HPE HPE 85 – Spring 2017 - Page 47

Practical therapeutics Issue 85 | Spring 2017 Treating paediatric short bowel syndrome The goals of treatment of short bowel syndrome in children are to promote intestinal adaptation, maintain growth and development, and prevent complications Jaini Shah MPharm PG Dip GPP Highly Specialist Pharmacist – Paediatric & Neonatal Nutrition, The Royal London Hospital, Barts Health NHS Trust, London, UK Email: jaini.shah@bartshealth.nhs.uk absorb sufficient nutrients, water and electrolytes to maintain adequate growth. NEC is the most common cause of SBS and its incidence is expected to rise due to the increased survival rates of premature neonates. 2 Short bowel syndrome (SBS) is a rare and potentially life-threatening condition characterised by a reduction in intestinal length, usually as a result of extensive surgical resection. This affects the ability to absorb nutrients, electrolytes and fluid. Common causes of SBS in children include necrotising enterocolitis (NEC), gastroschisis, intestinal atresia and midgut volvulus. 1 SBS is the leading cause of intestinal failure (IF) in children. IF occurs when the gastrointestinal tract is unable to Malabsorption In addition to the reduced intestinal surface area for absorption, other mechanisms may contribute to the malabsorption in SBS. Gastric acid hypersecretion inactivates pancreatic enzymes and this can impair the absorption of nutrients. 2 Increased gastric acid secretion may also cause diarrhoea 1 and increase stoma output. Due to the loss of intestinal mass, there is also a reduction in digestive enzymes responsible for carbohydrate digestion and absorption. 2 Intestinal adaptation Following resection, the intestine undergoes a process of adaptation whereby it increases in mass and surface area and this ultimately improves its absorption function. 3 Several factors are associated with successful adaptation including length of remaining bowel, presence of ileocecal valve, functional integrity and type of small bowel remaining (the ileum adapts better than the jejunum) and presence of intact colon. 2–5 The age at which resection occurs is an important factor affecting adaptation because preterm neonates have a greater potential for bowel growth. 6 Due to the FffW&V6W2খFW7Fw&wFB&R&VfW&&RFFW67&&RFR&Vr&vVVwF2W&6VFvRbFRWV7FVBVwF&6V@FRvR"6RbFR6B24%26&PFVfVB2&VGV7FFW7FVwFb&RFSRvVVBb4%0FR2FRvVVBb4%0&RFFw&wFBFWfVVB&FRFW7FFFF@&WfVB6Ɩ6F2"2F2&WV&W2VFF66Ɩ'FV&VfW'&VBF2FPWG&F7W'BFV5Bv6667G2bVFG&2v7G&VFW&v7BFWFFW'6RB&67BWB`5B26vFfR&VVf6VffV7G0FVBWF6W22vV0FVFǒ&VGV6rVF6&R67G2pVFW&WG&FFWG&F7W'B2'F@f"w&wFBFWfVVBFPv7G&FW7FG&7B2FR7@6v6B6fW7BvbfVVFpBWG&F&RvfV&ǒ"f7F&7WW&R6УCP