Jonathan E. Rhoads Lecture: Experiences and Observations in the Management of Patients With Short Bowel Syndrome

Abstract

In an era before parenteral nutrition (PN) was made practical by Stanley Dudrick, MD, and his colleagues, patients with prolonged intestinal dysfunction or short bowel syndrome would often die of malnutrition or its sequelae. Over the past 4 decades, the treatment of patients with short bowel syndrome had progressed from PN in the hospital to small bowel transplantation. Multimodal therapies have evolved in the management of these patients, including specialized diets and enteral supplements, oral rehydration fluids, antisecretory medication, and the use of growth factors. Home PN is lifesaving when these modalities are ineffective and a surgical procedure to restore or enhance gastrointestinal tract length or absorptive potential is impossible. Small intestine transplantation had been used to salvage those patients who developed life-threatening complications of home PN, but as the survival after intestinal transplant has approached that of liver transplantation, it may soon be considered as primary therapy for patients with short bowel syndrome. This article presents the author's experiences and observations after a 4-decade experience in the management of patients with short bowel syndrome.

Short‐Bowel Syndrome: Epidemiology, Hospitalization Trends, In‐Hospital Mortality, and Healthcare Utilization

“…Since the late 1960s, when a team of pioneers developed the technique for intravenous feeding to support patients with IF, there has been substantial progress in both medical and surgical management of SBS. [19][20][21][22] Over the past decades, we have seen the development of home PN programs and nutrition support teams dedicated to providing care for patients with SBS. 23 This has led to the development of several single and multicenter registries to study clinical outcomes in patients receiving home PN.…”

Intestinal Failure Management at the Cleveland Clinic

“…Most patients need HPN for less than 6 months either to manage complicated surgical conditions that resolve spontaneously or to restore gastrointestinal continuity and function through staged procedures. 8 In the early years of the program, patients were taught how to prepare their own PN solutions because there were no home infusion companies. The time required to train patients was 2 to 3 weeks, and training occurred in the hospital.…”

“…Home infusion companies were eventually established to prepare solutions, deliver them to patients, and manage insurance issues under Medicare part B. 8 This article reviews the Cleveland Clinic institutional guidelines for the management of intestinal failure, including longterm or HPN and related complications, intestinal rehabilitation, and small bowel transplantation. PubMed was searched in November 2008 for relevant articles; keywords used were home parenteral nutrition, short bowel syndrome, intestinal rehabilitation, and small-bowel transplantation.…”