Small bowel dilation in children with short bowel syndrome is associated with mucosal damage, bowel-derived bloodstream infections, and hepatic injury

Abstract

In children with short bowel syndrome, small bowel dilation correlates with mucosal damage, bloodstream infections of intestinal origin, and cholestatic liver injury. In addition to parenteral nutrition, small bowel dilation and intestinal bloodstream infections contribute to development of short bowel syndrome-associated liver disease.

Pediatric Intestinal Failure: The Key Outcomes for the First 100 Patients Treated in a National Tertiary Referral Center During 1984–2017

“…35 Despite the standardized CVC care policy, certain individuals with SBS experienced repeated culturepositive line infections, which may also originate from inflamed small intestine with dysfunctional epithelial barrier of dilated remaining small bowel. 24 Restoration of normal bowel caliber decreases occurrence of CRBSIs, which may also have contributed to our results. 23 Another major issue related with CVCs is loss of access sites especially during long-term PN, 36 and considering the critical nature of venous access, further research on risk and prevention of CV thrombosis, and innovative ways of securing long-term PN access are urgently needed.…”

“…We have used commercially manufactured 3‐in‐1 PN bags since 2011, likely also contributing to our currently low CRBSI rates . Despite the standardized CVC care policy, certain individuals with SBS experienced repeated culture‐positive line infections, which may also originate from inflamed small intestine with dysfunctional epithelial barrier of dilated remaining small bowel . Restoration of normal bowel caliber decreases occurrence of CRBSIs, which may also have contributed to our results .…”

“…Gastrointestinal contrast study is performed in patients with SBS with symptoms of bacterial overgrowth or obstruction and routinely 1 year postoperatively. Those with recalcitrant symptoms associated with pathological small‐bowel dilatation and unprogressive weaning of PN are assessed for autologous intestinal reconstructive (AIR) surgery . Patients with life‐threatening complications of PN are assessed with a multidisciplinary approach before decision on ITx, which were started in 2009 in Finland …”

New Insights Into Intestinal Failure–Associated Liver Disease in Children

“…( 57 ) In addition, a large proportion of patients with IF develop small intestinal dilation leading to stasis, inflammation, dysmotility, and SIBO, which promote barrier dysfunction and bacterial translocation and worsening of cholestasis and IFALD. ( 58 ) Various oral antibiotic regimens have been used empirically to treat/prevent SIBO, although there is little evidence of a benefit in IFALD. Alternative approaches that have been used, which also are not evidence based, include probiotic and prebiotic supplementation, such as non‐ d ‐lactate‐producing strains of Lactobacillus, and Bifidobacterium breve Yakult to recolonize the colon with nonpathogenic flora.…”

Lipid Emulsion Use in Pediatric Patients Requiring Long‐Term Parenteral Nutrition

“…The high rates of death and transplantation are explained by the high incidence of end‐stage liver disease caused by catheter‐related bloodstream infections and small intestinal bacterial overgrowth. Notably, pediatric surgeons in Finland reported evidence of a link between bowel dilatation, sepsis, and cholestatic liver disease . In particular, they found a significant correlation between small bowel diameter ratio and the grade of cholestasis in children with short bowel syndrome ( r = 0.534, P = .001), providing evidence of a direct relationship between liver disease, the underlying intestinal disease, and the occurrence of small intestinal bacterial overgrowth.…”