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

• Published in: Obshchai͡a︡ reanimatologii͡a Vol. 10; no. 1; pp. 43 - 57
• Main Authors: Khubutia, M. Sh, Ryk, A. A., Kiselev, V. V., Aleksandrova, I. V., Grishin, A. V., Godkov, M. A., Klychnikova, E. V., Shavrina, N. V., Sogreshilin, S. S., Titova, G. P., Borovkova, N. V.
• Format: Journal Article
• Language: English
• Published: Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia 15.06.2014
• Subjects: small intestine transplantation, enteral feeding, glutamine
• ISSN: 1813-9779; 2411-7110
• DOI: 10.15360/1813-9779-2014-1-43-57

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.