Center for Advanced Intestinal Rehabilitation | Ongoing Research Projects

At CAIR, we’re working continually to improve treatments for short bowel syndrome and related concerns. Some of our current and recent research projects include:

Markers for short bowel syndrome

Our researchers are measuring blood and stool markers of intestinal adaptation in children with short bowel syndrome over the course of a year. They will investigate how these markers relate to growth and weaning off of parenteral nutrition.

Development of a treatment algorithm for vitamin D deficiency

We have modified our treatment plan for vitamin D deficiency after looking at lab trends and made changes based on both age and levels of this vitamin. We will be collecting data to determine the effectiveness of our new recommendations in treating vitamin D deficiency.

Copper status in infants with prolonged dependence on parenteral nutrition

Prospective data was collected on a group of children with intestinal failure and dependence on parenteral nutrition. Our researchers are now analyzing their blood levels of copper and various potential risk factors for copper deficiency to help optimize prevention and treatment of this problem in pediatric short bowel syndrome.

Assessment of body composition

The Bodpod (also called air displacement plethysmography) is a safe, quick, non-invasive technique that measures both the muscle mass and fat mass in children. Since routine measures such as weight gain may not be sensitive enough to assess the actual gain of muscle mass, the Bodpod may allow for a better assessment of a child’s body composition.

Non-invasive assessment of liver fibrosis

Vibration-controlled transient elastography, also called fibroscan, is a new diagnostic tool to assess liver fibrosis in pediatric intestinal failure patients with associated liver disease. Fibroscan results for our CAIR patients have shown that the diagnostic tool is successful and a valid method for non-invasive monitoring of liver injury in this population.

Methionine breath test

Monitoring hepatic function has been limited to conventional blood testing or liver biopsy in patients with intestinal failure-associated liver disease. Metabolism of the stable isotope, L[1-13C] methionine has been shown to exclusively occur in the liver and to be a safe, non-invasive and valid measure of liver mitochondrial function. The CAIR team is currently assessing the feasibility and relevance of serial breath testing to measure changes in liver function over time.

Distraction enterogenesis

The remaining length of small intestine is the most significant factor in predicting whether a patient with short bowel syndrome will be able to successfully wean off parenteral nutrition. Techniques for lengthening intestine through mechanical stretch have been described, and the CAIR team has ongoing studies applying extraluminal stretch to elongate small bowel and stimulate tissue growth.

Long-term outcomes of ultra-short bowel syndrome

Our CAIR team recently reviewed long-term outcomes in patients with a history of midgut volvulus leading to ultra-short bowel syndrome. We have found that midgut volvulus with extensive bowel loss is associated with favorable long-term survival, and that weaning off parenteral nutrition is feasible with intestinal rehabilitation.

Long-term outcomes

Tens of thousands of children have short bowel syndrome; however, with the advent of parenteral nutrition and advances in intestinal rehabilitation, many are now surviving to adulthood. The primary aim of this study is to observe long-term medical and surgical outcomes of adolescents nearing adulthood as we work towards transition of care for these patients.

Quality of life

The CAIR team is surveying families of pediatric patients with intestinal failure for information regarding their quality of life with hopes of a better understanding the critical factors which affect this specific population. This information and enhanced understanding will help us to provide tailored medical treatment plans that can improve quality of life for our patients.

Effects of RELiZORB

Led by Mark Puder, MD, the primary goal of this study is to determine whether RELiZORB is associated with a reduction in calories from parenteral nutrition. We will also be measuring changes in children’s body weight by the end of the study. To determine if your child is eligible for this study, please contact: relizorbstudy@childrens.harvard.edu