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Review
. 2024 Aug 10;16(16):2648.
doi: 10.3390/nu16162648.

Current Status of Chronic Intestinal Failure Management in Adults

Héctor Solar  1 , Mariana L Ortega  1 , Gabriel Gondolesi  1
Affiliations
Review

Current Status of Chronic Intestinal Failure Management in Adults

Héctor Solar et al. Nutrients. .

Abstract

Background: Chronic intestinal failure (CIF) is a heterogeneous disease that affects pediatric and adult populations worldwide and requires complex multidisciplinary management. In recent years, many advances in intravenous supplementation support, surgical techniques, pharmacological management, and intestinal transplants have been published. Based on these advances, international societies have published multiple recommendations and guidelines for the management of these patients. The purpose of this paper is to show the differences that currently exist between the recommendations (ideal life) and the experiences published by different programs around the world.

Methods: A review of the literature in PubMed from 1980 to 2024 was carried out using the following terms: intestinal failure, CIF, home parenteral nutrition, short bowel syndrome, chronic intestinal pseudo-obstruction, intestinal transplant, enterohormones, and glucagon-like peptide-2.

Conclusions: There is a difference between what is recommended in the guidelines and consensus and what is applied in real life. Most of the world's countries are not able to offer all of the steps needed to treat this pathology. The development of cooperative networks between countries is necessary to ensure access to comprehensive treatment for most patients on all continents, but especially in low-income countries.

Keywords: intestinal failure; intestinal rehabilitation; intestinal surgery; parenteral nutrition.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Functional, pathophysiological, clinical, and severity classification of IF.
Figure 2
Figure 2
Multi- and interdisciplinary team (MIDT).
Figure 3
Figure 3
Steps of CIF management (* AGIRS: autologous gastrointestinal reconstruction surgery).
Figure 4
Figure 4
Examples of different autologous GI reconstruction surgeries (AGIRSs) that need to be adjusted to each individual case in order to obtain a more favorable final anatomy type. (1) and (2): Examples of AGIRS after bariatric surgery. (3): Example of an AGIRS requiring resection of remnant colon and ileorectal anastomosis. (4): Example of an AGIRS with 2 anastomoses and rescuing an abandoned intestinal segment. (5): Example of an AGIRS performed close to the ICV to obtain a type 3 anatomy. (6): Example of an AGIRS that requires sacrificing an abandoned segment, involved in a complex enterocutaneous fistula, with simultaneous removal of a dominant colonic stricture. (7): Example of an AGIRS requiring removal of a segment of small bowel stricture. (8): Example of an AGIRS requiring removal of an injured proximal intestinal segment and its replacement with a more preserved distal and abandoned one, obtaining a type 3 anatomy.
See this image and copyright information in PMC

References

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