{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzlrhe\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzlrhe\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/3\\\/4\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/3\\\/4\u0022}],\u0022ac\u0022:{\u0022spmdc;15\\\/3\\\/4\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;15\\\/3\\\/4\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ENutrition support professionals are responsible for maintaining the integrity of the gut mucosa. Coaching and teaching can be accomplished with electronic tools and apps. It may be possible to grow stem cells into intestinal tissue that can be transplanted back to patients without inducing immunocompromise. Pooling international data can improve patient outcomes.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eshort bowel syndrome\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emicrobiome\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Evilli\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eenteral feeding\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Estem cells\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Enutrition support\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EDouglas W. Wilmore, MD, Prof Emeritus, Harvard Medical School, Boston, Massachusetts, USA\u2014a pioneer in the field of clinical nutrition, the early use of glutamine administration to improve gut absorption, and the coordination of multidisciplinary intestinal failure nutrition teams\u2014delivered the conference keynote address. His address delved into the problems related to patients with short bowel syndrome (SBS) and challenged practitioners and researchers to keep advancing the field and improving patient outcomes.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ESBS is a malabsorption disorder caused by surgical removal of the small intestine. Dr Wilmore recalled early cases from his surgical training that focused his interest on factors that help the gastrointestinal (GI) tract adapt to deficiencies in nutrient absorption. A key factor in this adaptation was the development of parenteral nutrition (PN). He referred to data suggesting that 90% of people with at least 3 ft of bowel could live up to 10 years following bowel resection; however, survival declined to \u0026lt;\u200960% over the same time frame in patients with \u0026lt;\u20093 ft of bowel [Messing B et al. \u003Cem\u003EGastroenterology.\u003C\/em\u003E 1999]. According to Dr Wilmore, these patients are the ones who should be targeted for improvement in survival, and he challenged the audience to think about implementing changes that might increase survival to at least 90% in this group of patients.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe adult GI tract is about 27 ft long. At one end is the small bowel, comprising the duodenum, the jejunum, and the ileum (22.5 ft); at the other end is the colon (5 ft), separated from the small bowel by the ileocecal valve. While many practitioners do not include the duodenum when they discuss the length of the small bowel, Dr Wilmore suggested that they should. He cited 1960s Scandinavian studies showing that 80% of infused nutrients were absorbed in the first 2 to 3 ft of the small bowel. If this is indeed true, then many patients with SBS should be able to achieve a high degree of nutrient absorption.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe villi of the intestine\u2014finger-like projections that reside throughout the GI tract\u2014aid in absorption by increasing the surface area of the intestine. They also contain specialized cells that transport different types of nutrients into the blood. It has been estimated that the villi add 2700 sq ft to the surface area of the bowel\u2014unlike human skin, which has a square footage of only 18 sq ft. While noting that dermatologists are typically responsible for the 18 sq ft of skin, Dr Wilmore posed an interesting question: \u201cWho takes care of 2700 sq ft of intestinal mucosa?\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EIn self-response, he noted that nutrition support professionals uphold this responsibility by prescribing foods that keep the mucosa healthy. According to Dr Wilmore, the best diet for the health of the GI tract includes organic whole foods; at the bottom of the list are elemental diets. He also emphasized that because \u003Cem\u003Eany\u003C\/em\u003E food in the GI tract is better than no food at all and PN alone does not allow for mucosal adaption, enteral feeding is important because it stimulates mucosal growth, provides antigens to support immunity, enhances the barrier defense system of the gut, and nourishes the gut microbiome.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe second half of the keynote address focused on other strategies to improve patient outcomes among those with SBS. The first is communication, and Dr Wilmore described his experiences in coaching patients who had undergone SBS regarding how and what to eat. He urged clinicians to take advantage of electronic tools and apps, such as video chat, which allows patients to visually share the contents of their refrigerators and pantries. This same technology allows patients to be coached at the supermarket and restaurants as well. Wearable devices allow patients to track their calorie intake, steps taken, body composition, and hydration status. He also called for insurance companies to consider reimbursing patients for such devices, as well as reimbursing clinicians for time spent out of the office coaching patients and monitoring the data generated from these devices.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EDr Wilmore then went on to discuss the importance of the gut microbiome. There are 23\u2009000 genes in the human body but more than 1 million genes in the bacteria that reside within the human body\u2014most of them within the colon. These bacteria maintain a symbiotic relationship, with the \u201cgood\u201d bacteria keeping the pathogens under control. According to Dr Wilmore, diet is the most important element in maintaining the best bacterial balance for the gut biome; antibiotics are the worst.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EHe described an experiment whereby germ-free newborn mice received a fecal transplant from genetically related adult mice that were either obese or of normal weight [Turnbaugh PJ et al. \u003Cem\u003ECell Host Microbe.\u003C\/em\u003E 2008]. All the mice were then pair fed: half the young mice became obese and half did not. After examining the genes within the bacteria of the 2 groups of young mice, the researchers determined that some genes made enzymes that allowed previously nonabsorbed nutrients, such as complex carbohydrates and fiber nutrients, to be absorbed and used as energy by these animals. Dr Wilmore urged his colleagues to think about whether providing these organisms to patients with SBS could enhance nutrient absorption and digestion.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EWhile routine colon transplantation for patients with SBS is at least a few years away, Dr Wilmore hypothesized that transplantation might improve survival and provide patients with a healthier gut biome. He proposed several research programs that might support colon transplants, such as investigating ways to maintain the \u201cgood\u201d bacteria while eliminating the pathogens, as well as in vivo studies of the ideal growing nutrient solution for the intestinal tract. Once that ideal solution is identified, it may be possible to grow pieces of intestine in vitro. With use of patients\u2019 stem cells, it may even be possible to culture the cells into intestinal tissue that can be transplanted back to the patients without the need for immunosuppression.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EDr Wilmore closed his lecture by highlighting the importance of pooling data from the small global heterogeneous patient population who undergoes small bowel resection. He urged A.S.P.E.N. members to take the lead in collaborating with other countries to contribute their patient data and share the best therapies, best timing, and best ways to move ahead\u2014all with the goal of improving patient outcomes.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/3\/4.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlrhe\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}