# Intestinal Failure and Inflammatory Bowel Disease — GCMD Library living collection

Updated: n/a · 4 episodes · 54 cited statements

## Episodes
### Intestinal Failure
- [Advances in pediatric intestinal failure management and rehabilitation](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667) — podcast · 17:45 · [machine version](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667.md)

### Very Early Onset IBD
- [Surgical management of very early onset inflammatory bowel disease](https://library.globalcastmd.com/infographic/surgical-management-of-very-early-onset-inflammatory-bowel-disease-11402) — article · [machine version](https://library.globalcastmd.com/infographic/surgical-management-of-very-early-onset-inflammatory-bowel-disease-11402.md)
- [Surgical management of very early onset inflammatory bowel disease](https://library.globalcastmd.com/watch/surgical-management-of-very-early-onset-inflammatory-bowel-disease-11465) — video · 0:57 · [machine version](https://library.globalcastmd.com/watch/surgical-management-of-very-early-onset-inflammatory-bowel-disease-11465.md)

### Post-Transplant Complications
- [Pneumatosis intestinalis after hematopoietic stem cell transplantation: When not doing anything is good enough.](https://library.globalcastmd.com/article/pneumatosis-intestinalis-after-hematopoietic-stem-cell-transplantation-when-not-16882) — article · [machine version](https://library.globalcastmd.com/article/pneumatosis-intestinalis-after-hematopoietic-stem-cell-transplantation-when-not-16882.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=0) Defining Intestinal Failure and Intestinal Rehabilitation (Ep 1)
- [4:36](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=276) Multidisciplinary Intestinal Rehabilitation Programs and Outcomes (Ep 1)
- [7:54](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=474) Alternative Lipid Strategies in Parenteral Nutrition (Ep 1)
- [11:55](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=715) Central Line Complications and Protection Strategies (Ep 1)
- [13:45](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=825) GLP-2 Analogs for Short Bowel Syndrome (Ep 1)
- [16:54](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=1014) Summary: Integrated Approach to Intestinal Failure (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Intestinal failure is defined as reduction of functional intestinal mass below that which can sustain life, resulting in dependence on supplemental parenteral support for a minimum of 60 days within a 74 consecutive day interval. — Stephanie Oliveira (clinical) [Ep 1 · 0:26](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=26)
- More than 50% of intestinal failure cases are related to short bowel syndrome, with additional cases from mucosal enteropathies and dysmotility disorders. — Stephanie Oliveira (epidemiological) [Ep 1 · 0:43](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=43)
- Most short bowel syndrome cases in pediatrics occur during the neonatal period from gastroschisis, necrotizing enterocolitis, bowel atresia, and intestinal volvulus. — Stephanie Oliveira (clinical) [Ep 1 · 0:55](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=55)
- The field is now focusing on neurocognitive outcomes, quality of life, and caregiver burnout as more children survive intestinal failure. — Stephanie Oliveira (opinion) [Ep 1 · 1:18](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=78)
- The cause of chronic intestinal inflammation in intestinal failure survivors is not known. — Stephanie Oliveira (clinical) [Ep 1 · 1:37](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=97)
- The goal of intestinal rehabilitation is to optimize intestinal function and adaptation before the development of irreversible complications. — Stephanie Oliveira (clinical) [Ep 1 · 2:07](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=127)
- Intestinal adaptation is an active compensatory process that starts immediately after bowel resection. — Stephanie Oliveira (clinical) [Ep 1 · 2:30](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=150)
- Food, bacteria, and hormones in the gut enhance intestinal adaptation. — Stephanie Oliveira (clinical) [Ep 1 · 2:42](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=162)
- Enteral autonomy is defined as getting off TPN with all nutrition going through the gut, either by mouth or by feeding tube. — Stephanie Oliveira (clinical) [Ep 1 · 3:11](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=191)
- From 2010 to 2015, a repeat study with double the number of patients showed approximately 50% still reached enteral autonomy, but transplant rates and death rates significantly decreased. — Stephanie Oliveira (epidemiological) [Ep 1 · 3:33](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=213)
- Establishment of multidisciplinary teams is one factor that changed outcomes in intestinal failure. — Stephanie Oliveira (clinical) [Ep 1 · 3:46](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=226)
- Predictors of reaching enteral autonomy include greater residual bowel length, follow-up at an institution with an intestinal rehabilitation program, and no STEP procedure. — Stephanie Oliveira (clinical) [Ep 1 · 4:03](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=243)
- Patients should be referred to intestinal rehabilitation programs when not making progress, on prolonged TPN, or have significant comorbidities—sooner rather than later. — Stephanie Oliveira (guideline) [Ep 1 · 4:19](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=259)
- Patients should not be referred to intestinal rehabilitation programs when several complications have already occurred and transplant is the only remaining option. — Stephanie Oliveira (guideline) [Ep 1 · 4:39](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=279)
- Intestinal transplantation is considered when irreversible complications occur, but the number of transplants has significantly decreased over the last several decades. — Stephanie Oliveira (clinical) [Ep 1 · 4:49](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=289)
- Liver disease in intestinal failure ranges from mild cholestasis to profound steatosis (in older children/adolescents/adults), with ongoing inflammation, fibrosis, and ultimately cirrhosis leading to death or transplantation. — Paul Wales (clinical) [Ep 1 · 5:23](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=323)
- Risk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, inability to feed due to anatomy, recurrent infections/sepsis, and components of TPN. — Paul Wales (clinical) [Ep 1 · 5:41](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=341)
- The term 'intestinal rehabilitation program' was coined in the year 2000. — Paul Wales (clinical) [Ep 1 · 6:08](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=368)
- Intestinal rehabilitation teams improve outcomes through integration of care, improved communication, and better continuity. — Paul Wales (clinical) [Ep 1 · 6:12](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=372)
- Literature shows intestinal rehabilitation programs improve survival related to liver dysfunction, decrease septic episodes, reduce central line complications, reduce ICU admissions, and allow patients listed for transplant to come off the list due to improved status. — Paul Wales (epidemiological) [Ep 1 · 7:25](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=445)
- Lipids in parenteral nutrition are a source of essential fatty acids, a non-protein energy source important for growth, and fatty acids have a major role in cellular pathways. — Paul Wales (clinical) [Ep 1 · 8:02](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=482)
- Historically, most lipid emulsions in North America are soybean-based with high phytosterol content, high omega-6 long-chain polyunsaturated fatty acid content, and low antioxidant content. — Paul Wales (clinical) [Ep 1 · 8:15](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=495)
- Prolonged soybean-based lipid exposure is associated with deterioration of liver dysfunction, specifically cholestasis. — Paul Wales (clinical) [Ep 1 · 8:31](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=511)
- For every day an infant is exposed to soybean lipid dosed at greater than 2.5 g/kg/day, there is a 3% increase in the odds ratio of developing advanced liver disease. — Paul Wales (clinical) [Ep 1 · 8:51](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=531)
- First-generation lipid emulsions were soybean-based, rich in omega-6 PUFA (intralipid), available for 40 years. — Paul Wales (clinical) [Ep 1 · 9:15](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=555)
- Third-generation lipid emulsions reduce omega-6 and change the omega-6 to omega-3 ratio by adding omega-3 lipids. — Paul Wales (clinical) [Ep 1 · 9:32](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=572)
- Omega-6 lipids are metabolized to arachidonic acid, which produces leukotrienes and prostaglandins with a more pro-inflammatory profile. — Paul Wales (clinical) [Ep 1 · 9:51](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=591)
- Omega-3 lipids are metabolized through EPA and DHA and lead to production of cytokines with a less inflammatory profile. — Paul Wales (clinical) [Ep 1 · 10:01](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=601)
- Omega-3 lipids improve bile flow by decreasing lithogenicity of bile, decreasing steatosis, stimulating improved beta-oxidation and clearance, lowering oxidative stress, and supporting immune function. — Paul Wales (clinical) [Ep 1 · 10:15](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=615)
- Literature dating back decades shows that restricting soybean lipid exposure to 1 g/kg/day or less improves cholestasis. — Paul Wales (clinical) [Ep 1 · 10:42](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=642)
- In preterm babies, fat is important for growth, especially neurocognitive development, and there is risk of essential fatty acid deficiency if lipid dosing is restricted too much. — Paul Wales (clinical) [Ep 1 · 11:00](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=660)
- DHA and arachidonic acid are important for retinal and brain development. — Paul Wales (clinical) [Ep 1 · 11:22](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=682)
- None of the current lipid emulsions were designed for premature babies; they were all designed for adults in critical care settings. — Paul Wales (clinical) [Ep 1 · 11:26](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=686)
- Dr. Wales's team is working with industry to create a lipid emulsion specifically tailored to preterm babies with higher arachidonic acid content. — Paul Wales (clinical) [Ep 1 · 11:38](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=698)
- Central lines are the lifeline for intestinal failure patients, and without venous access, families cannot be supported. — Paul Wales (clinical) [Ep 1 · 12:03](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=723)
- Central lines carry risks of complications including infections, blockages, thrombosis, and breakage. — Paul Wales (clinical) [Ep 1 · 12:10](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=730)
- In the United States, there are approximately 240,000 central line-associated bloodstream infections (CLABSIs) annually, costing about $30,000 per infection, totaling approximately $2 billion per year nationwide. — Paul Wales (epidemiological) [Ep 1 · 12:24](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=744)
- 4% tetrasodium EDTA (Kitelock) is an antithrombotic, anti-fibrinolytic, and antimicrobial lock solution that satisfies all three criteria important for a good lock solution. — Paul Wales (clinical) [Ep 1 · 12:48](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=768)
- Kitelock is licensed in Europe and Australia but not available in the United States. — Paul Wales (clinical) [Ep 1 · 13:23](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=803)
- A multi-center randomized trial of Kitelock versus heparin launched 4 weeks ago and is actively recruiting patients, with results expected within the next year. — Paul Wales (clinical) [Ep 1 · 13:29](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=809)
- In short bowel syndrome, there are three anatomical subtypes: Type 1 (high jejunostomy), Type 2 (loss of distal small bowel/ileum and part of colon with small bowel-colonic anastomosis), and Type 3 (loss of mid-small bowel with retained ileum and intact colon). — Paul Wales (clinical) [Ep 1 · 13:58](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=838)
- Type 2 short bowel syndrome is the most common anatomical subtype in pediatrics. — Paul Wales (epidemiological) [Ep 1 · 14:26](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=866)
- Type 1 and Type 2 short bowel syndrome patients struggle because they lack an ileum. — Paul Wales (clinical) [Ep 1 · 14:31](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=871)
- Native GLP-2 hormone has a half-life of 7 minutes, making it impractical for clinical use. — Paul Wales (clinical) [Ep 1 · 14:53](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=893)
- Teduglutide is a GLP-2 analog with one amino acid alteration that has a half-life of 2 hours and is given once daily by subcutaneous injection. — Paul Wales (clinical) [Ep 1 · 15:00](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=900)
- Patients receiving teduglutide show a 40% reduction in TPN fluid and calorie requirements over a six-month period. — Paul Wales (clinical) [Ep 1 · 15:23](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=923)
- 70% of patients receiving teduglutide achieved the study endpoint of a 20% reduction in TPN requirements. — Paul Wales (clinical) [Ep 1 · 15:32](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=932)
- Teduglutide is licensed for children greater than 1 year of age. — Paul Wales (guideline) [Ep 1 · 15:48](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=948)
- Teduglutide has enabled children with very extreme anatomy to get off TPN. — Paul Wales (clinical) [Ep 1 · 15:50](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=950)
- Apraglutide is another GLP-2 analog with a longer half-life that can be given once weekly and is currently being studied. — Paul Wales (clinical) [Ep 1 · 16:02](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=962)
- Apraglutide works even better than teduglutide, producing more bowel lengthening. — Paul Wales (clinical) [Ep 1 · 16:10](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=970)
- These interventions (lipid optimization, central line protection, GLP-2 analogs) have led to a decrease in transplantation since 2008, largely because of the successes of intestinal rehabilitation. — Paul Wales (clinical) [Ep 1 · 16:36](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=996)
- Five-year outcomes of intestinal transplant are approximately 65%. — Paul Wales (epidemiological) [Ep 1 · 16:41](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=1001)
- The goal is to avoid transplant and lifelong immunosuppression whenever possible. — Paul Wales (opinion) [Ep 1 · 16:49](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=1009)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Chronic intestinal inflammation resembling Crohn's disease is now seen in intestinal failure patients and requires management with inflammatory bowel disease therapies like biologics. — Lizzy Lee summarizing the discussion [Ep 1 · 1:24](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=84)
- A 2012 Pediatric Intestinal Failure Consortium study showed 50% of intestinal failure patients achieved enteral autonomy, while 25% either died or had intestinal transplant. — Lizzy Lee summarizing a resource [Ep 1 · 3:19](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=199)
- Studies from Canada, Michigan, and Spain show that multidisciplinary intestinal rehabilitation teams improve survival. — Lizzy Lee summarizing the discussion [Ep 1 · 3:51](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=231)
- Second-generation lipid emulsions attempt to reduce omega-6 exposure by diluting the soybean component. — Lizzy Lee summarizing the discussion [Ep 1 · 9:26](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=566)
- Omega-6 fatty acids promote inflammation while omega-3s lead to a more anti-inflammatory response. — Lizzy Lee summarizing the discussion [Ep 1 · 9:43](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=583)
- In utero, babies receive significant amounts of DHA and arachidonic acid through the placenta, but standard lipid emulsions in TPN fall short of this. — Lizzy Lee summarizing the discussion [Ep 1 · 11:12](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=672)
- Patients with Type 3 short bowel syndrome have the best prognosis because they retain residual ileum. — Lizzy Lee summarizing the discussion [Ep 1 · 14:19](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=859)
- The ileum is where GLP-2 is naturally produced, so infants without it cannot generate the necessary hormone surge to drive their own intestinal adaptation. — Lizzy Lee summarizing the discussion [Ep 1 · 14:36](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=876)
- Children have greater adaptive potential than adults because of their inherent gut growth capacity. — Lizzy Lee summarizing the discussion [Ep 1 · 16:54](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=1014)
- The proportion of children reaching enteral autonomy has improved over the past 20 years. — Lizzy Lee summarizing the discussion [Ep 1 · 17:00](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=1020)
- Controlling liver disease buys time for intestinal adaptation. — Lizzy Lee summarizing the discussion [Ep 1 · 17:06](https://library.globalcastmd.com/watch/advances-in-pediatric-intestinal-failure-management-and-rehabilitation-16667?t=1026)

---
Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://library.globalcastmd.com/ai