Could Glucocorticoids Improve Enteral Feeding?

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Short bowel syndrome (SBS) in children is a rare disease with extremely high health care costs due to long-term parenteral nutrition (PN) requirements and the potential for frequent hospitalizations. Many patients can have PN requirements reduced or can wean from PN completely if enteral nutrition can be advanced successfully. However, risk factors such as production of inflammatory mediators and bacterial overgrowth can lead to intestinal inflammation in pediatric patients with SBS, and the authors of this study looked at the potential benefit of glucocorticoids in this specific population.

This retrospective study from a medical center with expertise in pediatric intestinal rehabilitation looked at all pediatric patients with SBS at their institution who had undergone glucocorticoid therapy for intestinal inflammation diagnosed by endoscopy with biopsy. Patients on glucocorticoids for organ transplantation or food allergy therapy were excluded. Those patients with SBS and who received glucocorticoid therapy received either prednisone or budesonide. Specifically, patients with high parenteral nutrition needs initially were placed on prednisone and then tapered to budesonide with sulfasalazine. Sulfasalazine was added if colonic inflammation was present. Patients with lower parenteral nutrition needs were initially placed on budesonide and sulfasalazine, and budesonide was eventually weaned off. All patients had linear growth monitored, and bone age and bone density were checked annually. Standard laboratory data was reviewed as well.

A total of 15 patients (9 girls) were included in this study. Gastroschisis was the leading cause of SBS occurring in 10 of the patients, and the median small bowel length for this patient group was 46 centimeters with most patients having at least half of their colon length conserved. Significant bowel inflammation with associated eosinophilia was present in the biopsies of 6 patients. The median age of starting glucocorticoid therapy and the median length of time these patients were on parenteral nutrition was 3.3 years. The median time of glucocorticoid therapy was 18 months (range 1-64 months). The ability to wean parenteral nutrition occurred in 11 patients once glucocorticoid therapy was initiated, and 7 patients were able to stop parenteral nutrition. The authors noted that linear growth was not affected, and no metabolic bone disease occurred in the study group.

Although the results are encouraging, it is still unknown if glucocorticoid therapy has the potential to reduce or remove parenteral nutrition needs in pediatric patients with SBS. The exact mechanisms for improvement in such patients are unknown (including the potential of intestinal microbiome changes), and a randomized controlled trial for this type of therapy is needed.

Wang F, Gerhardt B, Iwansky S, Hobson B, Logan S, Mercer D, Quiros-Tejeira R. Glucocorticoids improve enteral feeding tolerance in pediatric short bowel syndrome with chronic intestinal inflammation. Journal of Pediatric Gastroenterologists and Nutrition 2021; 73: 17-22.

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