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Date: 3 June 2020
Intestinal failure and specialist nutrition
In terms of digestion and nutrition, the small intestine is one of the most important parts of the gut. At approximately six metres long, the small intestine is where essential nutrients and water are absorbed into the body from the food we eat.
Intestinal failure is a broad term that refers to a variety of diseases or injuries to the small intestine which prevent it from absorbing adequate nutrients and water. Though people with intestinal failure may eat and drink, they do not absorb enough from this and so become malnourished and dehydrated.
For some people intestinal failure may be short term, for example, if they are waiting for surgery to repair an injury to the small intestine. However, for other people it may be life-long depending on their individual condition. A common cause of long-term intestinal failure is short bowel syndrome. Short bowel syndrome is where large sections of the small intestine have been removed due to injury or disease, leaving less than one metre of small intestine in place.
Managing intestinal failure
Nutrition Support Team
At the Queen Elizabeth Hospital Birmingham (QEHB), the Nutrition Support Team manages specialist nutrition and provides advice for people with complex nutritional needs, including those with intestinal failure. Patients are seen both as inpatients and outpatients, and we are a regional tertiary referral centre for home parenteral nutrition.
The weekly Intestinal Failure Clinic, held in the Centre for Rare Diseases, is a multi-disciplinary clinic where patients with specialist nutrition needs may be seen for assessment and follow-up. In this clinic patients will be reviewed by one of the team's Consultant Gastroenterologists, Nutrition Nurse Specialists, Dietitians and Pharmacists. See the section on ‘Meet the Nutrition Support Team’ for more information on current team members.
There are a variety of treatments to manage intestinal failure using specialist nutrition. The exact method used will depend on a person’s individual condition and needs. Some people may need a combination of the treatments described below.
- Oral rehydration solutions - these are drinks that help the small intestine to absorb water and essential salts to reduce dehydration. There are some well known oral rehydration solutions such as Dioralyte™; however, the usual recommended dose of these drinks is too low to be effective in intestinal failure. Therefore, the Nutrition Support Team will prescribe these drinks at higher doses depending on the person’s needs
- Enteral nutrition - this is a liquid nutrition that can be given in two ways: either in the form of high calorie, high protein specialist drinks or through a tube that goes into the stomach or small intestine, avoiding the need to take nutrition by mouth
- Parenteral nutrition - this means giving nutrition intravenously directly into the blood stream. With this method the gut is not used at all to receive or absorb nutrition, so this is often the only type of nutrition that can be given to people with severe intestinal failure. People who need parenteral nutrition long-term will usually have this at home (home parenteral nutrition). Parenteral nutrition is a highly complex way of giving nutrition that must be managed by a Nutrition Support Team with specialist experience