WHAT IS INTESTINAL FAILURE?


Intestinal failure is a serious condition that prevents a person from digesting and absorbing food and other essential nutrients, which leads to malnutrition, prevention of normal development (especially in children), a reduced quality of life and even death.

The most common cause of intestinal failure is short bowel syndrome, where at least half or more of the small intestine has been removed surgically. Ideally, a length of at least 200 cms of small bowel would ensure adequate nutrient absorption. If the large bowel is still present, a minimum length of 100 cms of small intestine is needed to ensure that adequate digestion of food occurs that would be enough to sustain life.

In children, conditions such as congenital anomalies, infections of the small bowel, extensive bowel surgeries and an inborn inability to absorb food can lead to intestinal failure.
In adults, extensive bowel surgeries, inflammatory bowel disease such as Crohn’s disease, radiation induced enteritis, severe celiac disease and tumors involving the small bowel or the mesentery can lead to short bowel syndrome and ultimately intestinal failure. The mesentery is a fold of tissue that connects the stomach and intestines to the abdomen.

What are some symptoms of intestinal failure?
These include diarrhea, poor appetite, weight loss, bloating, increased gas, foul smelling stool and vomiting.

What are some of the treatment options for a patient with intestinal failure?
This depends on how much of the small intestine is actually functional in a particular patient. We have already discussed how long the small bowel should be for adequate digestion and absorption of the food one eats.
In its initial stages, most patients require TPN, also known as total parenteral nutrition. This involves placing a catheter in the neck, chest, arm or groin in order to give liquid nutrition directly into the blood stream. TPN fluids are carefully created for each individual patient’s metabolic requirement and contains carbohydrates, fats, proteins, minerals and electrolytes in a precise formula. This can be given over 24 hours when the patient is unable to eat or drink anything by mouth or over a shortened period, say 12 or 18 hours, when a patient can take in some nutrition by mouth but not enough for his or her daily requirements.
Oral intake is then gradually introduced and advanced, as tolerated. Specialized oral solutions providing most of the nutrition is used to wean the patient off the TPN. As much as possible, regular food intake with adequate additional supplements would be the ultimate goal.

In some patients, adequate oral intake is not achievable and therefore the patient is TPN dependent for life. Complications related to TPN occur frequently and include catheter related infection or sepsis, glucose related abnormalities (high glucose or low glucose), liver dysfunction, serum electrolyte and mineral abnormalities, bone disease such as osteoporosis, stones in the kidney or gall bladder (gall stones) and allergic reactions to the contents of TPN. TPN also happens to be expensive and can therefore add to the burden of the disease itself.

Long term outlook for intestinal failure is dependent on how much of the intestine can be used normally without depending on TPN or any other specialized tube feedings. Severe complications related to long term TPN such as liver failure or severe catheter related access issues should prompt an evaluation for intestinal transplantation. This requires a referral to a transplant center that specializes in this procedure. As progress is being made on every front, the results of intestinal transplantation are constantly improving, providing a ray of hope to those afflicted with this dreadful disease.