Intestinal Failure
What is intestinal failure?
Intestinal failure occurs when the gut can no longer absorb nutrients.
Intestinal failure is most often caused by short bowel syndrome (SBS), a condition where at least half of the small intestine no longer functions or has been removed. SBS is caused by injury, disease or a previous surgery.
Patients with intestinal failure cannot absorb food they have eaten. Nutrients must be supplied directly to the bloodstream through a catheter inserted into a vein. This is called intravenous feeding or total parenteral nutrition (TPN).
People with permanent intestinal failure need TPN because their small intestine can’t process and absorb nutrients from food. People on long-term TPN may face complications or life-threatening infections.
Patients who are stable on TPN and who have few or no complications may be able to remain on this therapy for a long time.
The newest research and treatments have allowed some patients to be weaned from TPN through a process called intestinal rehabilitation.
However, if IR is not an option, the chance of problems due to TPN tends to increase over time. Complications from TPN can include:
- Catheter-related complications, including repeated infections or blood clotting around the catheter
- Metabolic complications such as changes in blood sugar levels or electrolyte disturbances
One serious possible complication from long-term TPN therapy is liver damage, which can occur when:
- Bacteria (from TPN not made in a clean environment) gets in the bloodstream and causes a blood infection
- Bile flow is not stimulated by normal food intake (eating by mouth)
- The ingredients in the TPN are not right for the body
There are a number of diseases and conditions that can lead to intestinal failure in children.
What’s special about the way Children’s treats intestinal failure?
Dr. Simon Horslen, medical director of Liver and Intestine Transplant at Children’s, and Dr. Jorge Reyes, who directs the Transplant Center at Children’s, are world-renowned experts in the field of intestinal and liver failure. Both have many years of experience treating children with complex digestive problems.
Dr. Horslen joined Children’s from the largest pediatric intestinal transplant center in the United States—University of Nebraska Medical Center in Omaha—where he was medical director. During his tenure in Nebraska, Dr. Horslen helped develop methods to successfully wean children from TPN using non-surgical therapies.
Dr. Reyes helped pioneer intestinal transplant surgery, which is a relatively new procedure developed within the last decade. Dr. Reyes is also one of the few surgeons in the U.S. who has performed 200 multi-organ transplants on children. Dr. Reyes is listed as one of the Best Doctors in America.
Children’s is the only program in the Pacific Northwest—and one of only a few in the country—that has specialists who can perform intestine transplants.
We also have the only complete Intestinal Care Program in the Pacific Northwest. The program helps children restore their intestine function without transplant through diet, medication and non-transplant surgical therapies.
We are committed to excellent patient and organ survival outcomes. We are constantly improving surgery techniques and drug therapy strategies so we can provide the most current treatments and the very best patient care.
We continue to advance the state of practice and understanding of transplant through our research programs. Currently, our top research priority is decreasing patients’ dependence on anti-rejection drugs.
We are also committed to recruiting and retaining the best transplant specialists.
What are the treatment options for intestinal failure?
Intestinal failure is treated with one of the following treatment options:
- Management of long-term TPN, which is a total nutritional mixture given through a vein. Sometimes TPN is a long-term or permanent solution.
- Intestinal rehabilitation, which restores intestinal function through diet, medication and sometimes non-transplant surgical therapies.
- Intestinal transplant, when the small intestine is replaced with an organ from a deceased donor.