Short bowel syndrome

The ill effects of total or near total starvation have been documented to the point where, in children, whenever the therapeutic choice is starvation versus parenteral nutrition, there is, in fact, no choice to be made (Dho-peshwarkar, 1983). This lack of choice is perhaps best illustrated by considering the short bowel syndrome. Although the potential for survival 

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Recently, multidimensional GC has been employed in enantioselective analysis by placing a chiral stationary phase such as a cyclodextrin in the second column. Typically, switching valves are used to heart-cut the appropriate portion of the separation from a non-chiral column into a chiral column. Heil et al. used a dual column system consisting of a non-chiral pre-column (30 m X 0.25 mm X 0.38 p.m, PS-268) and a chiral (30 m X 0.32 mm X 0.64 p.m, heptakis(2,3-di-(9-methyl-6-(9-tert-butyldimethylsilyl)-(3-cyclodextrin) (TBDM-CD) analytical column to separate derivatized urinary organic acids that are indicative of metabolic diseases such as short bowel syndrome, phenylketonuria, tyrosinaemia, and others. They used a FID following the pre-column and an ion trap mass-selective detector following the... 

Acute leukemia, acute lymphoma, short-bowel syndrome, liver disease (decreased clearance), diabetes mellitus, mitochondrial disease, and congenital enzyme deficiencies... 

Surgical intervention is a potential treatment option in patients with complications such as fistulae or abscesses, or in patients with medically refractory disease. Ulcerative colitis is curable with performance of a total colectomy. Patients with UC may opt to have a colectomy to reduce the chance of developing colorectal cancer. Patients with CD may have affected areas of intestine resected. Unfortunately, CD may recur following surgical resection. Repeated surgeries may lead to significant malabsorption of nutrients and drugs consistent with development of short-bowel syndrome. 

Major small bowel resection (e.g., short bowel syndrome)... 

The oligomeric formulas are also known as chemically defined formulas. This class of formulas can be subcategorized based on whether the formula contains all free amino acids (elemental formulas) or peptides (peptide-based) as the protein source. Some of these formulas contain a combination of free amino acids and small peptides. Actually, dipeptides and tripeptides in these formulas are absorbed more efficiently than free amino acids. Oligomeric formulas may be better tolerated than polymeric formulas for patients with defects in GI function and maybe particularly useful in patients with severe pancreatic dysfunction or significantly decreased GI surface area (e.g., short bowel syndrome). 

Factors directly related to the drug selection include an inappropriate selection of drug, dosage, or route of administration. Malabsorption of a drug product because of GI disease (e.g., short-bowel syndrome) or a drug interaction (e.g., complexation of fluoroquinolones with multivalent cations resulting in reduced absorption) may lead to potentially subtherapeu-tic serum concentrations. 

The regular digestion of dietary fats and fat-soluble substances and/or their absorption via the lipid route is compromised in the frame of various diseases such as cystic fibrosis, short bowel syndrome, cholestasis, and chronic inflammatory bowel diseases. 

Traber, M. G., Schiano, T. D., Steephen, A. C., Kayden, H. J., and Shike, M. (1994). Efficacy of water-soluble vitamin E in the treatment of vitamin E malabsorption in short-bowel syndrome. Am. J. Clin. Nutr. 59,1270-1274. 

Short Bowel syndrome Subcutaneous (Zorbitive) 0.1 mg/kg/day. Maximum 8 mg/day. 

Improved gastrointestinal function Short bowel syndrome in patients who are also receiving specialized nutritional support... 

Jeppesen PB Growth factors in short-bowel syndrome patients. Gastroenterol Clin North Am 2007 36(1) 109. [PMID ... 

Octreotide inhibits intestinal secretion and has dose-related effects on bowel motility. In low doses (50 meg subcutaneously), it stimulates motility, whereas at higher doses (eg, 100-250 meg subcutaneously), it inhibits motility. Octreotide is effective in higher doses for the treatment of diarrhea due to vagotomy or dumping syndrome as well as for diarrhea caused by short bowel syndrome or AIDS. Octreotide has been used in low doses (50 meg subcutaneously) to stimulate small bowel motility in patients with small bowel bacterial overgrowth or intestinal pseudo-obstruction secondary to scleroderma. 

Acquired biotin deficiency is extremely rare but may occur in special conditions such as long-term parenteral nutrition without biotin supplementation, short bowel syndrome and after excessive intake of raw egg white, which contains the potent bio-tin-binding protein avidin. The main symptoms are alopecia and skin abnormalities which resolve after administration of biotin [2, 30]. 

Abdominal surgery, radiation therapy Loss of absorptive surface Bypass Nutrient unavailability, deconjugation of bile acids Disturbed solubilization of lipids, decreased formation of micelles Short-bowel syndrome Enteroenteric fistual Bacterial overgrowth Loss of bile acids... 

Zorbtive (somatotropin) (US) Approval 2003 Recombinant human somatotropin receptors on a variety of cell types including myocytes, hepatocytes, adipocytes, lymphocytes, and hematopoietic cells. Short bowel syndrome Fertilitv and earlv embrvonic development unclear Developmental rats, rabbits Prenatal and postnatal development unclear Genetic toxicolosv none Carcinogenicitv none... 

Zorbtive Somatropin Serono 12/2003 Short bowel syndrome Mouse C127... 

History of recurrent bowel obstruction, meconium ileus, Crohn s disease, short bowel syndrome or prior intestinal surgery... 

Vitamin B12 deficiency most frequently is seen in people over 60 years of age (11). Deficiency of vitamin B12 in younger adults is rare, but can occur as a result of reduced absorption of vitamin B12, for example in pernicious anemia, atrophic gastritis type B, long-term use of blockers of acid secretion, or short bowel syndrome after resection of the terminal ileum (18,19). Vitamin B12 deficiency in children usually depends on inborn defects of vitamin Bi2 metabolism or on insufficient support during pregnancy and breastfeeding. 

A 36-year-old woman with short bowel syndrome developed progressive liver dysfunction 6 months after... 

When one young woman on chronic parenteral nutrition for short bowel syndrome presented with hepato-splenomegaly and pancytopenia (78), bone marrow examination showed the sea-blue histiocytes to be lipidladen macrophages. The total amount of fat in the regimen was subsequently reduced, and there was partial hematological improvement. The condition observed in this patient is analogous to that which occurs in Gaucher s disease and Niemann-Pick disease. 

Intestinal transplantation is combined with liver transplantation in 46% of cases, because of terminal liver failure (93). Of 78 patients who had received parenteral nutrition for more than 2 years n — 66) and/ or had short bowel syndrome and could not be weaned from parenteral nutrition (n = 12), 58 developed chronic cholestasis and 37 developed one or more severe liver complication (serum bilirubin concentration 60 pmol/l, factor V (proaccelerin) 50%, portal hypertension, encephalopathy, ascites, bleeding from the gastrointestinal tract, or histological findings consisting of extensive fibrosis and cirrhosis) after 6 (3-132) months and 17 (2-155) months respectively. Liver disease was responsible for deaths in 6.5% of the patients (22% of deaths). 

In adults receiving long-term parenteral nutrition, despite its anabolic effects on other tissues, there is no improvement in bone density. Infants treated with parenteral nutrition from birth also develop low bone density for age, suggesting that parenteral nutrition treatment in some way contributes to the osteopenia (5). A 17% long-term increase in spinal bone mineral content has been shown in patients who have received parenteral nutrition solntions without vitamin D. However, this rise was nearly balanced by a 15% fall in hip bone mineral content (115). In a Danish study of bone mineral content in adults receiving home parenteral nutrition for short bowel syndrome, despite the fact that all were on free oral intake as a supplement to the parenteral nutrition, 47% had mandibular osteoporosis while 33% had osteoporosis in the forearm and radiographic changes of osteoporotic fractures in the vertebral column. Dental and periodontal tissues were normal (116). 

Burstyne M, Jensen GL. Abnormal liver functions as a result of total parenteral nutrition in a patient with short-bowel syndrome. Nutrition 2000 16(ll-12) 1090-2. 

Malabsorption Syndromes. Patients at risk include those with celiac disease, tropical sprue, cystic fibrosis, and short bowel syndrome. Excessive intake of oral zinc supplements can cause anemia and hematological abnormalities in the absence of occult blood loss. The copper deficiency is caused by zinc induction of metallothionein in the mtesti-nal mucosa, which then sequesters dietary copper, blocking its absorption. 

Norose N, Terai M, Norose K. Manganese deficiency in a child with very short bowel syndrome receiving long-term parenteral nutrition. J Trace Elem Exp Med 1992 5 100-1. 

Ziegler, T.R., Fernandez-Estivariz, C., Gu, L.H., Bazargan, N., Umeakunne, K., Wallace, T.M., Diaz, E.E., Rosado, K.E., Pascal, R.R., Galloway, J.R. et al. (2002) Distribution of the H + /peptide transporter PepTl in human intestine up-regulated expression in the colonic mucosa of patients with short-bowel syndrome. The American Journal of Clinical Nutrition, 75 (5), 922-930. 

This unusual form of lactic acidosis is due to increased production and accumulation of D-lactate in circulation. The normal isomer synthesized in the human body is L-lactate but the D-lactate isomer can occur in patients with jejunoileal bypass, small bowel resection, or other types of short bowel syndrome. In these patients, ingested starch and glucose bypass the normal metabolism in the small intestine and lead to increased delivery of nutrients to the colon where gram-positive, anaerobic bacteria (e.g., Lactobacilli) ferment glucose to D-lactate. The D-lactate is absorbed via the portal circulation. 

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