Pediatric Surgery

Pediatric Short Gut/Intestinal Failure Clinic

Clinic Information

American Family
Children's Hospital

(608) 263-6420

Dr. Peter Nichol and members of the Pediatric Short Gut/Intestinal Failure ClinicUW Health's pediatric nutrition support program at American Family Children's Hospital in Madison, Wisconsin, offers comprehensive, individualized care for children with complex nutritional needs.
 
Our team of experts in the Pediatric Short Gut/Instetinal Failure Clinic provides patients with advanced medical and nutritional support and optimizes care by offering the most advanced therapies and the latest in clinical trials.
 
We take a family-centered approach to your child’s care by including parents in the treatment plan to ensure the course of treatment is a best fit for the patient and their family. Our goal is to provide standardized care and management of patients with short gut syndrome (SGS) and other complex nutritional needs. 

Our Team

Patients are seen by each member of our pediatric nutrition support team, which consists of a pediatric surgeon, pediatric gastroenterologist, pharmacy specialist and registered dietitian.

Short Gut Syndrome Overview
 
The most common cause of intestinal failure is short gut syndrome (SGS). SGS is a complex of symptoms that result from removal of a large portion of the small intestine. It can also be attributed to functional disease, trauma, pseudo-obstruction, motility disorders or absorption disorders/microvillus disease.
 
The small intestine is primarily responsible for food digestion and absorption of nutrients. In SGS, the small intestine often ends up widened and less effective at absorbing food. Children with SGS face multiple challenges - they experience poor absorption of nutrients and often times rely on intravenous feedings.
 
Common Causes of SGS
 
The main cause of SGS is surgical removal of half or more of the small intestine to treat intestinal diseases, injuries or defects present at birth.
 
Common causes of SGS are:
Symptoms of SGS
 
Children with SGS may have these symptoms:
Specific nutrient deficiencies may occur depending on what sections of the small intestine were removed or are not functioning properly. Sites of nutrient absorption in the small intestine are:
  • Duodenum, the first section of the small intestine, where iron is absorbed
  • Jejunum, the middle section of the small intestine, where carbohydrates, proteins, fat, and vitamins are absorbed
  • Ileum, the last section of the small intestine, where bile acids and vitamin B12 are absorbed.
  • Learn more: Information For Parents From Kids Health: The Digestive System
Children with SGS are also at risk for developing food sensitivities.
 
Diagnosing SGS
 
After a complete history is compiled, your doctor may administer a series of tests to diagnose SGS.  They can include:
Non-Surgical Treatment Options for SGS
 
The main treatment for short bowel syndrome is nutritional support. Treatment may involve use of oral rehydration solutions, parenteral nutrition, enteral nutrition and medications.
  • Oral rehydration solutions consist of sugar and salt liquids
  • Parenteral nutrition delivers fluids, electrolytes and liquid nutrients into the bloodstream intravenously (through a tube in a vein)
  • Enteral nutrition delivers liquid food to the stomach or small intestine through a feeding tube.
Pharmacological intervention also is essential to children with SGS. Our pharmacy specialist is available seven days a week to provide appropriate medication. Medicines are used in children with SGS to:
  • Slow the movement of food through the small intestine
  • Modify nutrition
  • Stimulate nutrient absorption
  • Inhibit bacterial growth
Hormones also can be used to promote growth of the bowel lining (mucosa), which helps it absorb more nutrients.
 
Surgical Treatment Options for SGS
 
Surgery could be performed to lengthen or adapt the small intestine to increase the absorptive surface and propel food. Intestinal transplantation is also an option for patients who do not respond to other treatment or experience complications from total parenteral nutrition.  Learn about intestinal (small bowel) transplantation
 
UW Health surgeons were the first in the state to perform the Serial Transverse Enteroplasty (STEP) procedure on children with SGS.  Read article (pdf)
 
The procedure lengthens the bowels and creates a more efficient environment for nutrients to be absorbed. In widened, static intestine, bacteria collect and lead to overgrowth and recurrent infection. STEP lengthens the intestine without diminishing the absorptive surface which allows for more motility and better geometry to propel food.
 
UW Health physical therapist Wendy Stewart also works with patients in the Pediatric Short Gut/Instetinal Failure Clinic.