The Mayo home parenteral
and enteral nutrition (HPEN) team consists of physicians, dietitians, and a
nurse, with ongoing communication and team work with home health companies,
primary care physicians, and other clinicians who may be involved in each
Their team evaluates
complex adult patients with severe stomach and intestinal problems such as:
intestinal failure; malabsorption; short bowel syndrome; failure to thrive after
bariatric surgery; vitamin and mineral deficiencies; gastroparesis; and
pseudo-obstruction. They offer one-time-only consultations, providing diagnostic
and treatment recommendations, and also provide long-term care.
If deemed appropriate,
HPEN support will be initiated and carefully monitored. Whenever appropriate,
they also work to wean individuals from parenteral nutrition (PN) using a
variety of dietary, pharmacologic, and surgical approaches. They assist patients
in the process of choosing a home health company if HPEN is necessary, and the
team will work with the home health staff to evaluate each patient’s optimal
nutrition. Patients receive individualized diet therapy to help nutritional
status and symptom control. They do not provide intestinal transplantation
Dr. John DiBaise, a
gastroenterologist, and Dr. Lori Roust, an endocrinologist, supervise the
medical aspects of each patient’s PN regimen. Dr. DiBaise, along with colleague
Dr. Kevin Ruff, also a gastroenterologist, follow and monitor the enteral (EN)
patients. They oversee and adjust the nutrition regimen as indicated by patient
progress, working as a team with the dietitian, nurse coordinator, home health
staff, and primary physician.
Lauri Rentz, RN, CGRN,
helps instruct the patient and caregivers to care for their new IV line and/or
EN feeding tube and provides ongoing education as needed. The person receiving
HPEN and/or his or her caregivers must master many technical procedures to
safely administer their nutrition formula. The nurse is instrumental in
maintaining ongoing communication with the patient to evaluate progress.
Michelle Mannebach, RD,
and Sherry Tarleton, RD, CNSC, provide initial and ongoing nutritional
assessment for patients receiving HPEN. The dietitians work with the physicians
in determining appropriate nutrient needs. The ability to eat, digest, and
absorb food will depend on each individual case. The dietitian provides
guidelines and instruction about the HPEN formulation, as well as types and
amounts of food the patient may eat if permitted.
For more information about
the program call (480) 301-6990.
UCLA Medical Center
Home Parenteral Nutrition Program
Dupont Transplant Center
Los Angeles, California
The Home Parenteral Nutrition (HPN) program at the UCLA Medical Center
was founded in 1974 by Dr. Marvin Ament. The program was the first of its kind
in California and serves both pediatric and adult patients. Consumers are seen
in a designated PN clinic, where besides receiving care from an expert
multidisciplinary team of physicians, RN specialists, a social worker, dietitian
and pharmacist, there are opportunities for meeting other HPN consumers.
The team at UCLA cares on average for 70 to 75 HPN consumers, as well as
individuals who are supported on enteral nutrition or who have successfully been
weaned from PN. The team has a strong commitment to consumer and caregiver
education, advocacy and support. Quality of life issues for consumers and
caregivers are a strong team focus.
The UCLA Medical Center provides a full range of experienced medical and
surgical specialists to support the special needs of the HPN population. The
UCLA Homecare Pharmacy was one of the first homecare pharmacies in Southern
California and continues as an experienced provider of HPN and other home
In 1991, the UCLA Intestinal Transplant program was founded under the
direction of Dr. Douglas Farmer, completing the full scope of services available
to individuals with intestinal failure. For more information regarding the HPN
program at UCLA contact Laurie Reyen, RN, MN (310) 825-4823 or
The multidisciplinary team of the Intestinal Rehabilitation Program at
Children’s Hospital of Los Angeles provides comprehensive care for children with
intestinal failure or related conditions through the Division of
Gastroenterology. The team’s goal is to help patients move from intravenous to
tube feeding to an oral diet while supporting normal growth and development. The
team coordinates care with other services in the hospital and with home care
agencies that provide products and nursing care in the home setting. The home
parenteral nutrition (HPN) service was established in 1978 by Russell Merritt,
MD, PhD, and has been offering full intestinal rehabilitation services since
The team works with
hospitalized patients to ensure that their nutritional needs are met; prepares
patients and their parents to use nutrition therapies at home; and cares for
children who need at-home nutrition support (including tube feeding and
intravenous nutrition). It also offers educational activities in the hospital
and the community, and research and quality of care initiatives. The
team includes physicians, nurses, occupational therapists, a dietitian, and a
For further information or an appointment, nurse coordinators can
be reached at (323) 361-5694 or
British Columbia Home Parenteral and Enteral Nutrition (BC HPEN) Programs
provide support to consumers within British Columbia (BC) and the Yukon. The
adult component of the Programs is operated out of St. Paul’s Hospital, a large
acute care, teaching and research hospital located in downtown Vancouver, BC.
The pediatric component of the Programs is largely operated out of BC Children’s
Hospital, located in Vancouver, BC.
Home Parenteral Nutrition (HPN) Program cares for about 75 adult and 5 pediatric
consumers. The BC Home Enteral Nutrition (HEN) Program averages 20-25 adult and
100 pediatric consumers. Both programs provide support to consumers with
mission is twofold: (1) to provide outstanding, comprehensive healthcare based
on current scientific principles and international standards of practice for
intestinal failure patients living in BC and the Yukon and (2) to be a clinical
and educational resource for healthcare providers.
information about the BC HPEN Programs, please visit
e-mail us at
or call us at 1-877-806-9353 (604-806-9353).
The Center for Intestinal Care and
Transplant at MedStar Georgetown Transplant Institute offers comprehensive care
of patients with intestinal insufficiency and intestinal failure. Patients are
of all ages, ranging from infants to adults, and include those who have not
achieved optimal outcomes during previous attempts at intestinal rehabilitation
or who may have no reasonable chance for nutritional independence. Children
include those with short bowel syndrome as well as other forms of intestinal
failure requiring parenteral nutrition (PN) support, such as pseudo-obstruction
and congenital secretory diarrhea syndromes. Adult patients include those who
have lost all or much of the gastrointestinal tract due to severe Crohn’s
disease, blood vessel thrombosis, tumors, traumatic injury, and complications of
Comprehensive assessment and treatment are provided by a multidisciplinary group
consisting of physicians, surgeons, dietitians, nurses, and social workers,
carried out inside and outside of the hospital. For both adults and children, a
combination of medical, surgical, and nutritional interventions, or
investigational studies, alone or in combination, may be utilized. MedStar
Georgetown Transplant Institute is among the most active centers of intestinal
transplantation in North America. As such, they indicate, “this option may be
offered to those with little or no other chance for recovery.”
You can contact the center at (202) 444-3700.
The Program for
Intestinal Rehabilitation and Liver/GI Transplantation was started in 1994, when
Dr. Andreas Tzakis joined the University of Miami as director of the program.
A combined effort
between the Department of Surgery, Division of Pediatric Surgery and Division of
Liver-GI Transplant, plus the Department of Pediatric Gastroenterology allows a
multidisciplinary approach to parenteral nutrition patients, resulting in
multimodal therapeutic strategies.
Patients with intestinal
dysfunction are evaluated and offered medical therapies with intestinal
adaptation protocols (with enteral and parenteral nutrition), in collaboration
with a team of dietitians and gastroenterologists. Surgical techniques of bowel
lengthening (including STEP procedure) and reconstruction are available to
complement medical management.
In addition, the center
offers alternative surgical techniques such as intestinal auto-transplantation.
Finally, intestinal and multivisceral transplantation is offered for those
patients with irreversible intestinal failure. This center performs over half of
the multivisceral transplants in the nation.
The adult liver/GI transplant associate director is Seigo Nishida, M.D.,
and the pediatric liver/GI transplant associate director is Tomoaki Kato, M.D.
More information about the program can be found at their Web site at
www.surgery.med.miami.edu/livergi/index.asp or by phone at
The Intestinal Rehabilitation
Program at Children’s Healthcare of Atlanta at Egleston/Emory University is a
multidisciplinary team of gastroenterologists, surgeons, neonatologists, nurses,
and dieticians who work together on the care of patients with short bowel
syndrome (SBS) and intestinal disorders. The primary goal of this program is
weaning patients from TPN and improving growth and neurodevelopmental outcomes
through in-patient and outpatient programs. There are also active research
protocols involving patients who wish to participate. The center offers
integrated services aimed at reducing parenteral nutrition dependence while
optimizing the infant’s growth and development. A support group involving
families, social workers and nurses helps families cope with short bowel
syndrome and intestinal failure. The program collaborates actively with the
adult nutrition support service at Emory University Hospital.
our services can be found at
IU Health is one of the nation’s largest transplant
centers. It offers care for both children and adults in need of intestine,
pancreas, liver, kidney and multi-organ transplants. IU Health supports each
patient through the transplant process using a network of medical professionals
experienced with dealing with intestinal failure and long-term complications
from parenteral nutrition.
Dr. Magnus has shared abstracts from
two papers he has published on intestinal transplantation: “Multivisceral
Transplantation: Expanding Indications and Improving Outcomes” (J
Gastrointest Surg, published online 16 Oct 2012) and “Intestinal
Transplantation in Infants with Intestinal Failure” (Clin Perinatol 40,
2013). E-mail firstname.lastname@example.org
if you are interested in reading the full article.
To find out more about the program’s outcomes and experience related to
intestine and multi-organ transplants, call (800) 382-4602, or visit
Boston Children’s Hospital
Center for Advanced Intestinal Rehabilitation
Established in 1980, our program is the nation¹s leading
referral center for children who require intravenous nutrition. We have already
taken care of more than 400 infants, children and adolescents from around the
world with medical and surgical problems that keep them from taking in nutrition
enterally. The HPN program at Boston Children’s Hospital cares for about
80 pediatric consumers at any one time, over 100 consumers per year.
We have expertise in high quality teaching on home care,
weaning off PN, screening for nutritional deficiencies/excess, screening and
treatment for bone disease associated with long-term PN use, intravenous iron
therapy at home to prevent need for blood transfusions, home-based IV
antibiotics, liver-protection PN strategies (low dose IV lipids, Omegaven), and
ethanol locks for line-infection-prevention.
For more information about HPN program at Boston
Children’s Hospital, please visit:
or e-mail us at
email@example.com or call us at (617) 355-6439.
The home parenteral
nutrition (HPN) program at the Mayo Clinic was started in 1972 when the first
patient was sent home on PN by Richard Fleming, MD, a gastroenterologist. A
second patient was discharged in 1975 and in 1976 four more patients were added
to the program. In 2012, Dr. Ryan Hurt took over from Darlene
Kelly, MD, PhD as the
gastroenterologist overseeing the program in Rochester, MN.
Other members of this specialized team include a gastroenterologist who takes
over when Dr. Hurt is out of town; a nurse
practitioner; and a nurse coordinator,
who is the link between Dr. Hurt and the patients. There is also a pharmacist,
a hospital social worker, a hospital dietitian, and the nurse educators who
train new patients. Mayo has vascular radiologists and surgeons who specialize
in catheter placement and problems, and, last but certainly not least, a
secretary. This team of people works with each person from the time they are
first diagnosed as needing long-term PN.
The program in Minnesota has
an average of 120 consumers at any one time. In 2011, Dr. Kelly calculated that the
team had worked with over 2,000 consumers who
had a total of 2,000 years of
When asked what the benefits
would be of a center of experience, Dr. Kelly felt the following was true.
“This is a team of people who have an express interest in HPN and continue to be
educated in this area. They network with other centers nationally and
internationally and work to keep themselves at the cutting edge of the therapy.
They work to be available to their consumers. They act as a resource to other
physicians in the field.”
Updated January 2013
Henry Ford Hospital
Intestine and Multivisceral Transplant Program
The Henry Ford Hospital Intestine and
Multivisceral Transplant Program, established in 2010, is the first and, at
this time, only program in Michigan performing intestine transplantation.
Their intestine transplant team approach offers patients care from
pre-transplantation through recovery and rehabilitation. Intestinal
transplant program patients receive service provided by specialists in
gastroenterology, intestinal transplant surgery, nutrition, social work,
psychology, and rehabilitation.
Each patient is also assigned an intestinal transplant program
coordinator—a nurse who coordinates all aspects of care and serves as the
patient’s liaison throughout the transplant process. The transplant
coordinator provides educational materials and support to patients and
families and is available twenty-four hours a day to respond to medical
Updated June 2014
Enteral Nutrition Program at Mayo Clinic in Rochester, Minnesota, was founded in
1984 and has evaluated over ten thousand adult and pediatric patients. They
evaluate approximately six hundred new patients annually. Their team of
nutrition specialists includes home enteral (HEN) dietitians, nutrition
physicians, nurses, and pharmacists who follow patients in the outpatient and
hospital setting. Team members work closely with patients and caregivers;
endoscopists and surgeons placing tubes; primary clinicians; and home medical
equipment companies. They develop individual nutrition plans to address the
nutrition program, hydration, feeding tube selection and care, medication
administration through feeding tubes, and comprehensive individualized
education. Their team also arranges HEN supplies and equipment.
coordinators and nutrition physicians include Adele Pattinson, RD, LD; Lisa Epp,
RD, LD; M. Molly McMahon, MD (Practice Chair of Nutrition); and Maria L.
Collazo-Clavell, MD (Chair of the Ambulatory Nutrition Physician Group). For
Updated February 2013
Children’s Mercy Hospital
Intestinal Rehabilitation Center
Kansas City, Missouri
The Intestinal Rehabilitation
Center at Children’s Mercy Hospital in Kansas City offers nutritional care to
children with intestinal failure. The center is the product of the collaboration
of the Department of Pediatric Gastroenterology and Pediatric/Transplant
Surgery. The multidisciplinary team consists of pediatric specialists with
experience in the care and management of patients with short bowel syndrome and
The center provides both
medical and surgical therapies to these groups of individuals. Their team
consists of gastroenterologists, pediatric surgeons, nurse practitioners, a
dietitian, a pharmacist, a social worker, and a psychologist. Joel Lim, MD, is
the Medical Director, and Richard Hendrickson, MD, is the Surgical Director.
program can be reached by calling (800) 806-8544.
Rehabilitation Program at the University of Nebraska Medical Center became
formally organized and incorporated the former Nutrition Restart Center (Boston) protocols and patient
follow-up in 2000. Prior to that, the surgeons, gastroenterologists, nurses, and
dieticians in the program had worked together informally on the care of patients
with short bowel syndrome (SBS) and intestinal disorders. Program staff include
Dr. Debra Sudan, Dr. Jon Thompson, and Dr. Richard Gilroy, who are international
leaders in the treatment of patients with intestinal failure.
The primary focus of
the program is weaning patients from TPN. Through in-patient and outpatient programs, the team teaches dietary
modifications and monitors patients to safely wean them. For patients who are
not candidates for weaning, they provide ongoing medical support and management.
Patients can also participate in research.
The center has
extensive experience in surgical therapy for patients with SBS. More than 60
percent of patients who have undergone surgical intestinal lengthening
procedures have been able to discontinue TPN. It is now twenty-four years since their longest survivor underwent such
Through these close
associations, the program can be aggressive in medical and surgical
interventions, resulting in the reversal of liver disease and clearing of
jaundice in patients who would otherwise have required transplantation. However,
the university has one of the oldest and most experienced intestinal transplant
programs as well. High-risk patients are closely monitored during their weaning
process; if the complications are not reversing, they may be placed on a waiting
list and undergo intestinal transplantation when appropriate.
The program includes
both adult and pediatric facets, with dedicated dieticians and nurse
The program can be reached by calling (800) 548-3701 or by
visiting their Web site,
Since the days when Dr. Burell Crohn first described inflammatory bowel (“Crohn’s”)
disease at Mount Sinai Medical Center in New York, the center has had a
tradition of GI and transplant excellence. It was one of the earliest intestinal
transplant centers in the country, with the first intestinal transplants in New
York State performed there in 1997. Twelve years and 120 intestinal transplants
later, under the current directorship of Kishore Iyer, MBBS, FRCS, FACS,
intestinal transplantation is placed firmly within a multi-disciplinary
Intestinal Rehabilitation Program. At a time when intestinal transplant volumes
at Mount Sinai continue to grow, transplant represents less than 20 percent of
the Intestinal Rehabilitation Program’s activity.
The program’s successes over the last two years, with a new but mature team,
relate to comprehensive multi-disciplinary representation. The adult
gastroenterology/hepatology services are led by Tom Schiano, MD, and Lauren
Schwartz, MD, with specific expertise and training in liver disease and advanced
nutrition support. Pediatric GI/liver services are led by Tamir Miloh, MD,
backed by a team of pediatric hepatologists led by Frederick Suchy, MD. The
program’s nursing and nutrition coordinators are led by Christine Chamberlain,
RN. A team of social workers that understands the complexities of intestinal
failure provides support for families and consumers. Consultants in closely
allied services like infectious disease and interventional radiology are
integral parts of the program.
An active child-life program provides respite, distraction, and stimulation for
younger patients. For families coming from out of state, a subsidized Transplant
Living Center is available as a “home away from home.”
The Cleveland Clinic Nutrition Support Team (NST) and Home
Parenteral Nutrition (HPN) program was established in 1975 by Ezra Steiger, MD,
who serves as the Acting Director of the NST and Director of the Intestinal
Rehabilitation Program founded in 2001. Le-Chu Su, MD, PhD, a
gastroenterologist, joined the NST in 2004 and works with the team to oversee
the management of patients requiring PN and/or intestinal care. Dr. Cristiano
Quintini, a liver and small bowel transplant surgeon, joined the Cleveland
Clinic NST in August 2007. Under his direction, the Cleveland Clinic has started
to evaluate patients for intestinal and multivisceral transplantation.
The home parenteral nutrition (HPN) program at the Cleveland Clinic is one of
the largest HPN programs in the United States. There are presently over one
hundred HPN consumers being cared for each day. The efforts of the program are
supported by two dietitians, two nurses, and a pharmacist, social worker, case
manager and secretary. In addition, the team works closely with interventional
radiologists with expertise in catheter placement and infectious disease
specialists who help manage catheter infections.
The Cleveland Clinic Intestinal Rehabilitation and Transplantation Program
offers a comprehensive, multidisciplinary approach to the treatment of severe
gastrointestinal dysfunction. An extensive assessment is performed to determine
the absorptive function of the gastrointestinal (GI) tract and to determine if
any nutritional deficiencies have developed. Individualized dietary instruction
is provided to teach patients about the diet that will be most readily absorbed.
Medications and supplements are prescribed to improve digestive and absorptive
function of the remaining bowel and consideration is given to the use of growth
factors to stimulate bowel adaptation. Patients are also evaluated to determine
the need for further surgical procedures including operations to restore
intestinal continuity, lengthen remaining intestine, and reconstruct or reverse
previous surgical procedures.
A visit to the Cleveland Clinic Intestinal Rehabilitation and Transplantation
program gives patients access to internationally recognized expertise in
nutrition support, gastroenterology, colorectal surgery, general surgery and
transplantation. Colorectal and general surgeons and gastroenterologists work
with the NST to manage the medical and surgical needs of patients with stomas,
fistulas, obstructions and inflammatory bowel disease. The Cleveland Clinic NST
and its supporting departments and programs also lead research in the area of
nutrition support and intestinal failure to advance the understanding of short
bowel syndrome and explore options to prevent and treat complications of PN.
Patients unable to adequately respond to therapeutic attempts at intestinal
rehabilitation or patients with severe PN-related complications have the option
of undergoing intestinal or multivisceral transplantation at the Cleveland
Intestinal Support Service (ISS) at Nationwide Children’s Hospital was
established in 2004 with the goal of providing exemplary care to a select group
of patients who have had significantly impaired intestinal function. This
includes those with short bowel syndrome, necrotizing enterocolitis, intestinal
atresias, abdominal wall defects, volvulus, long-segment Hirschsprung’s disease,
and other disorders that have resulted in the need for parenteral or enteral
offers a dedicated inpatient service staffed by members of the ISS as well as
comprehensive outpatient care. In addition to pediatric surgical and
interventional radiology expertise, Nationwide has a nationally recognized
motility team. While there is not an intestinal transplant program at Nationwide
Children’s Hospital, they have a close relationship with several transplant
programs, which allows children and families to remain closer to home prior to
transplant and once they are stable following transplant.
inception, the ISS has provided care for more than two hundred patients. The
majority of children Nationwide has cared for are able to wean from parenteral
nutrition to either all oral or a combination of oral and enteral feedings. The
time it takes to reach this goal varies from one person to another.
team members include Jane Balint, MD; Molly Dienhart, MD; Steven Teich, MD;
Sandra Jacobs, CNP; Patti Kegley, RN; Lia Headings, RN; Mary Kay Sharrett, RD;
Steve Plogsted, PharmD; Lynn Gutches, MSW; and Mindy Johnson.
ISS by calling Mindy Johnson at (614) 722-3485 or through their Web site,
The Nutrition and Intestinal Care Center at
Cincinnati Children’s Hospital Medical Center is a comprehensive center for the
management of patients with complex intestinal and liver disease. It combines
long-standing expertise in nutritional guidance, medical and surgical
intervention, liver transplantation, and recent advances in intestinal
transplantation to optimize the care of children with intestinal failure.
The center is led by pediatric gastroenterologist
Samuel Kocoshis, MD, and surgeons Maria Alonso, MD, and Frederick Ryckman, MD.
Patients are thoughtfully evaluated to ascertain whether intestinal
rehabilitation via nutritional and/or pharmacologic methods or non-transplant
bowel rehabilitative surgery is feasible, or if the patient will require
intestinal transplant. More than 300 liver transplants have been performed at
Cincinnati Children’s since 1986, and in 2003, the center performed its first
combined liver and intestinal transplant. The center’s small bowel transplant
program is the first program in the nine-state Midwest region designated by the
United Network for Organ Sharing (UNOS).
The center offers a range of multidisciplinary
services, from evaluation and diagnosis to nutritional, medical, and/or
surgical care to patient/family education and support groups. The center’s team
includes pediatric and transplant surgeons, pediatric gastroenterologists,
gastroenterology nurse coordinators, dietitians, social workers, and pastors.
Staff home care personnel can tap into local resources in the patient’s area
and ensure coordinated care when the patient returns home.
Cincinnati Children’s is also committed
to making a safe and effective transfer of research from the laboratory to
patient care, and researchers at the center are actively involved in several
ongoing research projects.
More information is available at
University of Pittsburgh
Intestinal Rehabilitation and Transplantation Center
The Intestinal Rehabilitation and
Transplantation Center at the University of Pittsburgh’s Thomas E. Starzl
Transplantation Institute provides care for adults and children with intestinal
failure. The program was established by Kareem M. Abu-Elmagd, MD, PhD, FACS, in
1990, and provides enteral and parenteral nutrition, intestinal rehabilitation,
and when needed, intestinal and multivisceral transplantation. The program
offers a full multidisciplinary team approach for both the pediatric and adult
components; the team may include transplant surgeons, gastroenterologists,
clinical fellows, nutritionists, pharmacists, physician assistants, nurse
coordinators, case managers, social workers, research coordinators, and other
support staff. These professionals have extensive experience in managing clients
who are unable to maintain their nutritional status through an oral diet as a
result of severe malabsorption or intestinal obstruction. The pediatric crew,
under the leadership of George Mazariegos, MD, is expanding its experience to
include neonates and premature babies with congenital and acquired intestinal
failure who need prompt comprehensive medical and surgical therapy.
The team approaches every individual case with
the hope to discontinue parenteral nutrition and resume full enteric support.
Some patients may be candidates for intestinal rehabilitation without the need
for transplantation. Different regimens, including diet modification, medical
supplements, growth factors, and reconstructive surgery, may be used in an
attempt to maximize nutrient absorption and minimize or eliminate the need for
parenteral nutrition. When intestinal rehabilitation is not an option or the
patient fails to respond to these therapeutic attempts, intestinal and
multivisceral transplantation is offered. The center has the largest series of
intestinal and multivisceral transplants in the world with the longest
For more information about our programs visit
www.upmc.com/services/transplant/abdominal-transplants/intestinal-rehabilitation-transplant/pages/default.aspx or call
toll-free (877) 640-6747.
at LeBonheur Children’s Hospital and the University of Tennessee Health Science
Center have managed inpatient and home parenteral and enteral nutrition (HPEN)
in children with short bowel syndrome (SBS) and other gastrointestinal and
surgical disease states for more than thirty years.
The Children’s Intestinal
Rehabilitation Center at LeBonheur (CIRCLe) was established in 2007. It is a
multidisciplinary and interprofessional team, representing pediatric
gastroenterology and surgery, neonatology, clinical pharmacy, clinical nutrition
(dietitians), and nursing. CIRCLe’s stated primary goal is to standardize and
optimize clinical management of patients with SBS through an evidence-based,
integrated, and interprofessional approach to patient care.
Major CIRCLe initiatives
are intestinal rehabilitation through surgical interventions, enteral feeding
success, and continual assessment; and management of long-term PEN to sustain
growth while decreasing catheter-related infections and hospitalizations,
intestinal failure–related liver disease, and nutrient deficiencies. SBS
patients in the community are managed through the CIRCLe clinic and the team
comes together monthly to discuss management of all SBS patients, inpatient and
outpatient, and their progress toward intestinal rehabilitation.
Research endeavors have
been directed toward altering the progression of intestinal failure through
innovative therapies, improved nutrient absorption, and reduced complications.
The center does not perform intestinal transplantation.
For more information
contact CIRCLe Coordinator, Ila McDonald, RN at (901) 287-6392.
Intestinal Rehabilitation Program at the Vanderbilt Center for Human Nutrition
provides evaluation and nutritional care to undernourished patients and patients
with intestinal failure. The center has extensive experience in providing care
to patients with short bowel syndrome, inflammatory bowel disease, malabsorption,
fistulas, radiation enteritis, bowel obstruction, ischemic bowel disease, and
eating disorders. The center’s mission is to deliver high quality care through
the combined efforts of a multidisciplinary team of health and research
and nurse practitioner nutrition specialists work closely with dietitians,
nurses, and pharmacists to offer medical evaluation, nutrition assessment,
individualized interventions, and follow-up monitoring. Therapeutic intervention
and management includes surgery for intestinal reconstruction, medications to
optimize nutrient absorption, placement of feeding tubes, and placement of
central venous access devices. Psychosocial issues are addressed by experienced
individuals who work in the program. Long-term monitoring is available for
consumers who require HPN, parenteral fluids, HEN, and specialized dietary
modification. A primary goal of the program is to minimize the patient’s
dependency on HPN. The program cares for an average of forty to fifty HPN
The Center for Human
Nutrition staff includes Douglas L. Seidner, MD, FACG, CNSP, Director,
gastroenterologist; Brian Collier, DO, CNSP, FACS, Co-director, surgeon;
Lawrence Gaines, PhD, psychologist; Vanessa J. Kumpf, PharmD, BCNSP, pharmacist;
Amy C. Lynch, MS, RD, CNSC, LDN, dietitian; Kimberly Currier, RN, MSN, NP, nurse
practitioner; Tanya Givens, RN, research nurse; and Mary Smith, RN, nutrition
University of Virginia
Digestive Health Center of Excellence
In the GI Nutrition clinic at the Digestive Health Center of Excellence at the
University of Virginia Health System, registered dietitians work with referring
physicians to provide specialized nutrition therapy and education for patients.
The GI nutritionists specialize in evaluating and developing nutrition care
plans for patients with the following conditions: malabsorption (might include
persistent diarrhea, continued unintentional weight loss, or inability to gain
weight, or be associated with altered anatomy from GI surgeries, such as
gastrectomy, Whipple procedure, roux-en-y, gastrojejunostomy); pancreatic
insufficiency; short bowel syndrome; unmanageable ostomy or stool output; and
gastroparesis with severe weight loss. The GI Nutrition clinic also evaluates
and develops nutrition care plans for those with supplemental or total
dependence on enteral (EN) or parenteral (PN) feedings who desire a reevaluation
of overall nutrition status and potential improvement on their existing plan, or
a desire to wean off of tube feeding or PN.
Since the GI Nutrition clinic’s inception ten years ago, the team has provided
consultation to over 2000 patients with these conditions. The GI nutrition
experts at the clinic are Carol Rees Parrish, MS, RD, and Nora Decher, MS, RD,
For more information about the clinic, contact Robert Fitzgerald,
administrative assistant, at (434) 243-4749 or
firstname.lastname@example.org, or visit their Web