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Small bowel transplant, Crohn's experts from around the world hosted by Georgetown

(Washington, DC) Fifty-two year-old Paul McNeel, a fire chief from Leonardtown, Maryland was 37 in 1996 when a sudden health problem caused the loss of his small intestine. Almost all of it had to be surgically removed to save his life. For 13 years after that, McNeel continued to fight fires and stayed alive only because he fed himself a special liquid formula through a tube that went from a port in his chest directly to his heart and into his bloodstream. Over time that feeding process called TPN or total parenteral nutrition took a toll on his body; it was damaging his liver and he began to suffer frequent and worsening infections. He began to run out of places to put new ports. McNeel eventually needed a life-saving transplant that 13 years earlier would not have been survivable. Thanks to research into improved surgical methods, better anti-rejection medications and a better understanding of how the small intestine works, Paul McNeel was able to have that transplant in May of 2009 at Georgetown University Hospital under the care of Thomas Fishbein, MD, executive director of the Georgetown Transplant Institute and a specialist in small bowel transplants. The Georgetown Transplant Institute is a collaborative program with scientific research and education programs run through Georgetown University Medical Center and the clinical arm operating at Georgetown University Hospital, Washington Hospital Center and Children's National Medical Center.

"I had never heard of a small intestine transplant when I started having all my health problems back in 1996," said Paul McNeel. "It was a hard life getting most of my nutrition from a tube and living with a constant upset stomach. I was really glad when I got my new intestine. It's allowed me to eat normally and become a whole person again."

Experts from all over the world who have helped thousands of people like Paul McNeel are coming together in Washington, DC, September 15-18, 2011 to share their latest research and clinical breakthroughs in the area of intestinal failure, small intestine transplant and rehabilitation. Dr. Fishbein, also president of the Intestinal Transplant Association, is hosting the International Small Bowel Transplant Symposium which comes to the United States just once every four years.

"The coming together of all these clinicians who specialize in the repair, rehabilitation or transplant of the small intestine represents the development of a new specialty that integrates treatments all dedicated to one purpose. In the past twenty years we have gone from most patients dying to most people living when they have an injury to or a disability from their small intestine," said Dr. Fishbein.

Topics include intestinal tissue engineering, the growth of bio-artificial small intestines in the laboratory; the discovery of the effects of a gene mutation called NOD2 that could lead to new treatments for Crohn's disease, a chronic disorder that causes inflammation of the GI tract, ongoing stomach cramps and diarrhea in a half a million people in the US; the development of a new TPN component derived from fish oil rather than vegetable oil that might be less toxic to the human liver; and the discovery of new biomarkers for organ rejection that could be tested non-invasively via a urine or stool sample rather than an invasive endoscopy.

"Small bowel transplantation has been one of the most challenging 'last frontiers' in transplant medicine," said Dr. Fishbein. "The small intestine itself has presented the medical community with huge challenges including infection and rejection that has taken us years to understand. About 80-percent of the body's entire immune system is found in the small intestine, leading to major immunologic complexities. That has helped us understand a great deal about organ rejection and the immune system itself. These are all very exciting developments in this field that has only begun to see real progress for patients in the past decade. It used to be that babies born with a small bowel deformity died within a few months; patients who suffered a trauma or injury to the small intestine later in life had very few life-saving options and if they did survive, they often faced a limited quality of life. Today, we can offer them life, and a good quality of life at that."

Another area of study is the rehabilitation and repair of the small intestine through new medications and dietary changes under the close scrutiny of physicians and clinicians who have experience with treating such patients. "Our ultimate goal is to try to get the small intestine to repair itself so a patient doesn't need a transplant. But if that's not possible, we take their treatment to the next step."

"I'm glad all these experts are coming together from all over the world like this," said McNeel. "All their work sure helped me and I know they'll help others like me. I'm pretty sure I would have died without my transplant. It gave me a new lease on life."


Contact: Marianne Worley
Georgetown University Medical Center

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