Patients with intestinal failure (IF) represent a challenging group. Their nutrition support and management need to be tailored based on the bowel segment resected, the amount of resection as well as underlying disease etiology. There is also ongoing debate for intestinal lengthening procedures and their timing for maximizing nutrient absorption. Enteral or parenteral nutrition support and their respective percentages to promote parenteral nutrition autonomy as well as the optimal surgical procedures to enable enteral nutrition delivery like gastrostomy / gastro-jejonostomy or jejunostomy tube and bolus vs continuous feeds present significant challenges. Challenges also remain in treating small bowel bacterial overgrowth as well as instituting gut motility modulators in such patients. Recent data also presents new evidence of alteration in nutrient absorption and assimilation based on influences by the gut microbiota, bile acids and systemic effects modulated by downstream targets with key gut luminal receptor activation. This preconference will present current evidence supporting clinical practices and highlight potential pitfalls in the management of this patient population.

Learning Objectives:

Identify key pathophysiological changes affecting nutrition status based on the site and amount of bowel segment resected
Critically examine the current indications, timing, and nutritional consequences of bowel lengthening and other surgical procedures for patients with intestinal failure
Discuss implications of variances in enteral feeding like continuous vs bolus feeding, type of formula, and route of nutrition delivery
Describe various medical therapies and the role of nutritional supplements (probiotics, pre-biotics, fiber) offered to improve enteral feeding tolerance with a goal of enteral autonomy
Summarize current basic and translational research alluding to the role of gut microbiota, bile acids and key gut signaling affecting nutrition outcomes in patients with intestinal failure

Valeria C. Cohran MD

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