Enteral Feeding as a Part of Combination Treatment in a Patient after Small Intestine Transplantation

Autor: M. Sh. Khubutia, A. A. Ryk, V. V. Kiselev, I. V. Aleksandrova, A. V. Grishin, M. A. Godkov, E. V. Klychnikova, N. V. Shavrina, S. S. Sogreshilin, G. P. Titova, N. V. Borovkova
Jazyk: English<br />Russian
Rok vydání: 2014
Předmět:
Zdroj: Общая реаниматология, Vol 10, Iss 1, Pp 43-57 (2014)
Druh dokumentu: article
ISSN: 1813-9779
2411-7110
DOI: 10.15360/1813-9779-2014-1-43-57
Popis: Objective: to describe the first experience with an enteral feeding regimen used as part of combination therapy in a patient after small intestine transplantation (SIT).Materials and methods. The results of treatment in a 48year-old male after heterotopic SIT for short bowel syndrome were given. The extent of the graft was 250 cm. The combination treatment aimed to restore graft functions and included immunosuppressive, infusion, transfusion, antibacterial, antiviral, and detoxification therapies and parenteral and enteral feeding (EF). Our elaborated EF regimen was divided into 3 steps: 1) early enteral therapy (on day 1) using a monomeric saline enteral solution and a specialized formula containing pharmaconutrients (glutamine, antioxidants, and tributyrine); 2) incorporation of a semielemental formula (on day 5); 3) use of polymeric formulas and clinical nutrition. Laboratory, ultrasound, radiological, and endoscopic monitoring and biopsy were performed.Results. The combination treatment using stepwise EF could satisfy a patient's protein-energy needs. Restoration of histological structures in the graft mucosa was observed during morphological examination on day 7. At enteroscopy, the intestinal mucosa was pink with prominent villi, motility, and bile-colored chyme. On day 7, there was a 150-ml self-colored stool. Data confirmed that the intestinal graft restored absorption and parietal digestion. On day 30, the patient was switched to polymeric formulas and curative diet. By the discharge from hospital, on day 86, his body mass index was 23.1 kg/m2.Conclusion. The positive treatment results in the patient became possible after SIT due to improvement of surgical techniques, current immunosuppression, and a comprehensive approach to treating him in the postoperative period. Our elaborated stepwise EF regiment is an important component of combination therapy after SIT and facilitates the restoration of the major functions of the transplanted intestine and its preparation for the assimilation of polysubstrate formulas and natural foods.
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