dysbiosis as well, [9][10][11] and novel cell culture systems may one day allow investigators to delineate this relationship further. 12 Among these considerations, there is also a potential that SBBO may confer an inflammatory bowel disease (IBD)-like phenotype on patients with SBS, 2,13,14 which may require use of antiinflammatory therapy in addition to or in lieu of antibiotic therapy.…”

A rare case of eosinophilic gastrointestinal disorders with short bowel syndrome after strangulated bowel obstruction

“…The choice of glucocorticoids should be individualized in children with SBS-related chronic intestinal inflammation. One study reported that some pediatric patients with significant eosinophils in their intestinal biopsy responded well to glucocorticoids [15]. Thus systemic glucocorticoids can be useful for treating EGIDs.…”

Self‐Assembled Integrative Nutrient Carrier Platform Containing Green Tea Catechin for Short Bowel Syndrome Treatment

“…[ 11 ] Nevertheless, with the short residence time in the intestine, the limited digestibility and absorbability in the intestine forces FNutF to combine with other drugs to treat SBS and undermines the long‐term benefit of this treatment clinically. [ 12 ] Therefore, the development of a new and pragmatic therapeutic strategy for SBS is warranted.…”