Clinical Management of Intestinal Failure

A complex disease entity, intestinal failure (IF) has only recently become accepted as a distinct clinical syndrome. Improvements across a wide range of disciplines—including critical care and organ transplantation as well as surgical, medical, and nutritional therapies—have led to a steady rise in survival and quality of life for patients with IF. Taking a current, multidisciplinary approach to their care, Clinical Management of Intestinal Failure offers intensive discussion of medical and nutritional issues in adults and children with intestinal failure. It addresses all facets of IF, including epidemiology, clinical presentation, intestinal rehabilitation, and transplantation.

Topics covered include:

• Etiology and epidemiology
• Pathophysiology and clinical assessment
• Medical and surgical management
• Prevention and treatment of complications
• Nursing management
• Emerging diagnostic and therapeutic methods
• Long-term care

Reflecting the diverse nature of IF clinical care and research, this book is written by a group of expert clinician scientists that includes gastroenterologists, surgeons, nurses, pharmacists, dietitians, social workers, and patients. They show how a multidisciplinary approach to patient care is instrumental in achieving optimal patient outcomes through more efficient lines of communication, improved monitoring of medications and their effects, detailed evaluation of growth parameters, and facilitation of the creative process that can lead to research breakthroughs.

Advancing the discipline of IF, this book summarizes the current state of the art of patient management as well as new developments in the science of tissue engineering, medical and surgical therapy, and transplantation.

Christopher Duggan, MD, MPH, has been performing clinical studies in the fields of pediatric nutrition, gastroenterology, and global health for over 20 years. He is an attending pediatric gastroenterologist and nutrition physician at Children’s Hospital Boston where he directs the Clinical Nutrition Service. He is the medical director of the Center for Advanced Intestinal Rehabilitation, one of the largest centers in the United States for the care of children with intestinal failure/chronic diarrhea syndromes. His funded research efforts include trials of nutrient supplementation in women and children susceptible to infectious diseases in Tanzania, India, and other countries. He is the codirector of the Harvard College course Nutrition and Global Health and mentors undergraduate, graduate, and postdoctoral students at Harvard. He is an associate professor of pediatrics at Harvard Medical School and an associate professor in the Department of Nutrition at Harvard School of Public Health.

, is the team leader with Surgical Programs and a clinical pharmacist with the Clinical Nutrition Service in the Division of Gastroenterology and Nutrition at Children’s Hospital Boston. She is also an associate professor of pharmacy practice at the Massachusetts College of Pharmacy in Boston. Her professional focus is on academic clinical pharmacy and research, and her areas of expertise include nutritional support for critically ill pediatric patients, nutritional support in intestinal failure, sterile products preparation, aluminum toxicity, and drug–nutrient interactions. Her research in the area of parenteral nutrition–associated liver injury is currently funded by the March of Dimes with additional funding coming from the FDA’s Orphan Drug Development Program.

, is the surgical director of the Center for Advanced Intestinal Rehabilitation (CAIR) at Children’s Hospital Boston, vice-chairman of pediatric general surgery at Children’s Hospital Boston, and the W. Hardy Hendren Professor of Surgery at Harvard Medical School. In addition to being a practicing pediatric surgeon he has a PhD in Nutritional Biochemistry from the Massachusetts Institute of Technology (MIT) and has had a career-long research interest regarding the metabolic requirements of critically ill infants as well as the surgical and nutritional management of children with intestinal failure. He is the president-elect of the American Society of Parenteral and Enteral Nutrition (ASPEN).