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Intestinal Insufficiency:

The intestines are the body's fluid-electrolyte balance. They are vital organs that provide the absorption of nutrients for growth-development and meeting the energy needs of the organism. Intestinal failure develops in genetically transmitted intestinal (intestinal) mucosal diseases and motility disorders or in surface area losses due to surgical resections. Intestinal insufficiency (RF) is incompatible with life, and body fluid-electrolyte balance and nutrition are provided by intravenous (IV) route in these patients.

Congenital and genetic diseases form the basis of the causes of RF. Therefore, the majority of patients cover the childhood age group. Although it is relatively rare in European and North American countries, its incidence is increasing in societies such as our country where consanguineous marriages and genetic diseases are common. There is no prevalence or frequency data for our country that can define the extent of the problem. However; The known fact is that some of these babies are lost before they can reach clinics experienced in gastrointestinal diseases, and those who have this chance can be diagnosed without being diagnosed because they can be recognized with a multidisciplinary approach that requires complex tests and analyzes.

In patients with intestinal insufficiency, the body's energy and fluid-electrolyte needs are provided intravenously (total parenteral nutrition, TPN). Provision of appropriate calories provides growth as well as an increase in the surface area and/or functions of the intestine in a group of patients (intestinal rehabilitation, adaptation). Intestinal adaptation can be achieved with TPN, as well as lengthening operations and experimental pharmacological treatments, especially in some of the patients with IC secondary to surgical resections; however, some RF patients remain dependent on TPN for life.

TPN is administered through a central intravenous line. During the follow-up of the patients, both mechanical and infectious complications of various metabolic and vascular lines due to TPN application develop frequently; As a result of developing complications, kidney and liver failure and problems progressing to transplantation of these organs may develop. Preventing complications, providing emergency and appropriate treatment, establishing a bridge for organ transplantation when necessary, and ultimately increasing the survival rate of these children, can only be managed by experienced pediatric gastroenterologists, pediatric surgeons, dietitians, pharmacologists, radiologists, psychologists, TPN nurses and social workers in the supervision and follow-up of IA patients. This can be achieved by a multidisciplinary team. Otherwise, the mortality rate in RA cases is very high.

Sustaining life in patients with intestinal failure is only possible with TPN; Therefore, these patients continue their lives dependent on the hospital. However; In order to increase the risk of infection in the hospital environment, to increase the cost and to reintegrate the patient into community life, TPN is applied at home in RF patients all over the world and is supported by health authorities. In our country, TPN cannot be applied at home. Intestinal or multi-organ transplantation is performed in cases where intestinal rehabilitation is unsuccessful and/or complications develop. For this reason, centers that monitor and control RF patients should also include organ transplant teams.

Intestinal insufficiency is one of the diseases with high mortality and morbidity in children. A meta-analysis report compiled from the literature reports that as a result of the follow-up of RF patients by specialized multidisciplinary centers, the survival rate of these children increases, complications such as infection decrease, coordination in patient follow-up is ensured, and transition to surgical or transplantation treatments is provided at an appropriate time (Stranger DJ, 2013). In addition to the positive effects in patient control, the application of sophisticated interdisciplinary analyzes enables the investigation of the causes of RF and the recognition of underlying mucosal diseases, and makes an academic contribution to the field of RF, which is currently in the group of diseases whose cause is not understood (Guarino A, 2003). It is reported that centralization and IY rehabilitation programs in this area lay the groundwork for research, development and coordination with national and international centers (Javid PJ, 2010).


EU Intestinal Insufficiency and Rehabilitation Center Goals:

1-Patient supervision

• Providing the disease and patient-specific, urgent, appropriate treatment by more than one discipline
• Reducing mortality
• Reducing complications
• Developing support programs for patient families
• Providing home follow-up of RF patients who can lead their hospital-dependent lives in our country
• Integration of patients into society
• Transition to surgery and transplantation treatments with appropriate timing

2-Academic goals

• Investigation of the prevalence of IY in Turkey by establishing coordination with the Ministry of Health and determining the size of the problem.
• Determining the causes of IY with interdisciplinary communication and applied analyzes
• Planning research projects in experimental IY models

3-Coordination

• Providing TPN and care support at home by establishing coordination with the Ministry of Health
• Establishing coordination with physicians, clinics and branches of science in the fields of neonatology, pediatric surgery, and pediatric gastroenterology in our country.
• Establishing coordination with international centers in the field of patient supervision and research projects