2011 - ISBTS 2011 Symposium
Oral Communications 3: Nutrition Outcomes
5.125 - Crohn’s disease-related short bowel syndrome: Outcomes in intestinal rehabilitation and transplantation
Presenter: Lauren, Schwartz, New York, United States
Authors: Lauren Schwartz1, Matthew Suh1, Thomas Schiano1, Christine Chamberlain1, Hiroshi Sogawa1, Kishore Iyer1
Crohn’s disease-related short bowel syndrome: Outcomes in intestinal rehabilitation and transplantation
Lauren Schwartz, Matthew Suh, Thomas Schiano, Christine Chamberlain, Hiroshi Sogawa, Kishore Iyer
Department of Intestinal Transplantation, Mount Sinai Hospital, New York, NY, United States
Background: Crohn’s disease (CD) accounts for 9 to18% of adult short bowel syndrome (SBS) and 8% of intestinal transplants (ITx). We review outcomes of intestinal rehabilitation (IR) and ITx in patients with CD.
Methods: We reviewed records of patients with SBS due to CD focusing on bowel anatomy, inflammatory activity, parenteral nutrition (PN) dependence and weaning, need for surgery or ITx, and outcomes.
Results: 24 of 238 (10%) intestinal failure patients over a 4-year period had SBS due to CD. All but 1 had clinically quiescent CD, and 6 were on immunomodulators. 11 patients were considered “stable” IR candidates. 2 of the 11 weaned off PN following enterocutaneous fistula (ECF) repairs. 3 additional patients had PN reductions. Both patients who achieved full enteral autonomy retained partial colon whereas most patients who remained PN dependent or required ITx (n=19) had an end ostomy. 7 patients underwent surgery to improve bowel function including 4 ECF repairs, 3 reverse segment procedures, and 1 resection of strictured small bowel. 4 of the surgical patients went on to require ITx evaluations. 6 patients were transplanted and 2 await ITx. 2 additional patients opted against ITx, 1 patient was too ill for ITx, and 1 patient died. Of the 6 ITx patients, 4 patients are alive with functional grafts off PN. 2 patients died post ITx due to infectious complications; 1of the 2 developed recurrent ECF without evidence of recurrent CD.
Conclusions: 45% of stable patients with SBS from CD were partially or fully weaned from PN, suggesting potential for IR. Surgery to correct ECF helped wean TPN; reverse segments appeared ineffective. ITx was indicated in over 50% of patients, but was only pursued in 25% due to medical instability or patient preference. Patient and graft survivals of 67% suggest comparable risk to other causes of SBS.
You must be logged in to view recordings
By viewing the material on this site you understand and accept that:
- The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
- The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
- The material is solely for educational purposes for qualified health care professionals.
- The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
- The information cannot be used as a substitute for professional care.
- The information does not represent a standard of care.
- No physician-patient relationship is being established.