# Short Bowel Syndrome — GCMD Library living collection

Also covered as: intestinal failure · gastroschisis · bacterial overgrowth · necrotizing enterocolitis · midgut volvulus · intestinal atresia · portal hypertension · hepatic steatosis

Experts: Dr. Ellen Encisco, Dr. Rod Gerardo, Dr. Michael Helmrath, Dr. Paul Wales

Updated: n/a · 10 episodes · 176 cited statements

## Episodes
### Foundations
- [Necrotizing Enterocolitis with Dr. Gail Besner](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297) — podcast · 46:29 · [machine version](https://library.globalcastmd.com/watch/necrotizing-enterocolitis-with-dr-gail-besner-297.md)
- [Intestinal rehabilitation: What is intestinal rehab? - Episode 1](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741) — video · 14:33 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741.md)
- [Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742) — podcast · 14:33 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742.md)

### Surgical Management
- [Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913) — podcast · 19:07 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913.md)

### Evidence & Research
- [Quick Literature Updates Episode 7](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686.md)
- [Disruption of enterohepatic Circulation of Bile acids ameliorates small bowel resection associated hepatic injury](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050.md)
- [Outcomes of Children With Short Bowel Syndrome: Experiences in a Multidisciplinary Intestinal Rehabilitation Unit Over Two Decades](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027) — video · 0:45 · [machine version](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027.md)
- [Impact of social determinants of health on outcomes in pediatric short bowel syndrome...](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896) — video · 0:43 · [machine version](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896.md)

### In-Depth Reviews
- [Intestinal Failure with Dr. Brad Warner](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296) — podcast · 52:46 · [machine version](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296.md)

### Long-Term Care
- [Care transition from a pediatric intestinal rehabilitation program to adult care and the risk of all-cause mortality: A retrospective cohort study](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901) — video · 1:01 · [machine version](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901.md)

## Chapters
- [0:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=4) Introduction and Program Context (Ep 4)
- [1:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=106) Defining Intestinal Failure (Ep 4)
- [4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290) Three Categories of Intestinal Failure (Ep 4)
- [8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=499) Timing of Diagnosis and Referral (Ep 4)
- [10:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=604) Multidisciplinary Team Approach (Ep 4)
- [12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=754) Outcomes and Future Challenges (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=0) Historical Context and Preoperative Philosophy (Ep 5)
- [4:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=257) Surgical Decision-Making at Birth (Ep 5)
- [7:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=423) Diagnosis-Specific Considerations (Ep 5)
- [10:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=645) STEP Procedure Technical Details (Ep 5)
- [17:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1073) Summary and Conclusion (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=0) Introduction and Program Expansion (Ep 3)
- [1:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=106) Defining Intestinal Failure (Ep 3)
- [4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290) Three Categories of Intestinal Failure (Ep 3)
- [8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=499) Timing of Diagnosis and Referral (Ep 3)
- [10:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=604) Team Approach and Long-term Outcomes (Ep 3)
- [13:14](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=794) Series Goals and Closing (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=0) Social determinants of health in pediatric short bowel syndrome (Ep 10)
- [0:00](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=0) Introduction and Definition of Intestinal Failure (Ep 1)
- [1:42](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=102) Prognostic Factors and Bowel Length Criteria (Ep 1)
- [7:07](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=427) Medical Management and TPN Strategy (Ep 1)
- [12:55](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=775) Lipid Formulations and Cholestasis Management (Ep 1)
- [17:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1071) Enteral Feeding Strategy and Adaptation (Ep 1)
- [26:01](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1561) Surgical Interventions: Lengthening Procedures (Ep 1)
- [38:10](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2290) Bacterial Overgrowth and Microbiome (Ep 1)
- [43:35](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2615) Growth Factors and Future Therapies (Ep 1)
- [46:32](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2792) Intestinal Transplantation and Multidisciplinary Care (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=0) Introduction: Survival Advances and Transition Risk (Ep 9)
- [0:09](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=9) Study Design and Population (Ep 9)
- [0:23](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=23) Key Findings: Mortality Disparity (Ep 9)
- [0:46](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=46) Clinical Implications (Ep 9)
- [0:00](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=0) Enterohepatic Circulation Disruption and Hepatic Injury in Small Bowel Resection (Ep 7)
- [0:00](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=0) Study Overview and Key Findings (Ep 8)
- [0:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=0) Introduction (Ep 6)
- [0:47](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=47) Hirschsprung's Disease Rectal Dissection Techniques (Ep 6)
- [1:35](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=95) Ileocecal Valve and Colon in Short Bowel Syndrome (Ep 6)
- [2:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=163) Surgeon Volume in Pediatric Thyroid Surgery (Ep 6)
- [3:35](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=215) Skin Closure Methods in Pediatric Wounds (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Intestinal failure is defined as insufficient gut function to absorb enough nutrients, fluids, and calories to support survival and, in children, growth" — Paul Wales (clinical) [Ep 4 · 2:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=125)
- "For a patient to be defined as having intestinal failure, they must have inadequate intestinal function necessitating parenteral support for at least 60 days" — Rod Gerardo (guideline) [Ep 4 · 2:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=144)
- "An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and associated needs" — Paul Wales (clinical) [Ep 4 · 3:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=183)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients" — Paul Wales (epidemiological) [Ep 4 · 4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290)
- "Causes of short bowel syndrome include congenital anomalies such as intestinal atresia, malrotation, volvulus, gastroschisis, and long segment Hirschsprung's disease" — Paul Wales (clinical) [Ep 4 · 5:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=306)
- "Acquired diseases of the newborn such as necrotizing enterocolitis can cause short bowel syndrome" — Paul Wales (clinical) [Ep 4 · 5:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=318)
- "Motility disorders occur when the bowel is unable to push contents through in a coordinated way due to abnormalities of the muscle itself or the nerves that control that muscle" — Paul Wales (clinical) [Ep 4 · 5:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=345)
- "Congenital enteropathies are conditions where the patient has all of their bowel but the mucosa does not work, leading to hypersecretion and profuse fluid losses" — Paul Wales (clinical) [Ep 4 · 6:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=377)
- "Some patients will have elements of two or three categories of intestinal failure in the way they present" — Paul Wales (clinical) [Ep 4 · 7:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=431)
- "A child with gastroschisis could have short bowel because it was not all viable, inflammation affecting absorption, and motility issues" — Ellen Encisco (clinical) [Ep 4 · 7:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=442)
- "Older pediatric patients can develop intestinal failure from inflammatory bowel disease or Crohn's disease where they have lost gut as a result of complications" — Paul Wales (clinical) [Ep 4 · 7:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=476)
- "Trauma, malignancy, and vascular thrombosis leading to gut loss are diagnoses seen more in older patients or adult series and less in pediatrics" — Paul Wales (epidemiological) [Ep 4 · 8:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=484)
- "There are three time points where families reach intestinal rehabilitation programs: prenatal diagnosis, postnatal acquired problems, and later presentations after discharge" — Michael Helmrath (clinical) [Ep 4 · 8:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=533)
- "Prenatal diagnoses that lead to intestinal rehabilitation typically include atresia with cystic fibrosis and gastroschisis" — Michael Helmrath (clinical) [Ep 4 · 9:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=555)
- "Postnatal acquired problems leading to intestinal rehabilitation include volvulus and necrotizing enterocolitis" — Ellen Encisco (clinical) [Ep 4 · 9:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=569)
- "Dietitians play a key role in understanding the nutritional needs of children in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 4 · 11:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=712)
- "Social work is a key component of the intestinal rehabilitation team" — Michael Helmrath (opinion) [Ep 4 · 12:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=721)
- "The survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival" — Rod Gerardo (epidemiological) [Ep 4 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=754)
- "Children with intestinal failure who survive long-term now develop chronic comorbidities including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life issues" — Paul Wales (clinical) [Ep 4 · 12:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=766)
- "Earlier recognition and taking advantage of the biology of the gut to adapt are time dependent" — Michael Helmrath (clinical) [Ep 4 · 2:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=160)
- "Intestinal rehabilitation streamlines care and improves communication with families and between care providers and team members" — Paul Wales (opinion) [Ep 4 · 3:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=235)
- "Intestinal rehabilitation comes down to key factors that drive the process: nutrition in the gut, nutrition in the body, and healing" — Michael Helmrath (clinical) [Ep 4 · 4:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=247)
- "Pattern recognition from multiple eyes on a baby who have seen them over time is important in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 4 · 4:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=259)
- "Adrian Bianchi first reported the longitudinal intestinal lengthening procedure (Bianchi procedure) that divides bowel along its two leaves and tubularizes it" — Michael Helmrath (clinical) [Ep 5 · 1:23](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=83)
- "In the 1980s and 1990s, babies with intestinal failure had poor outcomes primarily due to liver progression to inflammation and fibrosis associated with parenteral nutrition, lipids, and phytosterols" — Ellen Encisco (epidemiological) [Ep 5 · 1:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=110)
- "Rising direct bilirubin was recognized as a sign that children with intestinal failure would not do well" — Michael Helmrath (clinical) [Ep 5 · 2:13](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=133)
- "The first 4 months of life is when care for intestinal failure patients is most uncoordinated and surgical decisions have the most profound effect on long-term outcome" — Em Tombash (clinical) [Ep 5 · 2:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=149)
- "The gut doubles in length during the last trimester and the first year of life" — Michael Helmrath (clinical) [Ep 5 · 2:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=175)
- "Intestinal maturation occurs when the baby is fed; healthy growth of the intestine requires nutrition" — Michael Helmrath (clinical) [Ep 5 · 2:58](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=178)
- "Disrupting the feeding and maturation process affects not only the intestine's ability to absorb and digest but also peristalsis and function" — Michael Helmrath (clinical) [Ep 5 · 3:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=186)
- "Absorptive surface area comes from the waves of peristalsis moving over the villi, not from the exposed length of bowel" — Em Tombash (clinical) [Ep 5 · 3:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=212)
- "Lengthening bowel that doesn't have peristalsis does not increase absorption; it's just more static water" — Michael Helmrath (clinical) [Ep 5 · 3:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=226)
- "Very short bowel children can sometimes come off TPN because their motility is so good" — Michael Helmrath (clinical) [Ep 5 · 3:59](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=239)
- "The majority of pediatric short bowel syndrome cases present at birth due to neonatal causes: congenital GI anomalies or acquired conditions like necrotizing enterocolitis" — Paul Wales (epidemiological) [Ep 5 · 4:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=258)
- "When reestablishing bowel continuity, size discrepancy between bowel ends must be addressed or a functional obstruction will result even if the anastomosis is patent" — Paul Wales (clinical) [Ep 5 · 5:42](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=342)
- "If adequate bowel length exists, size discrepancy can be managed by resection back to appropriate caliber or tapering enteroplasty" — Paul Wales (clinical) [Ep 5 · 6:02](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=362)
- "In short bowel cases, serial transverse enteroplasty (STEP) can address size discrepancy without resecting mucosa" — Paul Wales (clinical) [Ep 5 · 6:28](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=388)
- "Gastroschisis patients don't tend to do as well regardless of intervention; STEP procedures in gastroschisis patients consistently underperform" — Paul Wales (clinical) [Ep 5 · 7:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=428)
- "Gastroschisis patients have inherent dysmotility from enteric nervous system damage due to amniotic fluid exposure" — Em Tombash (clinical) [Ep 5 · 7:21](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=441)
- "The enteric nervous system in gastroschisis must go through a healing and recovery phase that is attenuated by dysmotility and stasis" — Michael Helmrath (clinical) [Ep 5 · 7:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=452)
- "Atresia patients may have good peristalsis from bowel working against obstruction, and longitudinal stapling procedures may benefit them" — Michael Helmrath (clinical) [Ep 5 · 7:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=475)
- "Children who undergo STEP procedures in the first year of life sometimes never progress and are labeled as poor motility patients unable to tolerate enteral feeds" — Michael Helmrath (clinical) [Ep 5 · 8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=499)
- "Necrotizing enterocolitis patients do better than other intestinal failure etiologies because they have been fed before disease onset, initiating GI motility and maturation" — Michael Helmrath (opinion) [Ep 5 · 8:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=520)
- "STEP procedure requires bowel diameter of at least 5 centimeters to be worthwhile" — Paul Wales (clinical) [Ep 5 · 9:09](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=549)
- "At birth, neonatal bowel is usually not dilated enough to apply the STEP procedure" — Ellen Encisco (clinical) [Ep 5 · 9:36](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=576)
- "In scenarios where immediate anastomosis is not prudent, distal bowel can be accessed with a feeding tube to provide distal feeding and grow the bowel in caliber before a subsequent operation" — Paul Wales (clinical) [Ep 5 · 9:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=590)
- "Stepping the duodenum in non-rotated children is fraught with problems and causes significant issues later in life" — Michael Helmrath (opinion) [Ep 5 · 10:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=622)
- "The STEP procedure was originally described by HP Kim and Tom Jackson" — Paul Wales (clinical) [Ep 5 · 10:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=645)
- "Maintaining bowel alignment during STEP is critical; there is risk of longitudinal twisting if alignment is not maintained" — Paul Wales (clinical) [Ep 5 · 11:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=689)
- "An endo GIA stapler with vascular (white) load cartridge (2.5mm crimping to 1mm) is preferred over open GIA and prevents leaks better than the classic blue load" — Paul Wales (clinical) [Ep 5 · 12:26](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=746)
- "Target bowel caliber after STEP is 1.5 cm in babies and 2 to 2.5 cm in older infants or children" — Paul Wales (clinical) [Ep 5 · 13:23](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=803)
- "Making the bowel too narrow during STEP can cause obstruction, especially in patients with borderline motility" — Paul Wales (clinical) [Ep 5 · 13:36](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=816)
- "A U-stitch with 4-0 PDS should be placed in the crotch of each staple line to prevent potential leaks" — Paul Wales (clinical) [Ep 5 · 14:35](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=875)
- "Dog ears (blind loops) can form at the top and bottom of the STEP segment where bowel transitions in and out, and these can dilate over time" — Paul Wales (clinical) [Ep 5 · 15:08](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=908)
- "Dilated segments in STEP can allow the stepped segments to rotate away from each other and twist, forming a functional obstruction" — Ellen Encisco (clinical) [Ep 5 · 15:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=952)
- "STEP staple lines should be oriented perpendicular to the mesentery at 90 and 270 degrees (3 o'clock and 9 o'clock positions)" — Paul Wales (clinical) [Ep 5 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=754)
- "The duodenum should not be stepped; STEP should start where the bowel begins to dilate, usually distal to the duodenum" — Paul Wales (clinical) [Ep 5 · 16:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1011)
- "If duodenal narrowing is needed, a stapler should be used on the lateral side away from the bile duct and ampulla; plication sutures usually fail" — Paul Wales (clinical) [Ep 5 · 17:20](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1040)
- "The duodenum has no mesentery, making it impossible to orient staple lines at 3 and 9 o'clock positions as in the jejunum" — Michael Helmrath (clinical) [Ep 5 · 17:32](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-4-surgical-management-part-1-5913?t=1052)
- "Intestinal failure is defined as insufficient gut function to absorb enough nutrients, fluids, and calories to support survival and, in children, growth" — Paul Wales (clinical) [Ep 3 · 2:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=125)
- "New guidelines define intestinal failure as requiring parental support for at least 60 days" — Rod Gerardo (guideline) [Ep 3 · 2:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=144)
- "An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm providing coordinated care for children with intestinal failure through comprehensive management of specialized nutrition and associated needs" — Paul Wales (clinical) [Ep 3 · 3:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=183)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients" — Paul Wales (epidemiological) [Ep 3 · 4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290)
- "Causes of short bowel syndrome include congenital anomalies such as intestinal atresia, malrotation, volvulus, gastroschisis, and long segment Hirschsprung's disease" — Paul Wales (clinical) [Ep 3 · 5:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=306)
- "Acquired diseases of the newborn such as necrotizing enterocolitis cause short bowel syndrome" — Paul Wales (clinical) [Ep 3 · 5:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=318)
- "Motility disorders occur when abnormalities of the intestinal muscle itself or the nerves that control that muscle prevent coordinated movement of food and stool" — Paul Wales (clinical) [Ep 3 · 5:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=345)
- "Children with motility disorders are dependent on intravenous support" — Paul Wales (clinical) [Ep 3 · 6:10](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=370)
- "Enteropathies or congenital diarrheas are conditions where the patient has all of their bowel but the mucosal lining that digests and absorbs does not work" — Paul Wales (clinical) [Ep 3 · 6:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=377)
- "Mucosal defects lead to hypersecretion and profuse fluid losses such that the bowel is unable to tolerate or absorb nutrients" — Ellen (clinical) [Ep 3 · 6:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=390)
- "Some patients will have elements of one, two, or all three categories of intestinal failure" — Paul Wales (clinical) [Ep 3 · 7:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=431)
- "A child with gastroschisis could have short bowel because it was not all viable, inflammation affecting absorption, and motility issues" — Ellen (clinical) [Ep 3 · 7:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=442)
- "Most intestinal failure patients are infants or babies, but some older kids develop intestinal failure" — Paul Wales (epidemiological) [Ep 3 · 7:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=465)
- "Inflammatory bowel disease or Crohn's disease can lead to gut loss and intestinal failure in older patients" — Paul Wales (clinical) [Ep 3 · 7:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=476)
- "Trauma, malignancy, and vascular thrombosis leading to gut loss are diagnoses seen more in older patients or adult series and less in pediatrics" — Paul Wales (epidemiological) [Ep 3 · 8:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=484)
- "There are three time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later diagnosis after discharge" — Rod Gerardo (clinical) [Ep 3 · 8:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=531)
- "Prenatal diagnoses that lead to intestinal rehab referral include atresia with cystic fibrosis and gastroschisis" — Michael Helmrath (clinical) [Ep 3 · 9:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=555)
- "Postnatal acquired problems leading to intestinal rehab referral include volvulus and necrotizing enterocolitis" — Ellen (clinical) [Ep 3 · 9:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=569)
- "The intestinal rehab team includes surgeons, GI doctors, neonatologists, dietitians, social work, nurse practitioners, pharmacy, interventional radiology, pathology, endocrinology, and nephrology" — Michael Helmrath (clinical) [Ep 3 · 11:43](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=703)
- "Survival overall in big intestinal rehab programs is usually over 90% long-term survival" — Rod Gerardo (epidemiological) [Ep 3 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=754)
- "Long-term survivors now develop chronic comorbidities including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life issues" — Paul Wales (clinical) [Ep 3 · 12:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=766)
- "Earlier recognition and taking advantage of the gut's biology to adapt are time dependent" — Michael Helmrath (opinion) [Ep 3 · 2:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=160)
- "Intestinal rehabilitation comes down to key factors: nutrition in the gut, nutrition in the body, and healing" — Michael Helmrath (clinical) [Ep 3 · 4:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=247)
- "Pattern recognition from multiple experienced providers seeing patients over time is essential in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 3 · 4:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=259)
- "Families living within the region can benefit from understanding that delivery at an intestinal rehab center from the beginning is probably beneficial" — Michael Helmrath (opinion) [Ep 3 · 8:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=510)
- "Access and availability to an intestinal rehab program is still very rare" — Rod Gerardo (epidemiological) [Ep 3 · 8:41](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=521)
- "Innovation comes from multiple approaches to the problem and different visions, with more expertise bringing better outcomes" — Michael Helmrath (opinion) [Ep 3 · 10:25](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=625)
- "Transitioning older children with intestinal failure into their late teen years and later is a major obstacle that needs to be addressed" — Michael Helmrath (clinical) [Ep 3 · 10:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=651)
- "This was a retrospective cohort study of children with short bowel syndrome in an intestinal rehabilitation program, followed from 2006 to 2019." — Lizzie Lee (epidemiological) [Ep 10 · 0:07](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=7)
- "The study asked whether social determinants of health predict outcomes like bloodstream infections, liver disease, and achieving enteral autonomy." — Lizzie Lee (epidemiological) [Ep 10 · 0:16](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=16)
- "Social determinants of health do predict outcomes in pediatric short bowel syndrome." — Lizzie Lee (epidemiological) [Ep 10 · 0:24](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=24)
- "Distance from the hospital was associated with higher risks of serious complications in children with short bowel syndrome." — Lizzie Lee (epidemiological) [Ep 10 · 0:27](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=27)
- "Parental education was linked with fewer central line infections in children with short bowel syndrome." — Lizzie Lee (epidemiological) [Ep 10 · 0:33](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=33)
- "Clinicians need to consider social determinants of health to better support families of children with short bowel syndrome." — Lizzie Lee (opinion) [Ep 10 · 0:37](https://library.globalcastmd.com/watch/impact-of-social-determinants-of-health-on-outcomes-in-pediatric-short-bowel-syndrome-13896?t=37)
- "Intestinal failure is an umbrella term for when the small intestine is unable to absorb or digest enough nutrition to support the patient entirely by oral or enteral feeding" — Brad Warner (clinical) [Ep 1 · 1:42](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=102)
- "The intestine of a newborn or fetus doubles in length in the last trimester of gestation" — Brad Warner (clinical) [Ep 1 · 3:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=183)
- "For a neonate with ileocecal valve and entire colon, 10 to 15 centimeters of small intestine is a ballpark figure for salvageability" — Brad Warner (clinical) [Ep 1 · 4:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=243)
- "Without the colon and ileocecal valve, at least 15 to 20 centimeters would be a ballpark figure for salvageability" — Brad Warner (clinical) [Ep 1 · 4:37](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=277)
- "In adults with less than 50 centimeters of intestine, about 40% will not be alive after 5 to 10 years" — Brad Warner (epidemiological) [Ep 1 · 4:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=291)
- "For a patient with 15 centimeters of bowel and ileocecal valve, long term 50% should be able to wean from TPN, 25% would require transplant, and 25% would die" — Brad Warner (epidemiological) [Ep 1 · 5:56](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=356)
- "Intestinal adaptation in humans probably takes place over about a year or two after small bowel resection" — Brad Warner (clinical) [Ep 1 · 7:49](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=469)
- "Stool outputs of up to 40 ccs per kilo per day are acceptable when advancing enteral feeding" — Brad Warner (guideline) [Ep 1 · 8:30](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=510)
- "For TPN, shoot for about 100 to 120 calories per kilo per day for total calories, with about 50% from glucose and remainder from fat and protein" — Brad Warner (guideline) [Ep 1 · 10:22](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=622)
- "Generally shoot for about 2 to 3 g of protein per kilo per day and about 2 to 3 g of fat per kilo per day in TPN" — Brad Warner (guideline) [Ep 1 · 10:45](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=645)
- "A baby should gain about 20 to 30 g a day, which approximates in utero progression for a newborn" — Brad Warner (clinical) [Ep 1 · 12:05](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=725)
- "Lipid reduction strategy takes patients from 2 to 3 g per kilo per day of fat delivered daily down to about 1 g per kilo per day delivered twice or 3 times a week to reduce cholestasis" — Brad Warner (guideline) [Ep 1 · 12:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=773)
- "Omegaven is a fish oil-based fat primarily containing omega 3 fatty acids that are anti-inflammatory, compared to soybean-based intralipid with omega 6 fatty acids that are pro-inflammatory" — Brad Warner (clinical) [Ep 1 · 14:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=843)
- "SMOF lipid contains soybean (essential fatty acids), medium chain triglycerides (easily digested), olive oil, and fish oil, and has become the most commonly used lipid in Canada" — Brad Warner (clinical) [Ep 1 · 15:08](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=908)
- "Breast milk is the best choice for neonates because it contains growth factors like EGF and IGF, milk oligosaccharides that enhance adaptation, and other beneficial components" — Brad Warner (opinion) [Ep 1 · 18:11](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1091)
- "Complex formulas fed enterally may stimulate adaptation better than elemental formulas by causing secretion of enterotrophic hormones to a greater extent" — Brad Warner (clinical) [Ep 1 · 19:26](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1166)
- "There is a threshold percentage of enteral calories that prevents onset of liver damage from TPN, though the exact number is unknown" — Brad Warner (clinical) [Ep 1 · 21:19](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1279)
- "Time to consider surgical intervention is when patient hits a plateau enterally and starts backing away, or if going backward rather than forward in enteral tolerance" — Brad Warner (guideline) [Ep 1 · 22:33](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1353)
- "Multiple episodes of sepsis along with abdominal distention and dilated bowel loops is an indication for surgical intervention" — Brad Warner (guideline) [Ep 1 · 23:01](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1381)
- "If child is starting to get jaundiced, there is a role to evaluate the gut for subclinical portal bacteremia arising from dilated bowel loops" — Brad Warner (clinical) [Ep 1 · 23:18](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1398)
- "Dilated bowel loops cause bacterial overgrowth leading to secretory diarrhea that is not related to digestion-absorption capacity but to enzyme dysfunction" — Brad Warner (clinical) [Ep 1 · 23:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1433)
- "More than 4 to 5 centimeters of bowel dilation with failure to advance enteral feeds or going backward is an indication for surgical intervention" — Brad Warner (guideline) [Ep 1 · 25:43](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1543)
- "In a child who is completely stable after 3 years but not progressing, would interrogate bowel and if dilated would proceed with lengthening" — Brad Warner (opinion) [Ep 1 · 26:07](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1567)
- "If a child has over 100 centimeters of intestine, less than 5 or 10% should require TPN, suggesting possible underlying motility or mucosal problem" — Brad Warner (clinical) [Ep 1 · 27:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1673)
- "With less than 50 centimeters of intestine and bowel at least 4 to 5 centimeters dilated, there is an option for either Bianchi or STEP procedure" — Brad Warner (guideline) [Ep 1 · 28:37](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1717)
- "The STEP procedure has emerged to be the most commonly performed lengthening operation because it is easier to do with less risk of injuring mesenteric blood supply" — Brad Warner (clinical) [Ep 1 · 29:31](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1771)
- "STEP procedures can redilate requiring redo procedures, and outcomes are not as good if a redo STEP is needed compared to never needing a redo" — Brad Warner (clinical) [Ep 1 · 32:54](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1974)
- "You can do a Bianchi and then later do a STEP on top of it, but you cannot do a Bianchi once a STEP has been done" — Brad Warner (clinical) [Ep 1 · 33:26](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2006)
- "STEP procedures can cause dysmotility acting as a brake on intestinal transit" — Brad Warner (clinical) [Ep 1 · 35:04](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2104)
- "Would taper a child with dilated bowel who had at least 90 to 100 centimeters of intestinal length rather than performing a lengthening procedure" — Brad Warner (opinion) [Ep 1 · 38:21](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2301)
- "Chenodeoxycholic acid bile salts can be used to improve bile flow in TPN cholestasis" — Brad Warner (clinical) [Ep 1 · 39:00](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2340)
- "Cholecystokinin administration to promote bile flow and mitigate TPN cholestasis did not work in clinical trials" — Brad Warner (clinical) [Ep 1 · 39:23](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2363)
- "Gut bacteria in short gut syndrome become more efficient and help adapt by encouraging greater absorption and digestion, similar to an obesogenic microbiome" — Brad Warner (clinical) [Ep 1 · 41:54](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2514)
- "In mouse models, oral vancomycin to knock out gram positive organisms completely prevented hepatic steatosis after bowel resection" — Brad Warner (clinical) [Ep 1 · 42:19](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2539)
- "Teduglutide, a GLP-2 analog, has been demonstrated in randomized trials to reduce TPN requirements by about 1-2 liters per week in adults with short gut syndrome" — Brad Warner (clinical) [Ep 1 · 43:45](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2625)
- "Teduglutide is not yet approved for children in the United States due to concerns about malignancy risk from promoting proliferation" — Brad Warner (clinical) [Ep 1 · 44:34](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2674)
- "Growth hormone and glutamine combinations have shown primarily mixed results and have not been a huge advance in TPN weaning" — Brad Warner (clinical) [Ep 1 · 45:40](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2740)
- "Survival for small bowel transplant is about 50 to 60% at 5 years, with one year survivals now above 70 to 80%" — Brad Warner (epidemiological) [Ep 1 · 46:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2811)
- "The intestine is an immunogenic organ filled with white cells and macrophages that mount a huge graft versus host response requiring industrial strength immunosuppression" — Brad Warner (clinical) [Ep 1 · 47:11](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2831)
- "Ethanol locks for central lines have reduced significantly the number of sepsis episodes in patients with short gut syndrome" — Brad Warner (clinical) [Ep 1 · 49:22](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2962)
- "Multidisciplinary teams including pharmacists, nutritionists, surgeons, GI doctors, ID, radiology, and interventional radiology improve survival of intestinal failure patients" — Brad Warner (clinical) [Ep 1 · 51:16](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=3076)
- "Advances in medicine have dramatically improved survival rates for children with intestinal failure" — Julian Goddard (clinical) [Ep 9 · 0:00](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=0)
- "The study tracked 46 patients who turned 20 to evaluate outcomes during care transition" — Julian Goddard (epidemiological) [Ep 9 · 0:13](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=13)
- "59% of patients transitioned to adult focused programs while the rest continued receiving care at Cincinnati Children's" — Julian Goddard (epidemiological) [Ep 9 · 0:23](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=23)
- "Patients who transitioned to adult care had a 33% mortality rate" — Julian Goddard (epidemiological) [Ep 9 · 0:29](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=29)
- "Patients who stayed in pediatric care had a 5% mortality rate" — Julian Goddard (epidemiological) [Ep 9 · 0:29](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=29)
- "The two groups showed no obvious differences in medical complexity or disease burden" — Julian Goddard (clinical) [Ep 9 · 0:29](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=29)
- "The median time from transition to death was approximately 12 months" — Julian Goddard (epidemiological) [Ep 9 · 0:42](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=42)
- "Young adults with a history of intestinal failure aging out of pediatric care remain a critically vulnerable population" — Julian Goddard (opinion) [Ep 9 · 0:46](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=46)
- "Structured transition programs need to be developed and widely implemented for this population" — Julian Goddard (opinion) [Ep 9 · 0:46](https://library.globalcastmd.com/watch/care-transition-from-a-pediatric-intestinal-rehabilitation-program-to-adult-care-and-the-risk-of-all-cause-mortality-a-retrospective-cohort-study-11901?t=46)
- "Disruption of the enterohepatic circulation of bile acids is beneficial for the liver" — Cecilia Gigena (clinical) [Ep 7 · 0:00](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=0)
- "The study was conducted at Saint Louis Children's Hospital" — Cecilia Gigena (clinical) [Ep 7 · 0:13](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=13)
- "The study aim was to elucidate the driving force behind hepatic injury" — Cecilia Gigena (clinical) [Ep 7 · 0:13](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=13)
- "Three groups of mice were studied: sham, 50% with proximal or duodenal resection, and 50% with distal resection or resection of the ileocecal valve" — Cecilia Gigena (clinical) [Ep 7 · 0:22](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=22)
- "Tissue samples were taken at the second and 10th postoperative weeks" — Cecilia Gigena (clinical) [Ep 7 · 0:34](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=34)
- "Mice with distal resection show less hepatic oxidative stress" — Cecilia Gigena (clinical) [Ep 7 · 0:41](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=41)
- "Mice with distal resection show more hydrophilic bile acid profile" — Cecilia Gigena (clinical) [Ep 7 · 0:41](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=41)
- "Ileal resection could lead to less hepatic injury" — Cecilia Gigena (clinical) [Ep 7 · 0:41](https://library.globalcastmd.com/watch/disruption-of-enterohepatic-circulation-of-bile-acids-ameliorates-small-bowel-resection-associated-hepatic-injury-7050?t=41)
- "This is a retrospective study examining pediatric patients with short bowel syndrome" — Lizzie Lee (clinical) [Ep 8 · 0:10](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=10)
- "The study included 64 pediatric patients with short bowel syndrome" — Lizzie Lee (epidemiological) [Ep 8 · 0:10](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=10)
- "Patients were managed by a multidisciplinary intestinal rehab program" — Lizzie Lee (clinical) [Ep 8 · 0:10](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=10)
- "The study period was between 2001 and 2022" — Lizzie Lee (epidemiological) [Ep 8 · 0:10](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=10)
- "89% of patients survived" — Lizzie Lee (epidemiological) [Ep 8 · 0:22](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=22)
- "78% of patients were able to wean off parenteral nutrition" — Lizzie Lee (epidemiological) [Ep 8 · 0:22](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=22)
- "Survival rates improved over time" — Lizzie Lee (epidemiological) [Ep 8 · 0:22](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=22)
- "Fish oil-based parenteral nutrition was introduced in 2007" — Lizzie Lee (clinical) [Ep 8 · 0:31](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=31)
- "Introduction of fish oil-based parenteral nutrition improved survival" — Lizzie Lee (clinical) [Ep 8 · 0:31](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=31)
- "Intestinal failure associated liver disease was a factor that affected survival" — Lizzie Lee (clinical) [Ep 8 · 0:31](https://library.globalcastmd.com/watch/outcomes-of-children-with-short-bowel-syndrome-experiences-in-a-multidisciplinary-intestinal-rehabilitation-unit-over-two-decades-10027?t=31)
- "The study examined 277 children with Hirschsprung's disease, with about half receiving Soave procedure, a third Duhamel, and the rest Swenson" — Britney Levy (clinical) [Ep 6 · 0:47](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=47)
- "217 of the 277 children had long-term outcome data available" — Britney Levy (clinical) [Ep 6 · 1:10](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=70)
- "Duhamel procedure has the lowest risk of incontinence but the highest risk of constipation in school age children with Hirschsprung's disease" — Britney Levy (clinical) [Ep 6 · 1:15](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=75)
- "The Peters et al. study examined 55 pediatric patients with short bowel syndrome" — Rod Gerardo (clinical) [Ep 6 · 1:35](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=95)
- "Infants with an ileocecal valve had significantly shorter duration on parenteral nutrition" — Rod Gerardo (clinical) [Ep 6 · 1:50](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=110)
- "Patients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve" — Rod Gerardo (clinical) [Ep 6 · 2:05](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=125)
- "The Olsen et al. systematic review analyzed 10 studies with 6,430 patients" — Cecilia Gigena (epidemiological) [Ep 6 · 2:43](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=163)
- "The definition of a high volume surgeon varies widely from 9 thyroidectomies per year to over 200 thyroidectomies with at least 30 being in pediatric patients" — Cecilia Gigena (clinical) [Ep 6 · 3:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=180)
- "Thyroidectomies performed by high volume surgeons show shorter length of stays" — Cecilia Gigena (clinical) [Ep 6 · 3:20](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=200)
- "The Tendon et al. study was a prospective randomized control trial conducted between 2017 and 2018" — Ellen Encisco (clinical) [Ep 6 · 3:35](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=215)
- "The study compared three skin closure groups: sutures with tissue adhesive, sutures with adhesive tape, and sutures alone" — Ellen Encisco (clinical) [Ep 6 · 3:55](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=235)
- "Wounds were assessed at two weeks, six weeks, and more than six months after operation by surveying clinicians and parents" — Ellen Encisco (clinical) [Ep 6 · 4:10](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=250)
- "Wounds with tissue adhesive had poorer cosmesis at six weeks" — Em Tombash (clinical) [Ep 6 · 4:17](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=257)
- "The cosmesis difference between tissue adhesive and other closure methods was gone by six months" — Em Tombash (clinical) [Ep 6 · 4:25](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=265)
- "There was no difference between the three closure groups at six months for clinicians or for parents" — Em Tombash (clinical) [Ep 6 · 4:35](https://library.globalcastmd.com/watch/quick-literature-updates-episode-7-6686?t=275)

## Changelog
- Aug 31: 14 doctors auto-found from episode dossiers
- Aug 30: 14 doctors auto-found from episode dossiers
- Aug 30: 12 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 15 doctors auto-found from episode dossiers
- Aug 29: 15 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 15 items, 12 dossiers, summaries for 2 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 9 items, 8 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 9 items, 8 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 9 items, 8 dossiers, summaries for 2 audience(s)

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