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Intestinal Failure and Inflammatory Bowel Disease
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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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, Advances in pediatric intestinal failure management and rehabilitation · 4:19
Advances in pediatric intestinal failure management and rehabilitation
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Explore the latest advancements in pediatric intestinal failure, including innovative therapies and improved patient outcomes. Dr. Stephanie Bachi de Castro Oli
podcast17:45 · Nov 2026
Surgical management of very early onset inflammatory bowel disease
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Sarah J. Ullrich ∙ Annie Le-Nguyen ∙ Monica Holder ∙ Randi Wittenberg ∙ Allison Caja ∙ Aaron P. Garrison ∙ Beth A. Rymeski ∙ Nelson G. Rosen ∙ Jason S. FrischerPurpose
The incidence of inflammatory bowel disease in children under six years
article · Jan 2026
Surgical management of very early onset inflammatory bowel disease
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Sarah J. Ullrich ∙ Annie Le-Nguyen ∙ Monica Holder ∙ Randi Wittenberg ∙ Allison Caja ∙ Aaron P. Garrison ∙ Beth A. Rymeski ∙ Nelson G. Rosen ∙ Jason S. FrischerPurpose
The incidence of inflammatory bowel disease in children under six years
video0:57 · Feb 2026
Pneumatosis intestinalis after hematopoietic stem cell transplantation: When not doing anything is good enough.
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Pneumatosis intestinalis (PI) has been reported in hematopoietic stem cell transplant recipients (HSCT) since 1980s and at present there is no uniform consensus of the significance and management of this condition. We retrospectively review
article · Nov 2026
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Intestinal failure—defined as functional intestinal mass insufficient to sustain life without parenteral support for ≥60 days—arises most commonly from short bowel syndrome, mucosal enteropathies, and dysmotility [e16667-c1, e16667-c2]. In pediatrics, neonatal etiologies (gastroschisis, NEC, atresia, volvulus) predominate . Multidisciplinary intestinal rehabilitation programs now achieve enteral autonomy in ~50% of patients, with significant reductions in transplant and mortality rates since 2010 [e16667-c11, e16667-c12, e16667-c13, e16667-c14]. Key advances include lipid optimization: soybean-based emulsions (>2.5 g/kg/day) drive cholestasis, while restriction to ≤1 g/kg/day or omega-3-enriched formulations improve liver outcomes [e16667-c26, e16667-c27, e16667-c35]. Teduglutide, a GLP-2 analog, produces 40% TPN reduction in six months, with 70% of patients achieving ≥20% reduction; it is particularly effective in Type 1/2 short bowel where native ileal GLP-2 production is absent [e16667-c51, e16667-c54, e16667-c55]. Emerging challenges include chronic intestinal inflammation resembling Crohn's disease, now managed with biologics, though pathogenesis remains unclear [e16667-c5, e16667-c6]. The field has shifted focus to neurocognitive outcomes, quality of life, and caregiver burden as survival improves .
- Multidisciplinary intestinal rehabilitation programs achieve enteral autonomy in 50% of pediatric patients, with transplant and mortality rates significantly declining since 2010. [e16667-c11, e16667-c12, e16667-c13]
- Soybean lipid >2.5 g/kg/day increases advanced liver disease risk by 3% per day; restriction to ≤1 g/kg/day or omega-3 formulations reverse cholestasis. [e16667-c26, e16667-c27, e16667-c35]
- Teduglutide produces 40% TPN reduction over six months, with 70% achieving ≥20% reduction; it compensates for absent ileal GLP-2 in Type 1/2 short bowel. [e16667-c51, e16667-c54, e16667-c55]
- Chronic intestinal inflammation resembling Crohn's disease now occurs in IF survivors, requiring biologic therapy; etiology unknown. [e16667-c5, e16667-c6]
- Refer patients early to rehabilitation programs when progress stalls or TPN is prolonged; late referral after irreversible complications limits options to transplant alone. [e16667-c16, e16667-c17]
For patients & families
Intestinal failure happens when a child's bowel cannot absorb enough nutrition to sustain life, requiring intravenous feeding (called TPN) for at least 60 days . More than half of cases stem from short bowel syndrome, often caused by conditions like necrotizing enterocolitis, gastroschisis, or twisted bowel that occur in newborns [e16667-c2, e16667-c3]. The good news is that specialized intestinal rehabilitation teams—groups of doctors, nurses, dietitians, and surgeons working together—have dramatically improved outcomes [e16667-c13, e16667-c14]. About half of children now achieve "enteral autonomy," meaning they can get all their nutrition through the gut and stop TPN, while death and transplant rates have fallen significantly [e16667-c11, e16667-c12]. Doctors now use several strategies to help the bowel adapt and grow: adjusting the fat content in TPN to protect the liver , preventing line infections with better lock solutions , and giving a medication called teduglutide that mimics a natural gut hormone to promote bowel lengthening [e16667-c53, e16667-c54]. Children have remarkable capacity for their remaining bowel to adapt and take over feeding duties, especially when care starts early at a specialized center [e16667-c15, e16667-c63, e16667-c64].
Intestinal failure happens when a child's bowel cannot absorb enough nutrition to sustain life, requiring intravenous feeding (called TPN) for at least 60 days . More than half of cases stem from short bowel syndrome, often caused by conditions like necrotizing enterocolitis, gastroschisis, or twisted bowel that occur in newborns [e16667-c2, e16667-c3]. The good news is that specialized intestinal rehabilitation teams—groups of doctors, nurses, dietitians, and surgeons working together—have dramatically improved outcomes [e16667-c13, e16667-c14]. About half of children now achieve "enteral autonomy," meaning they can get all their nutrition through the gut and stop TPN, while death and transplant rates have fallen significantly [e16667-c11, e16667-c12]. Doctors now use several strategies to help the bowel adapt and grow: adjusting the fat content in TPN to protect the liver , preventing line infections with better lock solutions , and giving a medication called teduglutide that mimics a natural gut hormone to promote bowel lengthening [e16667-c53, e16667-c54]. Children have remarkable capacity for their remaining bowel to adapt and take over feeding duties, especially when care starts early at a specialized center [e16667-c15, e16667-c63, e16667-c64].
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Advances in pediatric intestinal failure management and rehabilitation
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.
clinicalStephanie Oliveira0:26 ↗
More than 50% of intestinal failure cases are related to short bowel syndrome, with additional cases from mucosal enteropathies and dysmotility disorders.
epidemiologicalStephanie Oliveira0:43 ↗
Most short bowel syndrome cases in pediatrics occur during the neonatal period from gastroschisis, necrotizing enterocolitis, bowel atresia, and intestinal volvulus.
clinicalStephanie Oliveira0:55 ↗
The field is now focusing on neurocognitive outcomes, quality of life, and caregiver burnout as more children survive intestinal failure.
opinionStephanie Oliveira1:18 ↗
Chronic intestinal inflammation resembling Crohn's disease is now seen in intestinal failure patients and requires management with inflammatory bowel disease therapies like biologics.
Host summaryLizzy Lee summarizing the discussion — not the host's own clinical position1:24 ↗
The cause of chronic intestinal inflammation in intestinal failure survivors is not known.
clinicalStephanie Oliveira1:37 ↗
The goal of intestinal rehabilitation is to optimize intestinal function and adaptation before the development of irreversible complications.
clinicalStephanie Oliveira2:07 ↗
Intestinal adaptation is an active compensatory process that starts immediately after bowel resection.
clinicalStephanie Oliveira2:30 ↗
Food, bacteria, and hormones in the gut enhance intestinal adaptation.
clinicalStephanie Oliveira2:42 ↗
Enteral autonomy is defined as getting off TPN with all nutrition going through the gut, either by mouth or by feeding tube.
clinicalStephanie Oliveira3:11 ↗
A 2012 Pediatric Intestinal Failure Consortium study showed 50% of intestinal failure patients achieved enteral autonomy, while 25% either died or had intestinal transplant.
Host summaryLizzy Lee summarizing a resource — not the host's own clinical position3:19 ↗
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.
epidemiologicalStephanie Oliveira3:33 ↗
Establishment of multidisciplinary teams is one factor that changed outcomes in intestinal failure.
clinicalStephanie Oliveira3:46 ↗
Studies from Canada, Michigan, and Spain show that multidisciplinary intestinal rehabilitation teams improve survival.
Host summaryLizzy Lee summarizing the discussion — not the host's own clinical position3:51 ↗
Predictors of reaching enteral autonomy include greater residual bowel length, follow-up at an institution with an intestinal rehabilitation program, and no STEP procedure.
clinicalStephanie Oliveira4:03 ↗
Patients should be referred to intestinal rehabilitation programs when not making progress, on prolonged TPN, or have significant comorbidities—sooner rather than later.
guidelineStephanie Oliveira4:19 ↗
Patients should not be referred to intestinal rehabilitation programs when several complications have already occurred and transplant is the only remaining option.
guidelineStephanie Oliveira4:39 ↗
Intestinal transplantation is considered when irreversible complications occur, but the number of transplants has significantly decreased over the last several decades.
clinicalStephanie Oliveira4:49 ↗
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.
clinicalPaul Wales5:23 ↗
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.
clinicalPaul Wales5:41 ↗
The term 'intestinal rehabilitation program' was coined in the year 2000.
clinicalPaul Wales6:08 ↗
Intestinal rehabilitation teams improve outcomes through integration of care, improved communication, and better continuity.
clinicalPaul Wales6:12 ↗
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.
epidemiologicalPaul Wales7:25 ↗
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.
clinicalPaul Wales8:02 ↗
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.
clinicalPaul Wales8:15 ↗
Prolonged soybean-based lipid exposure is associated with deterioration of liver dysfunction, specifically cholestasis.
clinicalPaul Wales8:31 ↗
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.
clinicalPaul Wales8:51 ↗
First-generation lipid emulsions were soybean-based, rich in omega-6 PUFA (intralipid), available for 40 years.
clinicalPaul Wales9:15 ↗
Second-generation lipid emulsions attempt to reduce omega-6 exposure by diluting the soybean component.
Host summaryLizzy Lee summarizing the discussion — not the host's own clinical position9:26 ↗
Third-generation lipid emulsions reduce omega-6 and change the omega-6 to omega-3 ratio by adding omega-3 lipids.
clinicalPaul Wales9:32 ↗
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