Clinical Management of Intestinal Failure

Christopher Duggan, MD, MPH, has been performing clinical studies in the fields of pediatric nutrition, gastroenterology, and global health for over 20 years. He is an attending pediatric gastroenterologist and nutrition physician at Children’s Hospital Boston where he directs the Clinical Nutrition Service. He is the medical director of the Center for Advanced Intestinal Rehabilitation, one of the largest centers in the United States for the care of children with intestinal failure/chronic diarrhea syndromes. His funded research efforts include trials of nutrient supplementation in women and children susceptible to infectious diseases in Tanzania, India, and other countries. He is the codirector of the Harvard College course Nutrition and Global Health and mentors undergraduate, graduate, and postdoctoral students at Harvard. He is an associate professor of pediatrics at Harvard Medical School and an associate professor in the Department of Nutrition at Harvard School of Public Health. Kathleen M. Gura , PharmD, BCNSP, FASHP, is the team leader with Surgical Programs and a clinical pharmacist with the Clinical Nutrition Service in the Division of Gastroenterology and Nutrition at Children’s Hospital Boston. She is also an associate professor of pharmacy practice at the Massachusetts College of Pharmacy in Boston. Her professional focus is on academic clinical pharmacy and research, and her areas of expertise include nutritional support for critically ill pediatric patients, nutritional support in intestinal failure, sterile products preparation, aluminum toxicity, and drug–nutrient interactions. Her research in the area of parenteral nutrition–associated liver injury is currently funded by the March of Dimes with additional funding coming from the FDA’s Orphan Drug Development Program. Tom Jaksic, MD, PhD , is the surgical director of the Center for Advanced Intestinal Rehabilitation (CAIR) at Children’s Hospital Boston, vice-chairman of pediatric general surgery at Children’s Hospital Boston, and the W. Hardy Hendren Professor of Surgery at Harvard Medical School. In addition to being a practicing pediatric surgeon he has a PhD in Nutritional Biochemistry from the Massachusetts Institute of Technology (MIT) and has had a career-long research interest regarding the metabolic requirements of critically ill infants as well as the surgical and nutritional management of children with intestinal failure. He is the president-elect of the American Society of Parenteral and Enteral Nutrition (ASPEN).

Introduction. Intestinal Failure. Etiology and Epidemiology of Intestinal Failure. Pathophysiology of Intestinal Failure. Motility Disorders in Intestinal Failure. Clinical Assessment of Intestinal Failure in Children. Clinical Assessment of Intestinal Failure in Adults. Gastrointestinal Endoscopy and Pathologic Findings. Radiographic Evaluation. Medical and Surgical Management. Principles of Bowel-Preserving Surgery. Medical and Nutritional Management. Parenteral Nutrition in Children. Parenteral Nutrition in Adults. Vascular Access Devices. Enteral Access. Transition to Enteral Nutrition. Drug Dosing and Pharmacokinetics. Autologous Intestinal Reconstruction Surgery. Intestinal Transplantation. Critical Care Management. Prevention and Treatment of Complications of Intestinal Failure. Central Venous Catheter Infections: Prevention and Treatment. Intestinal Failure–Associated Liver Disease. Use of Parenteral Fish Oil in the Management of IF–Associated Liver Disease. Osteopenia and Bone Health in Patients with Intestinal Failure. Micronutrient Deficiencies in Intestinal Failure. Bacterial Overgrowth of the Small Intestine. Nursing Management. Ostomy Management. Central Venous Catheter Care. Medication Administration in the Enterally Fed Patient. Emerging Diagnostic and Therapeutic Methods. Intravenous Fat Emulsions. Probiotics and Prebiotics. Tissue-Engineered Intestine. Assessment of Mucosal Mass and Hormonal Therapy. Long-Term Care. Home Parenteral and Enteral Nutrition. Quality of Life. Social and Medical Insurance Issues. Oral Aversion. A Patient’s Perspective. Ethical Issues in Patient Care. Support Groups. Index.