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Causes and Management of Intestinal Failure in Children
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GASTROENTEROLOGY 2006;130:S16–S28auses and Management of Intestinal Failure in Children
LIVIER GOULET and FRANK RUEMMELE
ntegrated Program of Intestinal Failure, Home Parenteral Nutrition and Intestinal Transplantation, National Reference Center for Rare
igestive Disease, H?pital Necker-Enfants Malades, Université Reni Descartes, Paris, France
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Sntestinal failure is a condition requiring the use of
arenteral nutrition as long as it persists. Causes of
evere protracted intestinal failure include short bowel
yndrome, congenital diseases of enterocyte develop-
ent, and severe motility disorders (total or subtotal
ganglionosis or chronic intestinal pseudo-obstruction
yndrome). Intestinal failure may be irreversible in some
atients, thus requiring permanent parenteral nutrition.
iver disease may develop with subsequent end-stage
iver cirrhosis in patients with intestinal failure as a
onsequence of both underlying digestive disease and
nadapted parenteral nutrition. Death will occur if com-
ined liver-intestine transplantation is not performed.
atheter-related sepsis and/or extensive vascular
hrombosis may impede the continuation of a safe and
fficient parenteral nutrition and may also require intes-
inal transplantation in some selected cases. Thus man-
gement of patients with intestinal failure requires an
arly recognition of the condition and the analysis of its
isk of irreversibility. Timing of referral for intestinal
ransplantation remains a crucial issue. As a conse-
uence, management should include therapies adapted
o each stage of intestinal failure based on a multidis-
iplinary approach in centers involving pediatric gastro-
nterology, parenteral nutrition expertise, home paren-
eral nutrition program, pediatric surgery, and liver
ntestinal transplantation program.
ntestinal failure (IF) is a condition of
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