Nebraska Health System (NHS) and the University of Nebraska Medical
Center (UNMC) are expanding their world-renowned intestinal failure and
transplantation programs with the creation of a new Intestinal Rehabilitation
Program. This new initiative will be started in partnership with
the Nutritional Restart Center (NRC) of Hopkinton, Mass., and will be located
in Omaha.
The new program will open to patients in August. It will offer patients
with intestinal failure comprehensive treatment options to help them transition
from total parenteral nutrition (TPN) to a more normal oral diet.
TPN is used to provide calories and nutrition intravenously for a patient
whose intestinal tract cannot digest or absorb nutrients normally.
Intestinal failure often means long-term and sometimes permanent dependence
upon TPN. Without TPN, the patients would become dehydrated, under
nourished and eventually die.
The principle cause of intestinal failure is short bowel syndrome, which
can result from injury, disease or as a result of surgical treatment of
complex intestinal conditions. In the past, patients often remained
dependent on TPN. A small minority of patients may benefit from surgical
procedures on their bowel, such as intestinal lengthening, tapering or
creation of reversed segments. In some patients it becomes impossible
or dangerous to continue TPN in the long term because of development of
life-threatening complications such as liver disease or central venous
catheter infections.
In the last few years, it has become apparent that patients who do not
tolerate TPN in the long term may enjoy an improved quality of life with
intestinal transplantation. Whatever the underlying reason for intestinal
failure, the goal of the new program is to improve the function of the
remaining bowel by employing unique, innovative and non-invasive strategies
pioneered at the NRC.
The ability to offer patients with intestinal failure a non-invasive
alternative to all the other treatment options we currently employ at NHS
and UNMC is a significant addition to our intestinal failure and transplant
programs, said Kishore Iyer, M.D., director of the new program.
In addition to optimizing the medical management of these patients, the
Intestinal Rehabilitation Program will teach patients what to eat and drink
and how to incorporate this new knowledge into their lifestyle once they
return home. The ultimate goal is to wean patients slowly from TPN
and improve their overall quality of life. An obvious benefit
will be the reduction and prevention of some of the recognized complications
associated with long-term TPN.
Over the past eight years, the NRC has treated nearly 400 patients,
representing the largest single experience in the area of intestinal rehabilitation
in the world, said Theresa Byrne, Ph.D. of the Massachusetts Center.
With an average follow-up period of two years, our studies have shown
that following intensive treatment at our center, about 40 percent of patients
are able to remain off TPN and another 40 percent experience a significant
reduction in their need for intravenous feedings. The success and
growth of our program, coupled with the complexity of the medical issues
confronting many of the patients, forced us to look for a new home that
could offer patients a full spectrum of services and interventions.
What we found at NHS and UNMC is ideal both in terms of clinical staff
and facilities. This one-stop comprehensive team approach to intestinal
failure means that we are now in a position to offer the most appropriate
therapy for the patient with intestinal failure, without being restricted
to one form of therapy or another.
Patients coming in to the Intestinal Rehabilitation Program in Omaha
will be admitted to Cooperative Care rooms in The Lied Transplant Center
with nutritional instruction and demonstrations taking place in the Cooperative
Care dining room. The clinical progress of the patients will be monitored
daily by a team of physicians, nurses, dietitians and other health-care
professionals, all of whom have a special interest and long-standing experience
in management of TPN and intestinal failure.
The team at NHS and UNMC has, over the years, evaluated and managed
about 300 patients with intestinal failure and performed more than 120
intestinal transplant operations, said Alan Langnas, D.O., chief of transplantation
at NHS and UNMC. This represents close to a third of the world experience
in intestinal transplantation. By joining forces with the NRC and
creating the new rehabilitation program we will provide our intestinal
failure patients a continuum of care they wont find anywhere else. We
can offer patients non-invasive treatments and if those fail, evaluate
them for a range of surgical procedures the last of which is transplantation.
Our goal will be to assist patients back to a more normal life. Thats
very exciting for us and more importantly for our patients, Dr. Langnas
added.
The Intestinal Failure Clinic at NHS and UNMC, which was established
about 10 months ago, sees two to three patients with intestinal failure
each week. Patients are assessed for intestinal disease, liver problems,
dietary management and in some cases for reconstructive surgical options.
Through a multi-disciplinary team approach, the clinic has already had
considerable success in weaning patients from TPN and even avoiding the
need for intestinal transplantation in some cases, said Dr. Iyer.
Where early evaluation for intestinal transplantation is appropriate,
this can be carried out immediately. The new Intestinal Rehabilitation
Program will aim to build on the early success of the Intestinal Failure
Clinic and on the premier international reputation of our intestinal and
liver transplantation programs, Dr. Iyer added.
The new rehabilitation program projects an average of six patients going
through the 14 to 26 day in-patient treatment plan at one time. In
addition to their medical, nutritional and nursing teams, patients have
the added benefit of a care partner who they select. That partner
can be a spouse, parent, relative or friend. That is the beauty of
the Cooperative Care philosophy, allowing patients a level of independence
and comfort, not routinely associated with hospitals.
Physicians at Harvard Medical School and Brigham and Womens Hospital
started the NRC program about eight years ago. Going forward, collaborative
research efforts will be focused in both Boston and in Omaha. The
ability to offer patients access to innovative research and this complete
continuum of care speaks well to our intestinal failure and transplant
programs, said Dr. Langnas.
The NHS and UNMC intestinal transplantation program is one of only four
in the United States to be approved for coverage by Medicare. While
interest in
intestinal transplantation is clearly on the increase, we believe it
is just as important to focus our efforts on developing non-invasive and
simpler medical and surgical options that may be more appropriate than
transplantation for some patients with intestinal failure, says Dr. Iyer.
Nationwide, approximately 50 private insurers have approved the NRC rehabilitation
program.
For more information on the Intestinal Rehabilitation Program, you can
log onto any of the following web sites: www.nebraskahealthsystem.com,
www.unmc.edu, or www.nrcenter.com.