I have no commercial relationships to disclose.

The Clinical Approach to SBS Management Neha Parekh MS, RD, LD, CNSD Cleveland Clinic, Cleveland OH Manager, Intestinal Rehab & Transplant Nutrition January 31, 2009

Presentation Overview

Intestinal Rehab & Transplant Program (IRTP) To enhance absorptive capacity, improve nutritional status, and reduce need for PN through the use of:

SBS Management within an IRTP Improves Survival

SBS Management within an IRTP Improves Survival o Survival in pts not able to wean off PN •Control group: 90% died •CAIR cohort: 33% died •(P < .01)

Modi et al. J Ped Surg. 2008; 43:20-24

Modi et al. J Ped Surg. 2008; 43:20-24

Early Referral to an IRTP Improves Outcomes in SBS Patients on Home PN or IVF

Early Referral to an IRTP Improves Outcomes in SBS Patients on Home PN or IVF Characteristic

332 new patients seen by CCIRP from 6/1/03 to 3/1/07

Age (yrs)

123 patients with SBS and received Home PN or IVF 43 patients on home PN/IVF for >2yrs (35%)

55 patients weaned off home PN/IVF within 2 yrs (45%)

30 patients weaned off due to IRP intervention (45%)

25 patients weaned off due to bowel reconnection or transplantation (45%)

Parekh NR. Xth International SB Transplant Symposium, Santa Monica, CA, Sept 2007.

Diagnoses Leading to SBS in an Adult IRTP

Mesenteric Vascular Infarction 12.3%

Other 15.8%

Weaned Off (N=55)

Crohn's disease 33.3%

53.0

On PN/IVF P >2yrs (N=43) 57.0

0.17

Gender (Female/Male)

32/23

33/10

0.054

Diagnosis (Crohn’s/Non-Crohn’s)

33/22

20/23

0.18

SB length (< 90cm)

7

20