Abstract

Glucocorticoids Improve Enteral Feeding Tolerance in Pediatric Short Bowel Syndrome with Chronic Intestinal Inflammation

J Pediatr Gastroenterol Nutr. 2021 Jan 28. doi: 10.1097/MPG.0000000000003058.Online ahead of print.

Fangfang Wang 1, Brandi K Gerhardt, Sarah N Iwansky, Brandy Hobson, Samantha Logan, David F Mercer, Ruben E Quiros-Tejeira

 
     

Author information

  • 1College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska Department of Clinical Nutrition, University of Nebraska Medical Center, Omaha, Nebraska Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska.

Abstract

Objectives: A group of short bowel syndrome (SBS) patients developed chronic intestinal inflammation while struggling weaning off parenteral nutrition (PN). They did not respond to standard management of SBS and food allergy. We treated them with glucocorticoids and described the outcome.

Methods: Our study is a retrospective descriptive study. We reviewed records from the intestinal rehabilitation program from 2006 to 2017. We identified 15 patients whose lab values, pathology results, and clinic notes were reviewed.

Results: We had more patients (n = 10) with diagnosis of gastroschisis, and more female patients (n = 9). Seven patients weaned off PN with median treatment duration of 5 months, five of which remained on budesonide for significant period of time (median: 7.5 months). One of these 7 patients relapsed, as the patient resumed glucocorticoids due to recurrence of chronic intestinal inflammation. Six of 15 children had significant eosinophils in their initial biopsy, 5 of these children weaned off PN while one's GI bleeding stopped. Four patients were not able to decrease PN calorie. Two of these patients'GI bleeding stopped, the other two had normalized histology.

Conclusions: For SBS children with histologically confirmed chronic intestinal inflammation, glucocorticoids may help promote enteral feeding tolerance. Glucocorticoids regimen should be chosen individually. Patients are more likely to respond if initial histology has significant eosinophilic infiltration. Patients may need to remain on glucocorticoids for over six months.

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