Lore Billiauws

Enhanced Ghrelin Levels and Hypothalamic Orexigenic AgRP and NPY Neuropeptide Expression in Models of Jejuno-Colonic Short Bowel Syndrome

Short bowel syndrome (SBS) patients developing hyperphagia have a better outcome. Gastrointestinal endocrine adaptations help to improve intestinal functions and food behaviour. We investigated neuroendocrine adaptations in SBS patients and rat models with jejuno-ileal (IR-JI) or jejuno-colonic (IR-JC) anastomosis with and without parenteral nutrition. Circulating levels of ghrelin, PYY, GLP-1, and GLP-2 were determined in SBS rat models and patients. Levels of mRNA for proglucagon, PYY and for hypothalamic neuropeptides were quantified by qRT-PCR in SBS rat models. Histology and immunostaining for Ki67, GLP-1 and PYY were performed in SBS rats. IR-JC rats, but not IR-JI, exhibited significantly higher crypt depths and number of Ki67-positive cells than sham. Fasting and/or postprandial plasma ghrelin and PYY concentrations were higher, or tend to be higher, in IR-JC rats and SBS-JC patients than in controls. Proglucagon and Pyy mRNA levels were significantly enhanced in IR-JC rats. Levels of mRNA coding hypothalamic orexigenic NPY and AgRP peptides were significantly higher in IR-JC than in sham rats. We demonstrate an increase of plasma ghrelin concentrations, major changes in hypothalamic neuropeptides levels and greater induction of PYY in SBS-JC rats and patients suggesting that jejuno-colonic continuity creates a peculiar environment promoting further gut-brain adaptations.

Dysmotility disorders: a nutritional approach.

Purpose of reviewChronic intestinal pseudo-obstruction (CIPO) results in markedly compromised peristalsis mimicking an intestinal occlusion. The main goals of CIPO management are to improve intestinal propulsion and to maintain adequate nutrition status. The review describes the global management of CIPO including methods of diagnosis and nutritional, pharmacological and surgical therapies. Recent findingsThe principles of CIPO management are to perform a physiological assessment of the gastrointestinal tract involved, to improve symptoms and to prevent malnutrition. We shall discuss the place of physiological motility tests such as intestinal manometry and the cine-magnetic resonance imaging to facilitate diagnosis. Home parenteral nutrition (HPN) is a frequently used therapy with a high dependence level. However, recent data are consistent with a good long-term prognosis. Currently, CIPO becomes a significant cause of chronic intestinal failure. We discuss the outcomes of HPN and surgery. SummaryCIPO is a rare and complex disease. Small bowel manometry remains a gold standard for diagnosis, but new imaging tools appear promising. The management of CIPO requires the cooperation of specialists involved in the intestinal failure field. The better knowledge of CIPO prognosis should encourage clinicians to propose intestinal transplantation in selected cases.

Teduglutide for treatment of adult patients with short bowel syndrome

ABSTRACT Introduction: The European Society for Clinical Nutrition has published recommendations on the ‘definition and classification of intestinal failure (IF)’. Two criteria must be present: a ‘decreased absorption of macronutrients and/or water and electrolytes due to a loss of gut function’ and the ‘need for parenteral support’. Home parenteral support (HPS) is the primary treatment for chronic IF but is associated with complications. Areas covered: The principal cause of chronic IF is short bowel syndrome (SBS). The aim of treatment is to maximize intestinal absorption and reduce or eliminate the need for HPS to achieve the best possible quality of life. Teduglutide, an analog of glucagon-like peptide 2, improves intestinal rehabilitation by promoting mucosal growth, reducing intestinal loss and promoting intestinal absorption. This article provides an overview and opinion on teduglutide for SBS. Expert opinion: Teduglutide may provide a new treatment strategy for SBS patients with chronic IF. When prescribed, patients should be informed of the benefits and risks of the drug and must be closely monitored in an expert center. Furthermore, as this treatment is costly, cost-effectiveness analysis as well as the risk-benefit ratio needs to be better evaluated.

Ultrashort bowel is an independent risk factor for liver fibrosis in adults with home parenteral nutrition

Intestinal failure‐associated liver disease is rare in adults and risk factors are unclear. The aim of this study was to determine risk factors of liver fibrosis in adults receiving home parenteral nutrition for intestinal failure and its impact on survival.

Intestinal adaptation in short bowel syndrome. What is new

Short bowel syndrome (SBS) is a well-known cause of intestinal failure (IF) (1). SBS occurs after extensive resection of the small bowel (RSB) resulting in a bowel length of less than 150/200 cm. The colon may have been partially or completely removed. SBS patients experience severe water and nutrient malabsorption, so that they are often managed with parenteral nutrition (PN) to supplement their oral intake (2-4). A complete understanding of the pathophysiology of SBS and postoperative adaptations may allow identifying the spontaneous processes that compensate for the reduction in absorptive surface. A better knowledge of these adaptive mechanisms may help to improve the management of patient nutrition, to reduce the need for PN and to prevent D-encephalopathy episodes. This review focuses on the overall adaptations described in adult SBS patients but does not review pediatric cases.