Annals of Clinical Nutrition and Metabolism

Sanghoon Lee

5 Articles

Vitamin D Deficiency is Prevalent in Short Bowel Syndrome Patients on Long-Term Parenteral Nutrition Support: SungHyo An, Sanghoon Lee, Hyun-Jung Kim, Hyo Jung Park, Jeong-Meen Seo; J Clin Nutr 2021;13(1):12-16. Published online June 30, 2021; DOI: https://doi.org/10.15747/jcn.2021.13.1.12

Abstract PDF: Purpose: Short bowel syndrome (SBS) is the most common etiology for intestinal failure (IF) and these patients are at high risk of developing micronutrient deficiencies. This study aimed at assessing the level of vitamins in adult SBS patients at different stages of their disease before the initiation of multidisciplinary intestinal rehabilitation.
Methods: Patient data from November 2015 to March 2017 were retrospectively reviewed. Adult patients who underwent extensive bowel resection and were classified as SBS-IF were selected. Clinical data including age, sex, etiology of IF, biochemical data, nutritional status, nutrition support, and outcome of intestinal rehabilitation were analyzed.
Results: Nine patients with SBS-IF were included in the analysis. There were 6 male patients and 3 female patients, with a median age of 55.0 years. Vitamin levels were analyzed at 306 days (median) after the development of SBS. At the time of vitamin levels screening, 4 patients were receiving daily intravenous vitamin supplementation. Five patients were not receiving vitamin supplementations, either intravenously or orally. Vitamin B12 was within the normal range in 6 patients and higher than normal in 3 patients. Vitamin D was within the normal range in 3 patients and lower than normal in 6 patients. Vitamin E was within the normal range in 7 patients and higher than normal in 2 patients. Folate was within the normal range in 8 patients (not checked in 1 patient). Ambulatory patients had significantly higher vitamin D levels compared to hospitalized patients (P=0.015).
Conclusion: Vitamin D levels had decreased in 67% of patients with SBS in Korea, while vitamin B12, folate, and vitamin E deficiencies were rarely seen.

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Nutritional Therapy Related Complications in Hospitalized Adult Patients: A Korean Multicenter Trial: Eun-Mi Seol, Kye Sook Kwon, Jeong Goo Kim, Jung-Tae Kim, Jihoon Kim, Sun-Mi Moon, Do Joong Park, Jung Hyun Park, Je Hoon Park, Ji Young Park, Jung-Min Bae, Seung Wan Ryu, Ji-Young Sul, Dong Woo Shin, Cheung Soo Shin, Byung Kyu Ahn, Soo Min Ahn, Hee Chul Yu, Gil Jae Lee, Sanghoon Lee, A Ran Lee, Jae Young Jang, Hyun Jeong Jeon, Sung Min Jung, Sung-Sik Han, Suk-Kyung Hong, Sun-Hwi Hwang, Yunhee Choi, Hyuk-Joon Lee; J Clin Nutr 2019;11(1):12-22. Published online June 30, 2019; DOI: https://doi.org/10.15747/jcn.2019.11.1.12

Abstract PDF: Purpose:
Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking.
Methods:
Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients’ demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected.
Results:
A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m². The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay.
Conclusion:
NT may induce or be associated with several complications, and some of them may seriously affect the patient’s outcome. NST personnel in each hospital should be aware of each problem during nutritional support.

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Multidisciplinary Intestinal Rehabilitation for Short Bowel Syndrome in Adults: Results in a Korean Intestinal Rehabilitation Team: Sojeong Yoon, Sanghoon Lee, Hyo Jung Park, Hyun-Jung Kim, Jihye Yoon, Ja-Kyung Min, Jeong-Meen Seo; J Clin Nutr 2018;10(2):45-50. Published online December 31, 2018; DOI: https://doi.org/10.15747/jcn.2018.10.2.45

Abstract PDF: Purpose:
Intense multidisciplinary team effort is required for the intestinal rehabilitation of patients afflicted with the short bowel syndrome (SBS). These include enteral and parenteral nutrition (PN) support, monitoring of complications related to treatment, and considering further medical or surgical options for intestinal adaptation.
Methods:
In the Intestinal Rehabilitation Team (IRT) at the Samsung Medical Center, we have experienced 20 cases of adult SBS requiring multidisciplinary intestinal rehabilitation. This study is a retrospective review of the collected medical records.
Results:
Of the 20 subjects treated, 12 patients were male and 8 patients were female. At the time of referral to the IRT, the mean age was 51.5 years, and the mean body weight was 50.1 kg, which was 90% of the usual body weight. The diseases or operative managements preceding massive bowel resection were malignancy in 11 cases, cardiac surgery in 2 cases, trauma in 2 cases and one case, each of tuberculosis, corrosive esophagitis, atrial fibrillation, simultaneous pancreas and kidney transplantation, and perforated appendicitis. Of these, there were 14 survivals and 6 mortalities. The fatalities were attributed to progression of disease, intestinal failure-associated liver disease, and sepsis (unrelated to intestinal failure) (2 cases each). Among the 14 surviving patients, 8 patients have been weaned off PN, whereas 6 are still dependent on PN (mean PN dependence 36%).
Conclusion:
This paper reports the results of multidisciplinary intestinal rehabilitation of adult short bowel patients treated at the Samsung Medical Center. Further studies are required to improve survival and enteral tolerance of these patients.

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Early Experience with Serial Transverse Enteroplasty in a Korean Intestinal Rehabilitation Team: Jiyoon Hong, Sang Oh Yun, Sanghoon Lee, Hyun-Jung Kim, Hyo Jung Park, Jeong-Meen Seo; Surg Metab Nutr 2018;9(1):11-15. Published online June 30, 2018; DOI: https://doi.org/10.18858/smn.2018.9.1.11

Abstract PDF: Purpose:

For patients with short bowel syndrome, surgery can play an important role in the management of intestinal failure (IF). Serial transverse enteroplasty (STEP) has become a popular choice of bowel lengthening among surgeons for its safety and effectiveness in improving enteral autonomy. In this study, we report 5 cases of STEP procedure on 4 patients.

Materials and Methods:

In the Intestinal Rehabilitation Team at Samsung Medical Center, all patients were managed by a multidisciplinary team specialized in the care of intestinal failure patients. Retrospective review of medical records was performed.

Results:

3 patients were children and 1 patient was an adult. Improvement in enteral autonomy was achieved in all patients following each STEP procedure. Suspected suture line leakage was seen in one patient, which was successfully managed by conservative treatment There were no other serious complications related to the procedures.

Conclusion:

STEP procedure continues to be an important management option in intestinal rehabilitation of patients with extreme short bowel. We report a small series of STEP performed safely and effectively in Korea.

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Intestinal Rehabilitation after Extensive Bowel Resection in Post-Gastrectomy Patients: Seung Rim Han, Sanghoon Lee, Chae-Youn Oh, Hyun-Jung Kim, Hyo Jung Park, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Jeong-Meen Seo; Surg Metab Nutr 2015;6(2):33-37. Published online December 30, 2015; DOI: https://doi.org/10.18858/smn.2015.6.2.33

Abstract PDF: Purpose:
Surgical complications requiring massive bowel resection after gastrectomy are rare. However, when such an event occurs the patient may develop short bowel syndrome and intestinal failure. We report our experience of intestinal rehabilitation in four post-gastrectomy patients.
Materials and Methods:
From January 2011 to June 2014, four cases of short bowel syndrome were identified in post-gastrectomy patients. All patients were managed by a multidisciplinary team specialized in the care of intestinal failure patients. Patients’ medical records were reviewed retrospectively.
Results:
The original diagnosis was early gastric cancer in all patients. One patient had synchronous esophageal cancer. Patients required extensive bowel resection due to bowel strangulation from internal herniation (3 cases), superior mesenteric artery torsion (1 case). Remnant small bowel length ranged from 10 cm to 80 cm and partial resection of the colon was performed in three cases. One patient received serial transverse enteroplasty (STEP) and one patient is receiving continuous enteral feeding via surgical gastrostomy. There were no cases of intestinal failure-associated liver disease. Two patients are receiving home parenteral nutrition in varying degrees. Two patients have been weaned off parenteral nutrition.
Conclusion:
Four post-gastrectomy patients with short bowel syndrome were managed. Despite application of various medical and surgical measures, weaning off parenteral nutrition was difficult in these patients.

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