Nutritional Benefit of Recycling of Bowel Content in an Infant With Short Bowel Syndrome

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To the Editor: Short bowel syndrome (SBS) is a major cause of intestinal failure (1). A proximal stoma is often constructed in patients with this condition. Recycling of bowel content (RBC) is a procedure that involves injection of chyme discharged from the proximal side of a stoma into the distal side (2–7). RBC is expected to salvage unabsorbed nutrients, facilitate maturation of intestinal function, and alter the gut microflora downstream of the stoma. We report on the effects of RBC on nutrition status, bowel maturation, and microbial composition of the gut in an infant with SBS. Potential benefits of adding synbiotics are also addressed.
A female infant with meconium peritonitis underwent extensive intestinal dissection with construction of a double-looped ileostomy, leaving 58 cm of the small intestine and an intact colon. RBC combined with synbiotic therapy (Clostridium butyricum, Bifidobacterium bifidum, and partially hydrolyzed guar gum) was started, weight gain improved and parental nutrition requirements decreased by 78% (Fig. 1). There was significant maturation of the intestinal mucosa with improved ileal villus length (205.36 ± 20.3 vs 555.34 ± 61.92 μm, P = 0.0016), width (64.67 ± 11.21 vs 118.93 ± 19.47 μm, P = 0.0016), and crypt depth (101.98 ± 8.99 vs 242.9 ± 15.857 μm, P = 0.0016). Diversity of the fecal microbiota was assessed periodically by using 16S ribosomal RNA gene sequencing and increased in response to RBC and synbiotic therapy, with the pattern of the microbiota becoming similar to that in healthy age-matched infants. In our case, RBC combined with synbiotic treatment may have improved nutritional status by preventing distal bowel atrophy and establishing a symbiotic intestinal microbiota.
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