Current concepts in the medical management of pediatric intestinal failure.

PURPOSE OF REVIEW: Medical management of children with intestinal failure has gained increased relevance in recent years, in part owing to the growth of small bowel transplantation as a therapeutic option. The capacity of a patient to attain enteral autonomy through intestinal adaptation is critical in the decision process of whether or not transplantation is beneficial. This article reviews several important advances in the field of intestinal rehabilitation, focusing on enhancing adaptation and briefly mentioning recent insights into the morbidity of intestinal failure.

RECENT FINDINGS: The field of intestinal rehabilitation has developed into a multidisciplinary venture with many facets. From a medical standpoint, intestinal adaptation efforts have come to focus upon identifying objective prognostic factors and therapies geared to increase functional gut mass. However, the stalwart of adaptive therapy remains the provision of enteral feeds, which must be balanced with nutritional goals. Although the common complications of parenteral nutrition therapy continue to affect outcomes, new therapies offer promise with regard to prevention of morbidity in this population.

SUMMARY: Medical intestinal rehabilitative therapy has progressed from the solitary concept of providing sufficient calories for growth to the promotion of enteral autonomy via intestinal adaptation. As strategies evolve with enhancing adaptation and minimizing morbidity, a clearer perspective will be gained regarding the difficult choice of rehabilitation versus transplantation as optimal therapy.