Our Intestinal Rehabilitation team is an integral part of the Miami Transplant Institute (MTI). For more than 20 years, our multidisciplinary team of experts has treated thousands of adult and pediatric patients with intestinal and multi-organ failure.
MTI has performed more than 400 intestinal and multivisceral transplants, ranking as a world leader for these types of procedures. However, less than 10 percent of patients with intestinal failure are candidates for intestinal transplant. Our team is able to use a multidisciplinary approach to intestinal rehabilitation, which allows these patients to be rehabbed without the need of transplantation. As a result, The Center for Intestinal Rehabilitation at the Miami Transplant Institute was established.
The Center for Intestinal Rehabilitation at the Miami Transplant Institute combines efforts within a multidisciplinary framework, resulting in a variety of therapeutic strategies for patients with intestinal failure. There is a strong relationship among transplant surgeons, gastroenterologists, neonatologists, and pediatric surgeons to provide comprehensive treatment for the most complex cases. In addition to physician support, The Center for Intestinal Rehabilitation at the Miami Transplant Institute has dedicated nurse practitioners, registered nurses, social workers, and dieticians evaluating and treating patients with intestinal failure. Patients receive customized medical treatment and surgical interventions to achieve enteral autonomy.
Finally, intestinal transplantation is offered for those patients with irreversible intestinal failure, poor quality of life, or life-threatening complications of parenteral nutrition.
What is Intestinal Failure?
Intestinal failure (IF) is the inability of the small bowel to ingest, digest, and absorb nutrients, water, and electrolytes needed to maintain nutrition in adults and promote growth in children. In other words, patients with IF cannot tolerate a regular diet. They cannot absorb enough nutrients from the food they eat and fluids they drink. A regular diet may lead to vomiting, abdominal pain, diarrhea and risk of dehydration. Patients with IF rely on specialized nutritional regimens to avoid these complications and maintain their health. They may not tolerate eating by mouth and may require enteral nutrition – specialized formulas given by a tube in the stomach (Gastrostomy tube) or in the small bowel (Jejunostomy tube). In many cases, patients may require parenteral nutrition- – nutrition given by a vein. This would require the placement of an intravenous catheter (Broviac, Hickman, Port a cath) through which IV nutrition can be given.
What causes Intestinal Failure?
There are two major types of intestinal failure – structural (due to short bowel syndrome) and functional.
The majority of patients with intestinal failure have short bowel syndrome (SBS), a condition that affects people who have part or all of their small intestine removed due to injury or surgery. In SBS, the remaining bowel length is insufficient to adequately absorb nutrients. Necrotizing Enterocolitis and Gastroschisis are examples of conditions leading to SBS in children and Crohn’s disease is an example in adults.
A second group of patients with intestinal failure suffer from functional disorders, conditions where there is adequate bowel length but the bowel’s muscle, nerves, or cells do not function properly. Total Aganglionosis, Hirschsprung’s Disease, and Chronic Idiopathic Pseudoobstruction (CIPO) are examples of functional disorders.
What are common causes of Intestinal Failure?
- Short bowel syndrome
- Intestinal atresia
- Necrotizing enterocolitis
- Hirschsprung’s or Total Aganglionosis
- Inflammatory bowel disease
- Vascular Thrombosis
- Motility disorders
- Megacystis Microcolon Intestinal Hypoperistalsis Syndrome
- Chronic intestinal pseudoobstruction
- Microvillus inclusion disease
- Tufting enteropathy
- Radiation enteritis
- Complex enterocutaneous fistulae
- Complications of Bariatric Surgery
- Desmoid Tumors with Intra-abdominal infiltration
- Multiple Polyposis: Gardner’s Syndrome and FAP
What is Intestinal Rehabilitation?
Intestinal rehabilitation is the process by which we improve the function of the remaining bowel, so that a patient can rely on their own gut, without the need for enteral or parenteral nutrition. This allows the patient to return to a more normal life. To achieve this, we will assess the remaining bowel in detail by means of history, laboratory tests, motility and functional tests, and imaging. This allows us to build an individualized feeding regimen that may include specific foods, specialized formulas, different modes of feeding administration, several medicines, and even an oral motor/speech therapy regimen. We will slowly transition a patient from parenteral nutrition (nutrition given through catheter placed in a vein) to enteral nutrition (specialized formulas given by a tube in the stomach or small bowel) to food by mouth.
Some patients whose bowel fails to adapt to changes in feeding and medical treatment may be benefit from a surgical intervention or Autologous Gastrointestinal Reconstruction (AGIR).
What is Autologous Gastrointestinal Reconstruction?
AGIR is a group of surgeries by where a patient’s own intestine is optimized to decrease symptoms of vomiting, diarrhea, constipation, and bacterial overgrowth to improve absorption of nutrients and fluids. Examples of AGIR include Bowel Tapering, Ostomy takedown, STEP procedure and Bianchi. A STEP (Serial Transverse Enteroplasty) Procedure is a surgical technique by which the short bowel may be lengthened, improving the absorption and motility.
What are the benefits of an Intestinal Rehabilitation Program?
In addition to the above techniques to achieve intestinal rehabilitation, our team works diligently to prevent complications of therapies such as parenteral nutrition. Complications of parenteral nutrition include liver failure, clots that lead to loss of venous access, and catheter-related infections. Prevention of these complications improves overall outcomes of patients with IF and increases the chance that they will rehabilitate their bowel.