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Donor milk nutrition for the preterm infant: Current standards, uses, and transitions

Key points 1. Pasteurized donor human milk is the preferred alternative feeding source when maternal milk is not available for preterm and low-birth-weight infants. 2. Holder pasteurization, freezing, and handling of donor human milk leads to decreased macronutrient content by reducing fat and protein levels. It also decreases many biologically active components that serve immunologic benefits. Some human milk immunoregulatory bioactives, such as human milk oligosaccharides,…

Human milk bioactives and roles in the GI tract

Key points In addition to nutrients, human milk contains myriad bioactive components that promote development of neonatal intestinal immunity. A range of bioactive proteins in human milk function in protection against infection, immunomodulation, and nutrient utilization. Human milk growth factors and hormones modulate growth and development of the intestines and have immunomodulatory effects. Human milk oligosaccharides promote a healthy intestinal microbiome and protect infants from infection.…

Monitoring of feeding tolerance in preterm infants

Key points 1. The current definition of feeding intolerance is based on nonspecific clinical signs and symptoms. 2. Research on feeding intolerance is limited by the lack of a more objective definition. 3. Current methods to monitor for feeding tolerance in the NICU are nonspecific and poor predictors of gastrointestinal pathology. 4. Emerging technologies to monitor for feeding tolerance show promise but need further development. 5.…

The liver and cholestasis (treatment and prevention)

Key points 1. Parenteral nutrition (PN) and intravenous lipid emulsions (ILEs) play an important role in nutrition for premature infants and infants with intestinal failure. 2. Infants with intestinal failure require prolonged PN and are at high risk for intestinal failure–associated liver disease (IFALD), which is histologically hallmarked by cholestasis. 3. Various ILEs are available and their oil source varies. 4. Pure soybean oil (SO ILE)…

Trophic factors in the neonatal gastrointestinal tract

Key points 1. The neonatal period is a highly dynamic period of gastrointestinal growth and functional development, and physiological changes during the fetal-neonatal period facilitate the transition from placental nutrient assimilation to oral ingestion via the gastrointestinal tract. 2. The cells within the fetal and neonatal gastrointestinal tract are influenced by extracellular signals from multiple sources, including (1) blood-borne factors in the circulation, such as hormones…

The brain-gut-microbiota axis

Key points 1. Bidirectional signaling occurs between the brain and intestine. 2. Microbes in the intestinal tract play a major role in the regulation of this signaling. 3. Disruption of these signaling processes can have a major effect on brain development and pathogenesis of neurobehavioral diseases such as depression, anxiety, and autism. Introduction The realization that gastrointestinal physiology is closely linked to the brain and vice…

Microbiome and multiomics of the developing intestine: Nutritional and environmental perturbations

Key points 1. Exposure of the intestine to certain microbes and/or their components and metabolites has implications for the future health of the individual as well as implications across generations via epigenetic mechanisms. 2. Responses of the host to the interactions of microbes, their antigens, and metabolic products need to be evaluated to better understand how they relate to the future health of the individual. 3.…

Intestinal mucosal immunity

Key points 1. In addition to being a digestive absorptive organ, the gastrointestinal tract is also one of the largest immune organs of the body. It is normally inhabited by commensal microbes and is exposed to a prodigious dietary antigen load. 2. Factors that play a role in balancing protection against pathogens and tolerance include a highly efficient mucosal barrier and a specialized multifaceted immune system…

Maturation of motor function: Clinical implications

Key points 1. Structural and functional development of gut motility in human infants is a process in continuum and varies with birth gestation, postnatal age, nutritional methods, acute illnesses and/or their treatments, comorbidities, and genetic factors. The entire process is complex and is dependent on maturation of the central and enteric nervous systems and gut musculature. 2. Gastrointestinal motility reflexes develop in utero , and several…

Damage Control: Management of Procedure-Associated Complications

List of Abbreviations CAN Colitis-associated neoplasia CD Crohn's disease CI Confidence interval CMV Cytomegalovirus CRE Controlled radial expansion CT Computed tomography EBD Endoscopic balloon dilation ECF Enterocutaneous fistula EEF Enteroenteric fistula ELS Electrolyte solution EMR Endoscopic mucosal resection ES Endoscopic stricturotomy ESD Endoscopic submucosal dissection ETAS Endoscopy treatment–associated stricture EUA Examination under anesthesia GI Gastrointestinal IBD Inflammatory bowel disease ICA Ileocolonic anastomosis ICR Ileocolonic resection IPAA…

Fecal Microbiota Transplantation as Therapy for Inflammatory Bowel Disease

List of Abbreviations CD Crohn's disease CDI Clostridium difficile infection CMV Cytomegalovirus CRP C-reactive protein DSMB Data Monitoring and Safety Committee FDA The Food and Drug Administration FMT Fecal microbiota transplantation IBD Inflammatory bowel disease NOD2/CARD15 Nucleotide-binding oligomerization domain-containing protein 2/caspase recruitment domain-containing protein 15 RCT Randomized controlled trial SCFA Short-chain fatty acid TNF Tumor necrosis factor UC Ulcerative colitis UCEIS Ulcerative Colitis Endoscopic Index of…

Endoscopic Treatment of Bezoars and Foreign Bodies in Patients With Inflammatory Bowel Disease

List of Abbreviations ASGE The American Society for Gastrointestinal Endoscopy CD Crohn's disease DBE Double-balloon endoscopy EBD Endoscopic balloon dilation ECCO The European Crohn's and Colitis Organisation EGD Esophagogastroduodenoscopy GI Gastrointestinal IBD Inflammatory bowel disease IPAA Ileal pouch-anal anastomosis NKSt Needle-knife stricturotomy NSAID Nonsteroidal antiinflammatory drug TNF Tumor necrosis factor UC Ulcerative colitis VCE Video capsule endoscopy Introduction Bezoars are accumulated indigestible foreign materials that can…

Diagnosis and Treatment of Inflammatory Bowel Disease–Associated Bleeding

List of Abbreviations APC Argon plasma coagulation BAE Balloon-assisted enteroscopy CD Crohn's disease CI Confidence interval CMV Cytomegalovirus CRC Colorectal cancer GI Gastrointestinal IBD Inflammatory bowel disease IPAA Ileal pouch-anal anastomosis NSAID Nonsteroidal antiinflammatory drugs OR Odds ratio PSC Primary sclerosing cholangitis TNF Tumor necrosis factor UC Ulcerative colitis VCE Video capsule endoscopy Acknowledgments The author is supported by the Ed and Joey Story Endowed Chair.…

Postoperative Crohn’s Disease Recurrence and Role of Endoscopy

List of Abbreviations AGA The American Gastroenterological Association CD Crohn's disease CI Confidential interval ECCO European Crohn's and Colitis Organisation POCER Postoperative Crohn's endoscopic recurrence TNF Tumor-necrosis factor Introduction Many patients with Crohn's disease (CD) will require intestinal resection surgery at some point in their disease course. Overall rates of surgery for CD as high as 80% when including tertiary care centers have been reported while…

Common Complications of Surgery for Crohn’s Disease and Ulcerative Colitis

List of Abbreviations ASA The American Society of Anesthesiologists CD Crohn's disease CT Computed tomography EBD Endoscopic balloon dilation EUA Examination under anesthesia IBD Inflammatory bowel disease IPAA Ileal pouch-anal anastomosis MRI Magnetic resonance imaging NKSt Needle-knife stricturotomy NSAID Nonsteroidal antiinflammatory drug PVF Pouch-vaginal fistula SSI Surgical site infection TNF Tumor necrosis factor UC Ulcerative colitis US Ultrasonography Introduction The incidence or prevalence of postoperative complications…

Overview of Surgical Treatment for Ulcerative Colitis

List of Abbreviations ATZ Anal transitional zone CI Continent ileostomy ET Enterostomal therapist IBD Inflammatory bowel disease IPAA Ileal pouch-anal anastomosis IRA Ileorectal anastomosis QOL Quality of life TAC Total abdominal colectomy TPC Total proctocolectomy UC Ulcerative colitis Introduction Ulcerative colitis (UC) is a chronic mucosal inflammatory disease of the colorectum that can have a widely varied presentation. Although many patients suffering from UC are successfully…

Multidisciplinary Approach to Stricturing Crohn’s Disease: Medical Versus Endoscopic Versus Surgical Therapy

List of Abbreviations ADA Adalimumab aOR Adjusted odds ratio AZA Azathioprine CCA Colo-colonic anastomosis CD Crohn's disease CI Confidence interval CTE Computed tomography enterography EBD Endoscopic balloon dilation ES Endoscopic stricturotomy GI Gastrointestinal H-M Heineke–Mikulicz HR Hazard ratio IBD Inflammatory bowel disease ICA Ileocolonic anastomosis ICR Ileocolonic resection IFX Infliximab IRA Ileorectal anastomosis MRE Magnetic resonance enterography NKSt Needle knife stricturotomy NSAID Nonsteroidal antiinflammatory drug OR…

Overview of Surgical Therapy for Crohn’s Disease

List of Abbreviations APR Abdominoperineal resection CD Crohn's disease CDAI The Crohn's Disease Activity Index CTE Computed tomography enterography FDA Food and Drug Administration HM Heineke–Mikulicz LIFT Ligation of the intersphincteric fistula tract MRE Magnetic resonance enterography SSIS Side-to-side isoperistaltic strictureplasty TNF Tumor necrosis factor TPN Total parenteral nutrition Introduction Crohn's disease (CD) is a chronic inflammatory disease of the intestinal tract with an unknown etiology…

Endoscopic Management of Hepatobiliary Complications of Inflammatory Bowel Disease

List of Abbreviations AASLD The American Association of Study for Liver Disease CC Cholangiocarcinoma CD Crohn's disease DC Direct cholangioscopy DIA Digital image analysis EASL The European Association for the Study of the Liver EIM Extraintestinal manifestations ERCP Endoscopic retrograde cholangiopancreatography EUS Endoscopic ultrasound FISH Fluorescence in situ hybridization FNA Fine needle aspiration IBD Inflammatory bowel disease IDUS Intraductal ultrasound IPAA Ileal pouch-anal anastomosis MRCP Magnetic resonance…

Endoscopic Detection and Removal of Colitis-Associated Dysplasia

List of Abbreviations CD Crohn's disease CI Confidence interval CRC Colorectal cancer DALM Dysplasia-associated lesion or mass EMR Endoscopic mucosal resection ESD Endoscopic submucosal dissection HDWL High-definition white light HGD High-grade dysplasia IBD Inflammatory bowel disease IT Isolation tipped LGD Low-grade dysplasia NBI Narrow-band imaging NNT Number needed to treat OR Odds ratio RCT Randomized controlled trial SCENIC The International Consensus Statement on Surveillance and Management…