Question
What is short gut syndrome and how is it managed?
Answer
Short gut or short bowel syndrome is a condition that occurs when a large portion of the intestines does not work normally. Either a large section of the bowel has been surgically removed, or a baby is born with abnormal intestines. The complications that frequently occur include failure to thrive, dehydration, and central line infections for patients on TPN (Total Parenteral Nutrition). These dangers are the reason that these patients require close medical and nutritional follow-up.
Intestinal failure is a side effect of short gut syndrome and is defined as the inability to sustain adequate nutritional, electrolyte or hydrational status in the absence of specialized nutritional support (Buchman, 2006). Research conducted by Buchman found that the largest single group of patients who receive home TPN were those with short bowel syndrome. Many medically fragile children require TPN for a variety of reasons, however a child with short guy syndrome will have the TPN for much longer. Of course, the longer the patient needs a PICC line or central line for their TPN, the higher the risk of complications and challenges for the family and patients. Therefore, it is important to transition a patient off of TPN as quickly as possible.
The purpose of intestinal rehabilitation is to help the child grow at an adequate pace. Strategies and therapies are designed to make the bowel work better, including nutrition support, nutritional rehabilitation, medical management or restorative surgery. This is done by using specialized formula, manipulating the rate and schedules of enteral feeds, and balancing feeds, fluids, TPN, IV fluids and enteral feeds. Medications are integrated as needed and surgeries are coordinated when needed as well. Therapies are constantly readjusted based on whether or not the child is gaining weight, if they have had any additional surgeries, and if their oral skills are advancing.
In summary, the goal of intestinal rehabilitation is to transition the child off TPN, for the child to tolerate enteral feeds, and maximize oral interest.
Please refer to the SpeechPathology.com course, The Speech Pathologist's Role with the Pediatric Intestinal Rehabilitation Population, presented in partnership with Cincinnati Children's for more in-depth information about speech pathology services that are beneficial to pediatric patients with short bowel syndrome.
