Those who should consider intestinal rehabilitation include individuals:
- With short bowel syndrome
- With malabsorption syndrome
- With intestinal failure or severe gastrointestinal dysfunction
- Seeking to reduce of eliminate the need for parenteral nutrition
- Struggling to maintain their weight or nutritional status (including hydration) without relying on intravenous fluid
- Having repeated episodes of inflammatory bowel disease which interferes with maintaining a normal nutritional status
- With chronic diarrhea, dehydration or weight loss due to malabsorption
- With intestinal disease (e.g., crohn’s disease, radiation enteritis)
- Who need to reduce diarrhea and control stool output
- Who need to gain weight
The goal of The Center for Gut Rehabilitation and Transplantation (CGRT) is to improve function of any remaining bowel, so that a patient can return to a more normal life. The staff and clinicians accomplish this with intensive nutrition counseling, oral rehydration solutions, techniques using enteral feeding, medications, growth factors, and, sometimes, restorative surgery.
An individual seeking consultation from the CGRT can expect to go through a comprehensive assessment to determine the absorptive function of the gastrointestinal tract and establish if any nutritional deficiencies exist. A diet prescription can then be personalized based on the structure and function of the remaining gastrointestinal tract. Intensive diet instruction is provided to teach which foods and liquids will be most readily absorbed. Medications are also prescribed to improve digestive and absorptive function of the remaining bowel. A small number of patients have been found to have bowel out-of-circuit as a result of previous surgery. Sometimes, this can be put back into continuity with the rest of the usable bowel, so that absorptive function can be improved.
The Center for Gut Rehabilitation and Transplantation can also assist with enhancing bowel adaptation in patients with intestinal failure in order to decrease reliance on parenteral nutrition. Additionally, these patients may be candidates for growth factors to help promote adaptation of the bowels and decrease their reliance on parenteral nutrition.
Karen Giaco, MS, RD, LD, CNSD
Title: Manager, Home Nutrition Support and Center for Gut Rehabilitation and Transplantation
Education: MS Nutrition and Dietetics, University of Akron, Ohio; BS Chemistry, John Carroll University, University Heights, Ohio; Coordinated Undergraduate Program: University of Akron, Ohio
Specialty Area: Home Parenteral Nutrition, Nutrition Support
Other: Member of American Society of Parenteral and Enteral Nutrition; Member of Ohio Society of Parenteral and Enteral Nutrition; Member of Academy of Nutrition and Dietetics; Clinical Nutrition Management DPG; Member of Ohio Dietetic Association
Neha Parekh, MS, RD, LD, CNSC
Title: Project Manager, The Center for Gut Rehabilitation and Transplantation
Education: M.S. Nutrition, New York University, NY
BS Food, Nutrition & Dietetics, Case Western Reserve University, Cleveland, OH
Dietetic Internship: Bronx VA Medical Center, NY
Specialty Area: Intestinal Rehabilitation, Intestinal Transplant, Short Bowel Syndrome, Intestinal Failure, Intestinal Failure-Associate Liver Disease, Small Bowel Bacterial Overgrowth, Intestinal Dysmotility, Renal Oxalate Stones, Plasma Citrulline, Malabsorption, Gastrointestinal Nutrition, Home Nutrition Support, Parenteral Nutrition, Enteral Nutrition, Fluid and Electrolyte Management, Vitamin and Mineral Status, Nutrition-focused Physical Exam, Body Composition
Other: Member of Academy of Nutrition and Dietetics; Member of Dietitians in Nutrition Support; Member of American Society for Parenteral and Enteral Nutrition; Member of Ohio Society of Parenteral and Enteral Nutrition
Mary Jo Alberino, RD, LD, CNSC
Title: Center for Gut Rehabilitation and Transplantation Dietitian
Education: BS Nutrition, University of Akron, Ohio
Dietetic Internship: Cleveland Clinic, Cleveland, Ohio
Specialty Area: Intestinal Rehabilitation, Intestinal Transplant, Short Bowel Syndrome, Intestinal Failure, Intestinal Failure-Associate Liver Disease, Small Bowel Bacterial Overgrowth, Renal Oxalate Stones, Plasma Citrulline, Malabsorption, Gastrointestinal Nutrition, Home Nutrition Support, Parenteral Nutrition, Enteral Nutrition, Fluid and Electrolyte Management, Vitamin and Mineral Status, Nutrition-focused Physical Exam, Body Composition
Other: Member of Academy of Nutrition and Dietetics; Member of American Society of Parenteral and Enteral Nutrition; Member of Ohio Society of Parenteral and Enteral Nutrition
Lisa Moccia, RD, LD, CNSD
Title: Center for Gut Rehabilitation and Transplantation Dietitian
Education: BS Applied Science Food and Nutrition, Youngstown State University, Ohio
Coordinated Undergraduate Program, Youngstown State University, Ohio
Specialty Area: Intestinal Rehabilitation, Intestinal Transplant, Short Bowel Syndrome, Intestinal Failure, Intestinal Failure-Associate Liver Disease, Small Bowel Bacterial Overgrowth, Renal Oxalate Stones, Plasma Citrulline, Malabsorption, Gastrointestinal Nutrition, Home Nutrition Support, Parenteral Nutrition, Enteral Nutrition, Fluid and Electrolyte Management, Vitamin and Mineral Status, Nutrition-focused Physical Exam, Body Composition
Other: Member of Academy of Nutrition and Dietetics; Member of Dietitians in Nutrition Support Group; Member of American Society of Parenteral and Enteral Nutrition
Cassandra Pogatschnik RD, LD, CNSC
Title: Center for Gut Rehabilitation and Transplantation Dietitian
Education: BS Nutrition and Food, University of Minnesota, Minneapolis/St. Paul
Coordinated Undergraduate Program, University of Minnesota
Specialty Area: Intestinal Rehabilitation, Intestinal Transplant, Short Bowel Syndrome, Intestinal Failure, Intestinal Failure-Associate Liver Disease, Small Bowel Bacterial Overgrowth, Renal Oxalate Stones, Plasma Citrulline, Malabsorption, Gastrointestinal Nutrition, Home Nutrition Support, Parenteral Nutrition, Enteral Nutrition, Fluid and Electrolyte Management, Vitamin and Mineral Status, Nutrition-focused Physical Exam, Body Composition
Other: Member of Academy of Nutrition and Dietetics; Member of American Society of Enteral and Parenteral Nutrition
Jill Brown, MS, RD, LD
Title: Center for Gut Rehabilitation and Transplantation Dietitian
Education: BA, Kent State University, Kent, Ohio;
MS Public Health Nutrition, Case Western Reserve University, Cleveland, Ohio
Dietetic Internship: Public Health Nutrition, Case Western Reserve University, Cleveland, Ohio
Specialty Area: Intestinal Rehabilitation, Intestinal Transplant, Short Bowel Syndrome, Intestinal Failure--Associated Liver Disease, Small Bowel Bacterial Overgrowth, Renal Oxalate Stones, Plasma Citrulline, Malabsorption, Gastrointestinal Nutrition, Home Nutrition Support, Parenteral Nutrition, Enteral Nutrition, Fluid and Electrolyte Management, Vitamin and Mineral Status, Nutrition-focused Physical Exam, Body Composition, Weight Mangement, Eating Disorders, Body Image, Nutrition and Mental Health
Other: Member Academy of Nutrition and Dietetics
Anne Furman, RD, LD
Title: Center for Gut Rehabilitation and Transplantation Dietitian
Education: BA Economics, Marketing, and Mathematics, Saint Mary's College, Notre Dame, Indiana
BS Dietetics, University of Akron, Ohio; Coordinated Undergraduate Program, University of Akron
Specialty Area: Intestinal Rehabilitation, Intestinal Transplant, Short Bowel Syndrome, Intestinal Failure, Intestinal Failure-Associated Liver Disease, Small Bowel Bacterial Overgrowth, Renal Oxalate Stones, Plasma Citrulline, Malasorption, Gastrointestinal Nutrition, Home Nutrition Support, Parenteral Nutrition, Enteral Nutrition, Fluid and Electrolyte Management, Vitamin and Mineral Status, Nutrition-Focused Physical Exam, Body Composition
Other: Member of the Academy of Nutrition and Dietetics, Member of American Society of Parenteral and Enteral Nutrition
Tom Pemberton, DTR
Title: Center for Gut Rehabilitation and Transplantation Dietetic Technician
Education: AAS Dietetic Technology, Cuyahoga Community College
Specialty Area: Intestinal Rehabilitation and Transplant Program, Colorectal Surgery, Celiac Disease
Other: Member of Academy of Nutrition and Dietetics; Member of Cleveland Dietetic Association
Porter MJ. Intestinal Failure Associated Liver Disease. OSPEN Access. 2011:18(1):2.
Moccia L, Pogatschnik C. Infective Endocarditis - What the Clinician Caring for the Parentereral Nutrition Patients Need to Know. OSPEN Access. 2011:19(4): 5-7.
Parekh NR, Lennon EA. Intestinal Transplantation: Steps to Timely Referral and Successful Outcome. ASPEN Dietetic Practice Section Newsletter. Fall 2011.
Rhoda KM, Parekh NR, Lennon E, Shay-Downer C, Quintini C, Steiger E, Kirby DF. The Multidisciplinary Approach to the Care of Patients with Intestinal Failure at a Tertiary Care Facility. Nutr Clin Pract. 2010:(25) 2:183-191.
Porter MJ, Parekh NR, Soliman M, Shay-Downer C, Lennon E, Barco K, Hamilton C, Lopez R, Hashimoto K, Su L, Steiger E, Kirby DF, Quintini C. Liver Function Tests May Not Represent a Reliable Marker of Intestinal Failure-Related Liver Disease. Clinical Nutrition Week 2010 - Scientific Abstracts JPEN. 2010:(34):171.
Shatnawei A, Parekh NR, Rhoda KM, Speerhas R, Stafford J, Dasari V, Quintini C, Kirby DF, Steiger E. Intestinal failure management at the Cleveland Clinic. Arch Surg. 2010;145 (6):521-7.
Parekh NR, Seidner DL, Steiger E. Managing short bowel syndrome: Making the most of what the patient still has. Cleveland Clinic Journal of Medicine. 2005:72(9):833-8.
Professional Posters
Chhatriwalla EG, Parekh NR, Steiger E, Seidner DL, Su LC, Lopez, R. Factors Associated with Micronutrient Deficiency in Intestinal Failure.
Parekh NR, Natowicz M, Lopez R, Seidner DL, Su L, Steiger E. Plasma citrulline is a marker of home parenteral nutrition dependence in patients with short bowel syndrome
Parekh NR, Steiger E, Seidner DL. Recombinant Human Growth Hormone Reduces Fluid Requirements in a Parenteral Nutrition Dependant Patient with Short Bowel Syndrome
Parekh NR, Shay C, Lennon E, Chhatriwalla E, Jaeckel C, Coffman K, Su L, Steiger E, Quintini C. Patient Referral, Evaluation and Selection Process within an Intestinal Rehabilitation and Transplantation Program
Parekh NR, Steiger E, Seidner DL. Determination of Residual Length via Surgical, Radiological or Historical Data in Patients with Short Bowel Syndrome and Intestinal Failure
National/International Presentations
International Small Bowel Transplant Society Conference, Washington, D.C., Sept 2011:
Parekh NR.“Intestinal Rehabilitation: What Really Works.”
Parekh NR. “Post-transplant management of Chyle Leak.”
American Dietetic Association Annual Conference, San Diego, CA, Sept 2011:
Parekh NR. “Navigating Intestinal Surgery: How to Assess and Feed the Altered Gastrointestinal Tract.”
Digestive Disease Nursing Symposium, Cleveland, OH, Sept 2011:
Porter MJ. “Nutritional Options for the Colorectal Surgery Patient.”
Parekh NR. “Anatomy and Physiology of the Colorectal Surgery Patient.”