A study on pediatric short bowel syndrome found that symptomatic anastomotic ulceration typically emerges years after the initial anastomosis, and suggested that changing from a special liquid formula to regular solid foods might be connected to the bleeding in anastomotic ulcers.

The following is a summary of “Whole Foods Introduction Associated With Symptomatic Anastomotic Ulceration in Children With Short Bowel Syndrome,” published in the December 2023 issue of Pediatrics by Zong, et al.

For a study, researchers sought to delve into the intricate details of anastomotic ulceration (AU) as a severe complication of pediatric short bowel syndrome (SBS). Specifically, they sought to identify markers associated with symptomatic bleeding AUs in children with SBS and to understand factors influencing the resolution of bleeding. Additionally, they explored the potential relationship between dietary modifications and symptomatic anastomotic hemorrhage.

For a comprehensive analysis, they performed a retrospective chart review encompassing 381 patients from the Intestinal Rehabilitation Program between 2013 and 2022. The inclusion criteria were based on patients displaying symptomatic AUs, evident from endoscopic procedures revealing AUs combined with notable gastrointestinal bleeding. The dataset collected a wide array of information, including patient demographics, clinical attributes, dietary history, radiological findings, and histopathological data. Descriptive statistics were employed to decipher presenting patterns.

Among the cohort, 22 patients manifested AUs, with a median follow-up duration post-identification being 2.9 years. Intriguingly, AUs typically emerged several years subsequent to the initial anastomosis, with a median span of 3.2 years. Notable characteristics encompassed features like bowel stricture (observed in 4 out of 22 patients), small bowel-colon anastomosis (19/22), partial colectomy (17/22), and increased consumption of whole foods (12 out of 18). Surgical interventions were notably effective for those with anastomotic stricture, witnessing the resolution of bleeding in a significant proportion. Conversely, recurrent bleeding was prevalent among patients lacking stricture. A noteworthy observation was that, among those without stricture, reducing whole foods in the diet correlated with either an improvement or complete resolution of bleeding in a majority.

The study underscored the importance of meticulous characterization of intestinal anatomy, especially in children with definitive anastomotic strictures, as it seems to influence the therapeutic response. Additionally, the research indicated a potential link between the onset of bleeding from AU and a dietary shift from elemental or hydrolyzed enteral formula to whole food-based diets. The intriguing observation suggested that specific components within the enteral diet might contribute to the pathogenesis of AU. However, to solidify the findings and hypotheses, further rigorous studies were warranted.

Source: journals.lww.com/jpgn/abstract/2023/12000/whole_foods_introduction_associated_with.21.aspx