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Program Descriptions

The Mayo Clinic
HomePEN Management Team

Scottsdale, Arizona

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 person’s case.

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 services.

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.

Updated 12/1/11

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 infusion therapies.

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 nsler@mednet.ucla.edu.

Children’s Hospital of Los Angeles
Intestinal Rehabilitation Program

Los Angeles, California

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 2008.

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 social worker.


For further information or an appointment, nurse coordinators can be reached at (323) 361-5694 or ccox@chla.usc.edu.

British Columbia Home Parenteral and Enteral Nutrition Program
British Columbia and the Yukon, Canada

The 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. 

The 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 intestinal failure.

Our 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.

For more information about the BC HPEN Programs, please visit www.bchomenutrition.org, e-mail us at homePEN@vch.ca or call us at 1-877-806-9353 (604-806-9353).

MedStar Georgetown Transplant Institute
Center for Intestinal Care and Transplant

Washington, D.C.

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 previous surgery.

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.

University of Miami, Miller School of Medicine
Intestinal Rehabilitation and Liver/GI Transplant Division

Miami, Florida

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 (305) 355-5000.

Children’s Healthcare of Atlanta at Egleston/Emery University
Intestinal Rehabilitation Program

Atlanta, Georgia

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.


Information about our services can be found at www.pediatrics.emory.edu/divisions/gastroenterology/resource.html.

Transplant/Indiana University Health
Indianapolis, Indiana

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 metzgel@mail.amc.edu 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 iuhealth.org/transplant/

Updated 3/6/14

Boston Children’s Hospital
Center for Advanced Intestinal Rehabilitation

Boston, Massachusetts

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: www.childrenshospital.org/hpn or  e-mail us at hpn@childrens.harvard.edu or call us at (617) 355-6439.

Mayo Clinic – HPN

Rochester, Minnesota

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 catheter experience.

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

Detroit, Michigan

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 emergencies.

Updated June 2014

Mayo Clinic – HEN

Rochester, Minnesota

The Home 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.

HEN dietitian 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 more information,

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 intestinal disorders.

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.


The program can be reached by calling (800) 806-8544.

University of Nebraska Medical Center
Intestinal Rehabilitation Program

Omaha, Nebraska

The Intestinal 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 a procedure.

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 coordinators.


The program can be reached by calling (800) 548-3701 or by visiting their Web site, www.nebraskamed.com/transplant/intestine-rehab.aspx.

Mount Sinai Medical Center
New York, New York

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.”

Cleveland Clinic

Cleveland, Ohio

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 Clinic.

Nationwide Children’s Hospital
Intestinal Support Service

Columbus, Ohio

The 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 nutrition support.

Nationwide 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.

Since its 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.

ISS core 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.

Contact the ISS by calling Mindy Johnson at (614) 722-3485 or through their Web site, www.nationwidechildrens.org/intestinal-support-service.

Cincinnati Children’s Hospital Medical Center
Nutrition and Intestinal Care Center

Cincinnati, Ohio

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 www.cincinnatichildrens.org/intestine.

University of Pittsburgh
Intestinal Rehabilitation and Transplantation Center

Pittsburgh, Pennsylvania

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 survivors.


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.

The Children’s Intestinal Rehabilitation Center at LeBonheur (CIRCLe)

Memphis, Tennessee

Nutrition-based clinicians 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.

Vanderbilt University Medical Center
Intestinal Rehabilitation Program

Nashville, Tennessee

The 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 professionals.

Physician 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 patients.

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 support nurse.

University of Virginia
Digestive Health Center of Excellence

Charlottesville, Virginia

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, CNSC.


For more information about the clinic, contact Robert Fitzgerald, administrative assistant, at (434) 243-4749 or rf7r@virginia.edu, or visit their Web site, www.ginutrition.virginia.edu.

Updated March, 2014

This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.


Updated in 2015 with a generous grant from Shire, Inc. 


This website was updated in 2015 with a generous grant from Shire, Inc. This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.
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