About Your Visit

Prior to Your Visit....
The Northwestern  Intestinal Rehabilitation and Transplant Center is a unique multidisciplinary program that includes a gastroenterologist, transplant surgeon, dietitian, nurses, and a pharmacists.  You will see each during your visit.  Your first step should be to contact us, or to have your regular physician contact us.  We’d like to know what problems you are experiencing, and which are the most urgent.  You will need to have a complete set of your medical records sent to us to review.  Preferably, this should be done prior to your visit.  Specifically, we want a copy of the operative report for each abdominal surgery you’ve had, your most recent laboratory results and other relevant tests.  For recent CT, MRI, or other abdominal x-rays, we’d like a CD of the actual films, in addition to the reports.  These can be obtained from the radiology department of the hospital where they were performed.  In addition, if you have inflammatory bowel disease (Crohn’s disease, ulcerative colitis) or other significant pathology of your intestine, we will need to review your most recent biopsies.  We will need the actual slides.  These can be obtained by contacting the pathology department where your endoscopies or surgeries were performed.  In general, the pathology department will send the slides do us directly.  We will return them after our review is completed.

If you are coming from outside the area, please contact us for an estimate of the length of time you will need to be in Chicago for your evaluation.  This time period may vary depending on your diagnosis, and what testing you’ve already had performed, and what we estimate we will need to do.  Note that after seeing you in our clinic, we may determine additional testing may be required, which may lengthen your stay or require another visit.

Please contact us to that we may assist you with hotel accommodations and other logistics.

During Your Visit...
The Intestinal Rehabilitation and Transplant Clinic meets Thursday afternoons in the Gastroenterology area of the Galter Outpatient Pavilion of Northwestern Memorial Hospital (251 W. Huron St, 17th floor).  Depending on your medical issues, you may be initially seen on Monday morning or afternoon if testing needs to be completed prior to your Thursday clinic visit.  If that is the case, you will be initially assessed by our gastroenterologist and nurse.  During the Thurs clinic visit you will meet with the full team, who will review your test results, and determine an appropriate treatment plan, as well as determine if additional evaluation is necessary (for example, if you will need to undergo a full intestinal transplant evaluation).  You will receive dietary information, as well instructions for a specific medical and/or surgical plan from the clinic physicians,  nurses, and dietitians.  We will discuss, as appropriate medical management, non-transplant surgical options, and intestinal transplant options as we feel are most appropriate.  Your PN prescription will be reviewed if you receive PN, and adjustments made.  Appropriate follow-up visits will be scheduled.  A copy of our report will be sent to your regular physician and others you feel should receive it.

Follow-Up...

The purpose of our Intestinal Rehabilitation Program is to optimize the function of the remaining small bowel, with the intent of eliminating or decreasing the patient’s dependence on parenteral nutrition. Defining a timeline and algorithm is a critical step to a successful program, as it facilitates the decision making process and streamlines patient care with timely and effective treatment approaches. This process also helps identify which patients would benefit from intestinal transplantation.

Our program is based on a 4-stage algorithm with specific goals and timelines to improve efficiency and utility. Patients who meet the criteria for intestinal rehabilitation and/or intestinal transplantation are defined as follows:

  1. Have been receiving, or are expected to receive, parenteral nutrition for > 1 year
      1. < 200 cm of small bowel remaining
      2. >200 cm with diagnosis of Crohn’s disease, radiation enteritis, Desmoid tumor, Familial Polyposis, CHIPS, mesenteric venous thrombosis
  2. No active malignancy
  3. No significant co-morbidities that exclude them as candidates for intestinal rehabilitation or transplantation

We defined our parenteral nutrition weaning algorithm and timeline into 4 phases:

  1. Stabilization (1 month): Fluid and parenteral nutrition needs defined and their provision modified until stable state achieved. Diet, oral rehydration drinks, and anti-motility drugs initiated and optimized. Intestinal rehabilitation candidacy determined and patient-specific plan created. Baseline parameters obtained.
  1. Optimization (3-6 months): Interventions may include: surgical strategies (gut lengthening, re-anastomosis, etc.), hormonal strategies (growth hormone, etc), and dietary reeducation.
  1. Weaning (1-3 months): Weekly parenteral nutrition weaning with goal of decreasing burden as much as possible. Includes weekly monitoring of weight, vital signs, urine/ stool output, fluid and dietary intake, anti-motility medication needs, clinical status, and monitoring of laboratory values including vitamins and trace elements.
  1. Triage (1-3 months): Evaluation of success or failure of weaning with 3 patient categories: (i) freedom from parenteral nutrition, (ii) partial parenteral nutrition reduction, (iii) no parenteral nutrition reduction.

Patients who are weaned from parenteral nutrition are monitored weekly until stable, upon which time they are evaluated quarterly for one year to ensure they do not develop nutritional deficiencies. In patients for whom all appropriate avenues for achieving freedom from parenteral nutrition have been attempted, intestinal transplantation is considered.