Secondary Logo

Journal Logo

Letters to the Editor

Nutritional Benefit of Recycling of Bowel Content in an Infant With Short Bowel Syndrome

Tanaka, Aya; Nakayama-Imaohji, Haruyuki; Shimono, Ryuichi; Suzuki, Motoo; Fujii, Takayuki; Kubo, Hiroyuki; Yasuda, Saneyuki; Koyano, Kousuke; Nakamura, Shinji§; Katsuki, Naomi||; Kuwahara, Tomomi

Author Information
Journal of Pediatric Gastroenterology and Nutrition: September 2017 - Volume 65 - Issue 3 - p e75-e76
doi: 10.1097/MPG.0000000000001630
  • Free

To the Editor: Short bowel syndrome (SBS) is a major cause of intestinal failure (1). A proximal stoma is often constructed in patients with this condition. Recycling of bowel content (RBC) is a procedure that involves injection of chyme discharged from the proximal side of a stoma into the distal side (2–7). RBC is expected to salvage unabsorbed nutrients, facilitate maturation of intestinal function, and alter the gut microflora downstream of the stoma. We report on the effects of RBC on nutrition status, bowel maturation, and microbial composition of the gut in an infant with SBS. Potential benefits of adding synbiotics are also addressed.

A female infant with meconium peritonitis underwent extensive intestinal dissection with construction of a double-looped ileostomy, leaving 58 cm of the small intestine and an intact colon. RBC combined with synbiotic therapy (Clostridium butyricum, Bifidobacterium bifidum, and partially hydrolyzed guar gum) was started, weight gain improved and parental nutrition requirements decreased by 78% (Fig. 1). There was significant maturation of the intestinal mucosa with improved ileal villus length (205.36 ± 20.3 vs 555.34 ± 61.92 μm, P = 0.0016), width (64.67 ± 11.21 vs 118.93 ± 19.47 μm, P = 0.0016), and crypt depth (101.98 ± 8.99 vs 242.9 ± 15.857 μm, P = 0.0016). Diversity of the fecal microbiota was assessed periodically by using 16S ribosomal RNA gene sequencing and increased in response to RBC and synbiotic therapy, with the pattern of the microbiota becoming similar to that in healthy age-matched infants. In our case, RBC combined with synbiotic treatment may have improved nutritional status by preventing distal bowel atrophy and establishing a symbiotic intestinal microbiota.

Clinical course in an infant with short bowel syndrome. Temporal changes in the amount of recycled bowel content, average weight gain, daily weight, and caloric intake per kilogram in relationship to parental and enteral feedings are shown. RBC = recycling of bowel content.


1. Goulet O, Ruemmele F. Causes and management of intestinal failure in children. Gastroenterology 2006; 130:s16–s28.
2. Gardner VA, Walton JM, Chessell L. A case study utilizing an enteral refeeding technique in a premature infant with short bowel syndrome. Adv Neonatal Care 2003; 3:258–271.
3. Lydia R, Sujoy B, Heike R. What is the evidence on the practice of mucous fistula refeeding in neonates with short bowel syndrome? J Periatr Gastroenterol Nutr 2006; 43:267–270.
4. Puppala BL, Mangurten HH, Kraut JR, et al. Distal ileostomy drip feeding in neonates with short bowel syndrome. J Pediatr Gastroenterol Nutr 1985; 4:489–494.
5. Schafer K, Zachariou Z, Loffler W, et al. Continuous extracorporeal stool-transport system: a new and economical procedure for transitory short-bowel syndrome in prematures and newborns. Pediatr Surg Int 1997; 12:73–75.
6. Al-Harbi K, Walton JM, Gardner V, et al. Mucous fistula refeeding in neonates with short bowel syndrome. J Pediatr Surg 1999; 34:1100–1103.
7. Wong KKY, Lan LCL, Lin SCL, et al. Mucous fistula refeeding in premature neonates with enterostomies. J Pediatr Gastroenterol Nutr 2004; 39:43–45.
Copyright © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition